Zabrocka Ewa, Sierko Ewa, Wojtukiewicz Marek Z
Department of Oncology, Medical University of Białystok, Poland.
Adv Clin Exp Med. 2016 Nov-Dec;25(6):1185-1192. doi: 10.17219/acem/62652.
Positron emission tomography (PET-CT) has become a valuable implement in the management of Hodgkin lymphoma (HL). However, since PET-CT is a relatively new imaging method, its capabilities have not been fully explored.
The aim of the study was to evaluate the role of PET-CT at different points in HL management.
The medical documentation of 47 HL patients treated at the Comprehensive Cancer Center in Białystok, Poland, was analyzed retrospectively. The study group consisted of 15 men and 32 women, aged 18-59 years, in HL clinical stages II-IV, treated either with chemotherapy or sequential chemoradiotherapy.
In 65.2% of the patients who underwent post-chemotherapy PET-CT scanning before their qualification for adjuvant radiotherapy (RT), PET-CT was decisive in qualifying them for RT, by establishing whether or not metabolic partial remission (PR) had occurred. With regard to the achievement of partial or complete response (CR), computed tomography (CT) and PET-CT results correlated in 45.5% of the patients after the completion of chemotherapy, and in 18.7% after the completion of the entire treatment (chemotherapy or chemoradiotherapy). Among the patients from the advanced-stage group (stages III/IV stage and/or bulky HL), morphological PR in CT scans after two to three courses of chemotherapy was more often associated with a lack of metabolic CR in posttreatment PET-CT scanning (p = 0.022) than in other patients. Post-treatment PET-CT scanning was shown to be highly prognostic of a relapse-free follow-up (p < 0.0001) and superior to post-treatment CT imaging in relapse prediction (p < 0.0001).
Compared to CT, PET-CT was more accurate in residual masses assessment. Notable ability of PET-CT in relapse-free follow-up prediction encourages to more common use of PET-CT in clinical practice. Further clinical research on the need for RT in patients with PR in CT parallel to CR in PET-CT is required.
正电子发射断层扫描（PET-CT）已成为霍奇金淋巴瘤（HL）治疗中的一种重要手段。然而，由于PET-CT是一种相对较新的成像方法，其功能尚未得到充分探索。
本研究旨在评估PET-CT在HL治疗不同阶段的作用。
回顾性分析波兰比亚韦斯托克综合癌症中心治疗的47例HL患者的医疗记录。研究组包括15名男性和32名女性，年龄在18至59岁之间，处于HL临床II-IV期，接受化疗或序贯放化疗。
在65.2%接受辅助放疗（RT）资格评估前进行化疗后PET-CT扫描的患者中，PET-CT通过确定是否发生代谢部分缓解（PR），对其是否适合RT起决定性作用。关于部分缓解或完全缓解（CR）的达成情况，化疗完成后，45.5%的患者计算机断层扫描（CT）和PET-CT结果相关，整个治疗（化疗或放化疗）完成后，这一比例为18.7%。在晚期组（III/IV期和/或大块HL）患者中，两到三个化疗疗程后CT扫描中的形态学PR与治疗后PET-CT扫描中缺乏代谢CR的相关性（p = 0.022）高于其他患者。治疗后PET-CT扫描显示对无复发生存期具有高度预后价值（p < 0.0001），在复发预测方面优于治疗后CT成像（p < 0.0001）。
与CT相比，PET-CT在残留肿块评估方面更准确。PET-CT在无复发生存期预测方面的显著能力促使其在临床实践中更广泛地应用。需要对PET-CT达到CR而CT平行显示PR的患者是否需要RT进行进一步的临床研究。
