Fused FDG-PET/contrast-enhanced CT detects occult subdiaphragmatic involvement of Hodgkin's lymphoma thereby identifying patients requiring six cycles of anthracycline-containing chemotherapy and consolidation radiation of spleen.
BACKGROUND
Spleen and liver assessment for occult involvement of Hodgkin's lymphoma (HL) challenges current staging procedures.


METHODS
We prospectively evaluated event-free survival (EFS) in 103 HL patients staged with fused 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/contrast-enhanced computed tomography (CT) to identify those at greatest risk for abdominal relapse. The EFS of this series was compared with that of a historical cohort of 100 HL patients staged with separate FDG-PET and diagnostic CT acquisitions.


RESULTS
Thirty-one of the 103 patients staged with FDG-PET/contrast-enhanced CT were found to have spleen involvement and 10 patients liver involvement, whereas 14 of the 100 patients staged with separate procedures were found to have spleen involvement and 3 patients liver involvement. There were significantly more intensive treatments (six courses of anthracycline-containing chemotherapy and spleen radiation) in the fused PET/CT group than in the historical cohort (P ≤ 0.04). At a median follow-up of 27 months, five events occurred in the fused PET/CT group (HL relapse, 4 patients; carcinoma, 1 patient) and 19 events in the historical cohort (HL relapse, 18 patients; acute promyelocytic leukemia, 1 patient). Ten of the 18 relapses in the historical cohort were localized in the spleen and/or liver area. None of the four relapses in the fused PET/CT group was localized below the diaphragm. Thus, FDG-PET/contrast-enhanced CT-guided treatment resulted in a 95% EFS, whereas separate FDG-PET and diagnostic CT-guided treatment resulted in an 81% EFS (P = 0.002).


CONCLUSIONS
FDG-PET/contrast-enhanced CT is an accurate frontline single imaging diagnostic tool enabling effective tailored treatment in HL patients.
Picardi
M
M
Division of Hematology, Department of Biochemistry and Medical Biotechnology, University of Naples 'Federico II' University Medical School, Naples.
Soricelli
A
A
Fondazione SDN, Naples.
Grimaldi
F
F
Division of Hematology, Department of Biochemistry and Medical Biotechnology, University of Naples 'Federico II' University Medical School, Naples.
Nicolai
E
E
Fondazione SDN, Naples.
Gallamini
A
A
Hematology Department, S. Croce e Carle Hospital, Cuneo, Italy.
Pane
F
F
Division of Hematology, Department of Biochemistry and Medical Biotechnology, University of Naples 'Federico II' University Medical School, Naples. Electronic address: fabpane@unina.it.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001761:Bleomycin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003287:Contrast Media; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D015251:Epirubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012008:Recurrence; D013154:Spleen / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D001761:Bleomycin; D015251:Epirubicin; D005047:Etoposide; D003520:Cyclophosphamide; D011241:Prednisone