title: The role of FDG-PET imaging and involved field radiotherapy in relapsed or refractory diffuse large B-cell lymphoma.
abstract: We examined the role of fluorodeoxyglucose-positron emission tomography (FDG-PET) and the addition of involved field radiotherapy (IFRT) as potential modifiers of salvage therapy. From January 2000 to June 2007, 83 patients with chemosensitive relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL) underwent FDG-PET scans following second-line chemotherapy before high-dose therapy with autologous stem cell rescue (HDT/ASCR). We evaluated the prognostic value of having a negative FDG-PET scan before HDT/ASCR and whether IFRT improved the outcomes. Median follow-up was 45 months, and the 3-year PFS, disease-specific survival (DSS) and OS were 72, 80 and 78%, respectively. Multivariate analysis revealed that a positive FDG-PET scan had worse PFS (hazard ratio=(HR) 3.4; P=0.014), DSS (HR=7.7; P=0.001) and OS (HR=5.4; P=0.001), and that patients not receiving IFRT had worse PFS (HR=2.7; P=0.03) and DSS (HR=2.8, P=0.059). Patients who received IFRT had better local control with fewer relapses within prior involved sites compared with those that did not receive IFRT (P=0.006). These outcomes confirm the important prognostic value of FDG-PET scans before undergoing HDT/ASCR. It also suggests that the role of IFRT should be evaluated further.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Hoppe
authors.forename: C H
authors.initials: CH
authors.lastname: Moskowitz
authors.forename: Z
authors.initials: Z
authors.lastname: Zhang
authors.forename: J C
authors.initials: JC
authors.lastname: Maragulia
authors.forename: R D
authors.initials: RD
authors.lastname: Rice
authors.forename: A S
authors.initials: AS
authors.lastname: Reiner
authors.forename: P A
authors.initials: PA
authors.lastname: Hamlin
authors.forename: A D
authors.initials: AD
authors.lastname: Zelenetz
authors.forename: J
authors.initials: J
authors.lastname: Yahalom
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000188:drug therapy / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049268:Positron-Emission Tomography / Q000009:adverse effects; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18