PET predicts prognosis after 1 cycle of chemotherapy in aggressive lymphoma and Hodgkin's disease.
Early identification of chemotherapy-refractory lymphoma patients provides a basis for alternative treatment strategies. Metabolic imaging with (18)F-FDG PET offers functional tissue characterization that is useful for assessing response to therapy. Our objective was to determine the predictive value of (18)F-FDG PET early during chemotherapy (after 1 cycle) and at the completion of chemotherapy for subsequent progression-free survival (PFS) in patients with aggressive non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD).


METHODS
(18)F-FDG PET (dual-head coincidence camera with attenuation correction) was performed before and after 1 cycle of chemotherapy on 30 patients (17 NHL, 13 HD; mean age, 52.3 +/- 16.0 y). For 23 of the 30 patients, (18)F-FDG PET data were also obtained after the completion of chemotherapy. The patients had a median follow-up of 19 mo (range, 18-24 mo). Follow-up of PFS was compared between patients with positive and negative (18)F-FDG PET results obtained after the first cycle of chemotherapy and at the completion of chemotherapy.


RESULTS
Positive (18)F-FDG PET results obtained both after the first cycle and at the completion of therapy were associated with a shorter PFS (median, 5 and 0 mo, respectively) than were negative (18)F-FDG PET results (PFS medians not reached). A statistically significant difference in PFS between positive and negative (18)F-FDG PET results was obtained both after the first cycle and at the completion of chemotherapy (P < or = 0.001). The PFS and (18)F-FDG PET results obtained after the first cycle correlated better than those obtained after the completion of chemotherapy (r(2) = 0.45 vs. 0.17). (18)F-FDG PET had more false-negative results after the last cycle (6/17 cases, or 35%) than after the first cycle (2/13 cases, or 15%). Thus, (18)F-FDG PET had greater sensitivity and positive predictive values after the first cycle (82% vs. 45.5% and 90% vs. 83%, respectively) than after the last cycle.


CONCLUSIONS
(18)F-FDG PET after 1 cycle of chemotherapy is predictive of 18-mo outcome in patients with aggressive NHL and HD and may earlier identify patients who would benefit from more intensive treatment programs.
Kostakoglu
Lale
L
Division of Nuclear Medicine, Department of Radiology, Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, New York 10021, USA. lak2005@mail.med.cornell.edu
Coleman
Morton
M
Leonard
John P
JP
Kuji
Ichiei
I
Zoe
Holly
H
Goldsmith
Stanley J
SJ
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013997:Time Factors; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18