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Non-Hodgkin-Lymphome − PET in Diagnostik und Therapiesteuerung

  • Dirk HellwigEmail author
  • Ulrich Dührsen
Leitthema
  • 20 Downloads

Zusammenfassung

Hintergrund

Die kombinierte Positronen-Emissions-Tomographie und Computertomographie mit 18F‑Fluorodesoxyglucose (FDG-PET/CT) ist international anerkannter Standard zur Diagnostik und Therapiesteuerung bei Non-Hodgkin-Lymphomen (NHL). Auch bei dieser Tumorentität etabliert sich in Deutschland zunehmend der Einsatz der PET.

Ziel

Klinisch relevante Indikationen der FDG-PET/CT in der Versorgung von Patienten mit indolenten und aggressiven NHL werden dargestellt.

Material und Methoden

Relevante Leitlinien werden ausgewertet, typische Befundkonstellationen exemplarisch dargestellt sowie klinisch relevante Expertenempfehlungen und Erstattungssituationen in Deutschland diskutiert.

Ergebnisse

Die FDG-PET/CT ist die genaueste nichtinvasive Methode zum Staging und Restaging bei NHL. Internationale Leitlinien enthalten fundierte Empfehlungen zum gezielten Einsatz der FDG-PET/CT bei NHL-Patienten. Indikation und Ausmaß der Bestrahlung bei follikulären Lymphomen hängen wesentlich von PET/CT-Befunden ab. Bei aggressiven NHL lassen Zwischenergebnisse der OPTIMAL>60-Studie einen Überlebensvorteil bei Nachbestrahlung ausschließlich PET-positiver Bulk-Reste erwarten. Die Messung des Tumorgesamtvolumens mit der PET erlaubt eine überragende Prognoseabschätzung. Die Verfügbarkeit der PET in der deutschen Versorgung ist noch durch die inhomogene Erstattungssituation bei gesetzlich Versicherten limitiert.

Schlussfolgerungen

Der gezielte Einsatz der FDG-PET/CT bei Patienten mit NHL ist internationaler Versorgungsstandard und kann bei Staging, Risikostratifizierung, Beurteilung des Therapieansprechens und Therapiesteuerung helfen. Parallel zur Entwicklung internationaler Empfehlungen und nationaler S3-Leitlinien sollten frühere negative Beschlüsse des Gemeinsamen Bundesausschusses zur PET bei Lymphomen angepasst werden.

Schlüsselwörter

Lymphome 18F‑Fluorodesoxyglucose Positronen-Emissions-Tomographie Staging Risikostratifizierung 

Non-Hodgkin’s lymphoma—PET for diagnosis and treatment evaluation

Abstract

Background

18F‑fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is an internationally recognized standard for the diagnosis and treatment guidance in non-Hodgkin’s lymphoma (NHL). The use of PET in NHL is also becoming increasingly established in Germany.

Objective

Presentation of clinically relevant indications for FDG-PET/CT in the treatment of patients with indolent and aggressive NHL.

Material and methods

Evaluation of relevant guidelines, examples of typical findings, discussion of clinically relevant expert recommendations and the reimbursement situation in Germany.

Results

The FDG PET/CT procedure is the most accurate non-invasive method for staging and restaging in NHL. International guidelines provide well-founded recommendations for the targeted use of FDG PET/CT in NHL patients. The indications for and extent of radiotherapy for follicular lymphoma are largely dependent on the PET/CT findings. In aggressive NHL the interim results of the OPTIMAL>60 study raise the expectation of a survival benefit after radiotherapy of PET-positive bulk residues. The measurement of total metabolic tumor volume by PET provides outstanding prognostic information. The availability of PET in Germany is still limited by regional differences in reimbursement policies of statutory health insurance providers.

Conclusion

The selective use of FDG PET/CT in patients with NHL is an international standard of care that facilitates staging, risk stratification, assessment of treatment response and treatment guidance. In the light of international recommendations and national S3 guidelines, earlier negative decisions by the Federal Joint Committee (G-BA) on PET in lymphomas need to be reconsidered.

Keywords

Lymphoma FDG PET Staging Risk stratification 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D. Hellwig und U. Dührsen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Abteilung für NuklearmedizinUniversitätsklinikum RegensburgRegensburgDeutschland
  2. 2.Klinik für HämatologieUniversitätsklinikum EssenEssenDeutschland

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