FDG-PET 有助于预测原发性中枢神经系统淋巴瘤治疗失败：一项 LOC 网络前瞻性多中心研究。
Interim FDG-PET improves treatment failure prediction in primary central nervous system lymphoma: An LOC network prospective multicentric study.
机构信息
Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France.
INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France.
出版信息
Neuro Oncol. 2024 Jul 5;26(7):1292-1301. doi: 10.1093/neuonc/noae029.
BACKGROUND
The purpose of our study was to assess the predictive and prognostic role of 2-18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/MRI during high-dose methotrexate-based chemotherapy (HD-MBC) in de novo primary central nervous system lymphoma (PCNSL) patients aged 60 and above.
METHODS
This prospective multicentric ancillary study included 65 immunocompetent patients who received induction HD-MBC as part of the BLOCAGE01 phase III trial. FDG-PET/MRI were acquired at baseline, post 2 cycles (PET/MRI2), and posttreatment (PET/MRI3). FDG-PET response was dichotomized with "positive" indicating persistent tumor uptake higher than the contralateral mirroring brain region. Performances of FDG-PET and International PCNSL Collaborative Group criteria in predicting induction response, progression-free survival (PFS), and overall survival (OS) were compared.
RESULTS
Of the 48 PET2 scans performed, 9 were positive and aligned with a partial response (PR) on MRI2. Among these, 8 (89%) progressed by the end of the induction phase. In contrast, 35/39 (90%) of PET2-negative patients achieved complete response (CR). Among the 18 discordant responses at interim (PETCR/MRIPR), 83% ultimately achieved CR. Eighty-seven percent of the PET2-negative patients were disease free at 6 months versus 11% of the PET2-positive patients (P < .001). The MRI2 response did not significantly differentiate patients based on their PFS, regardless of whether they were in CR or PR. Both PET2 and MRI2 independently predicted OS in multivariate analysis, with PET2 showing a stronger association.
CONCLUSIONS
Our study highlights the potential of interim FDG-PET for early management of PCNSL patients. Response-driven treatment based on PET2 may guide future clinical trials.
TRIAL
LOCALYZE, NCT03582254, ancillary of phase III clinical trial BLOCAGE01, NCT02313389 (Registered July 10, 2018-retrospectively registered) https://clinicaltrials.gov/ct2/show/NCT03582254?term=LOCALYZE&draw=2&rank=1.
背景
本研究旨在评估在 60 岁及以上初治原发性中枢神经系统淋巴瘤（PCNSL）患者中，在接受大剂量甲氨蝶呤为基础的化疗（HD-MBC）期间，2-18F-氟-2-脱氧-D-葡萄糖（FDG）正电子发射断层扫描（PET）/磁共振成像（MRI）的预测和预后作用。
方法
这项前瞻性多中心辅助研究纳入了 65 名接受诱导性 HD-MBC 的免疫功能正常的患者，该研究为 BLOCAGE01 期 III 期试验的一部分。在基线、第 2 个周期（PET/MRI2）和治疗后（PET/MRI3）采集 FDG-PET/MRI。FDG-PET 反应以“阳性”表示肿瘤摄取持续高于对侧镜像脑区来进行二分法。比较 FDG-PET 和国际 PCNSL 协作组标准在预测诱导反应、无进展生存期（PFS）和总生存期（OS）方面的性能。
结果
在进行的 48 次 PET2 扫描中，9 次为阳性，与 MRI2 上的部分缓解（PR）一致。其中，8 例（89%）在诱导期结束时进展。相比之下，35/39（90%）的 PET2 阴性患者达到完全缓解（CR）。在中期（PETCR/MRIPR）有 18 次不一致的反应中，83%的患者最终达到 CR。6 个月时，87%的 PET2 阴性患者无疾病，而 PET2 阳性患者为 11%（P<.001）。无论是否处于 CR 或 PR，MRI2 反应均不能根据患者的 PFS 来区分患者。在多变量分析中，PET2 和 MRI2 均独立预测 OS，其中 PET2 相关性更强。
结论
我们的研究强调了 FDG-PET 对 PCNSL 患者进行早期管理的潜力。基于 PET2 的反应驱动治疗可能指导未来的临床试验。
试验
LOCALYZE，NCT03582254，BLOCAGE01 期 III 期临床试验的辅助试验，NCT02313389（2018 年 7 月 10 日注册-回顾性注册）https://clinicaltrials.gov/ct2/show/NCT03582254？term=LOCALYZE&draw=2&rank=1。
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