Abstract
Purpose
Positron emission tomography (PET) was evaluated in low-grade non-Hodgkin lymphoma (NHL) to determine its impact on staging and management and to compare PET and gallium scans.
Methods
PET resulted in management plan changes in 74 patients with untreated low-grade NHL stages I to III. Patient outcomes to 12 months were documented.
Results
PET identified additional lesions in 50% of patients, led to a change in stage in 32%, and had a significant impact on management in 34%. Inferior progression-free survival was noted in patients with additional lesions detected by PET (p=0.001) and in the 28% of patients upstaged by PET to stage III or IV (p=0.024). In a subset of 16 patients undergoing both PET and gallium scans, PET was found to be superior.
Conclusion
PET has a major role in the management of low-grade NHL in addition to its proven role in aggressive lymphoma.
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References
MacManus MP, Hoppe RT. Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University. J Clin Oncol 1996;14:1282–90.
Paryani SB, Hoppe RT, Cox RS, Colby TV, Rosenberg SA, Kaplan HS. Analysis of non-Hodgkin’s lymphomas with nodular and favorable histologies, stages I and II. Cancer 1983;52:2300–7.
Vaughan Hudson B, Vaughan Hudson G, MacLennan KA, Anderson L, Linch DC. Clinical stage 1 non-Hodgkin’s lymphoma: long-term follow-up of patients treated by the British National Lymphoma Investigation with radiotherapy alone as initial therapy. Br J Cancer 1994;69:1088–93.
Gospodarowicz MK, Bush RS, Brown TC, Chua T. Prognostic factors in nodular lymphomas: a multivariate analysis based on the Princess Margaret Hospital experience. Int J Radiat Oncol Biol Phys 1984;10:489–97.
McLaughlin P, Fuller LM, Velasquez WS, Butler JJ, Hagemeister FB, Sullivan-Halley JA, et al. Stage III follicular lymphoma: durable remissions with a combined chemotherapy-radiotherapy regimen. J Clin Oncol 1987;5:867–74.
Murtha AD, Rupnow BA, Hansosn J, Knox SJ, Hoppe R. Long-term follow-up of patients with stage III follicular lymphoma treated with primary radiotherapy at Stanford University. Int J Radiat Oncol Biol Phys 2001;49:3–15.
Jacobs JP, Murray KJ, Schultz CJ, Wilson JF, Goswitz MS, Stevens CW, et al. Central lymphatic irradiation for stage III nodular malignant lymphoma: long-term results. J Clin Oncol 1993;11:233–8.
Schöder H, Meta J, Yap C, Ariannejad M, Rao J, Phelps ME, et al. Effect of whole-body 18F-FDG PET imaging on clinical staging and management of patients with malignant lymphoma. J Nucl Med 2001;42:1139–43.
Partridge S, Timothy A, O’Doherty MJ, Hain SF, Rankin S, Mikhaeel G. 2-Fluorine-18-fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of Hodgkin’s disease: influence on patient management in a single institution. Ann Oncol 2000;11:1273–9.
Karam M, Novak L, Cyriac J, Ali A, Nazeer T, Nugent F. Role of fluorine-18 fluoro-deoxyglucose positron emission tomography scan in the evaluation and follow-up of patients with low-grade lymphomas. Cancer 2006;107:175–83.
Jerusalem G, Beguin Y, Najjar F, Hustinx R, Fassotte MF, Rigo P, et al. Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F- FDG) for the staging of low-grade non-Hodgkin’s lymphoma (NHL). Ann Oncol 2001;12:825–30.
Longo DL, Schilsky RL, Blei L, Cano R, Johnston GS, Young RC. Gallium-67 scanning: limited usefulness in staging patients with non-Hodgkin’s lymphoma. Am J Med 1980;68:695–700.
Ben-Haim S, Bar-Shalom R, Israel O, Haim N, Epelbaum R, Ben-Shachar M, et al. Utility of gallium-67 scintigraphy in low-grade non-Hodgkin’s lymphoma. J Clin Oncol 1996;14:1936–42.
Bar-Shalom R, Yefremov N, Haim N, Dann EJ, Epelbaum R, Keidar Z, et al. Camera-based FDG PET and 67Ga SPECT in evaluation of lymphoma: comparative study. Radiology 2003;227:353–60.
Wirth A, Seymour JF, Hicks RJ, Ware R, Prince M, MacManus MP, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography, gallium-67 scintigraphy, and conventional staging for Hodgkin’s disease and non-Hodgkin’s lymphoma. Am J Med 2002;112:262–8.
Hoffmann M, Kletter K, Becherer A, Jager U, Chott A, Raderer M. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) for staging and follow-up of marginal zone B-cell lymphoma. Oncology 2003;64:336–40.
Blum RH, Seymour JF, Wirth A, MacManus M, Hicks RJ. Frequent impact of [18F]fluorodeoxyglucose positron emission tomography on the staging and management of patients with indolent non-Hodgkin’s lymphoma. Clin Lymphoma 2003;4:43–9.
Tsukamoto N, Kojima M, Hasegawa M, Oriuchi N, Matsushima T, Yokohama A, et al. The usefulness of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and a comparison of (18)F-FDG-PET with (67)gallium scintigraphy in the evaluation of lymphoma: relation to histologic subtypes based on the World Health Organization classification. Cancer 2007;110:652–9.
Hoffmann M, Kletter K, Diemling M, Becherer A, Pfeffel F, Petkov V, et al. Positron emission tomography with fluorine-18-2-fluoro-2-deoxy-D- glucose (F18-FDG) does not visualize extranodal B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT)-type. Ann Oncol 1999;10:1185–9.
Schöder H, Noy A, Gönen M, Weng L, Green D, Erdi YE, et al. Intensity of 18fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin’s lymphoma. J Clin Oncol 2005;23:4643–51.
Acknowledgements
The authors wish to acknowledge the Australian Government Department of Health and Ageing for funding, and the Australian and New Zealand Association of Physicians in Nuclear Medicine for managing, the PET Data Collection Project, and to acknowledge Amanda Byrne, Andrew Chicco, Terri Davies, Elizabeth Drummond, Sonia Harwood and Debbie Lennon and the staff of the PET centres involved in the study for their contribution.
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Scott, A.M., Gunawardana, D.H., Wong, J. et al. Positron emission tomography changes management, improves prognostic stratification and is superior to gallium scintigraphy in patients with low-grade lymphoma: results of a multicentre prospective study. Eur J Nucl Med Mol Imaging 36, 347–353 (2009). https://doi.org/10.1007/s00259-008-0958-z
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DOI: https://doi.org/10.1007/s00259-008-0958-z