title: Combined modality treatment for PET-positive non-Hodgkin lymphoma: favorable outcomes of combined modality treatment for patients with non-Hodgkin lymphoma and positive interim or postchemotherapy FDG-PET.
abstract: OBJECTIVE
  To evaluate outcomes of patients treated for aggressive non-Hodgkin lymphoma (NHL) with combined modality therapy based on [(18)F]fluoro-2-deoxy-2-d-glucose positron emission tomography (FDG-PET) response.
  
  
  METHODS
  We studied 59 patients with aggressive NHL, who received chemotherapy and radiation therapy (RT) from 2001 to 2008. Among them, 83% of patients had stage I/II disease. Patients with B-cell lymphoma received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)-based chemotherapy, and 1 patient with anaplastic lymphoma kinase-negative anaplastic T-cell lymphoma received CHOP therapy. Interim and postchemotherapy FDG-PET or FDG-PET/computed tomography (CT) scans were performed for restaging. All patients received consolidated involved-field RT. Median RT dose was 36 Gy (range, 28.8-50 Gy). Progression-free survival (PFS) and local control (LC) rates were calculated with and without a negative interim or postchemotherapy FDG-PET scan.
  
  
  RESULTS
  Median follow-up was 46.5 months. Thirty-nine patients had negative FDG-PET results by the end of chemotherapy, including 12 patients who had a negative interim FDG-PET scan and no postchemotherapy PET. Twenty patients were FDG-PET-positive, including 7 patients with positive interim FDG-PET and no postchemotherapy FDG-PET scans. The 3-year actuarial PFS rates for patients with negative versus positive FDG-PET scans were 97% and 90%, respectively. The 3-year actuarial LC rates for patients with negative versus positive FDG-PET scans were 100% and 90%, respectively.
  
  
  CONCLUSIONS
  Patients who had a positive interim or postchemotherapy FDG-PET had a PFS rate of 90% at 3 years after combined modality treatment, suggesting that a large proportion of these patients can be cured with consolidated RT.
authors.affiliation: Harvard Radiation Oncology Program, Boston, Massachusetts, USA.
authors.forename: Lia M
authors.initials: LM
authors.lastname: Halasz
authors.forename: Heather A
authors.initials: HA
authors.lastname: Jacene
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Catalano
authors.forename: Annick D
authors.initials: AD
authors.lastname: Van den Abbeele
authors.forename: Ann
authors.initials: A
authors.lastname: Lacasce
authors.forename: Peter M
authors.initials: PM
authors.lastname: Mauch
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Ng
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000379:methods*; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008224:Lymphoma, Follicular / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D017728:Lymphoma, Large-Cell, Anaplastic / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D018365:Neoplasm, Residual; D049268:Positron-Emission Tomography / Q000379:methods; D011241:Prednisone / Q000008:administration & dosage; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D000069283:Rituximab; D017211:Treatment Failure; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone; D008727:Methotrexate