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PET beim Hodgkin-Lymphom

Verbessert die Positronenemissionstomographie die Behandlung?

PET in Hodgkin’s lymphoma

Can positron emission tomography improve the therapy?

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Wenn die FDG-PET nach 2 Zyklen Chemotherapie (Interim-PET) negativ ist, entwickelt sich nur selten ein Rezidiv. Daraus folgt ein hoher negativer prognostischer Wert der FDG-PET im Therapiemonitoring des Hodgkin-Lymphoms. Der Schritt zur responseadaptierten Therapie (Therapie-Deeskalation) mittels Interim-PET sollte in Therapieoptimierungsstudien wissenschaftlich begleitet werden. Dies erhöht die Patientensicherheit und sollte eine Referenzbegutachtung der Interim-PET einschließen. Nach Abschluss der Chemotherapie konnte in der HD15-Studie der German Hodgkin Study Group (GHSG) ein progressionsfreies Überleben bei 95% der PET-negativen Patienten in partieller Remission gezeigt werden. Bei Verzicht auf eine Strahlentherapie bei Patienten in partieller Remission mit Restgewebe ≥2,5 cm erhöhte sich die Rate an Frührezidiven im Vergleich zur Patientengruppe in kompletter Remission nicht. Das Gesamtüberleben nach 5 Jahren bleibt abzuwarten. Eine solche Therapiekonsequenz muss sich aber stets an der Intensität der zuvor durchgeführten Chemotherapie orientieren.

Abstract

PET-negative patients after 2 cycles of chemotherapy (interim-PET) rarely develop a relapse. Thus, the negative prognostic value of interim-PET in therapy monitoring of Hodgkin’s lymphoma is high. The next clinical step towards response-adapted therapy (therapy de-escalation) using interim-PET should be embedded in clinical trials and scientific evaluation. This increases the safety for the patients and PET should be evaluated by a second reader. After completion of chemotherapy the progression-free survival was 95% for PET-negative patients in partial remission, as shown in the HD15 trial of the German Hodgkin Study Group (GHSG). Thus, consolidation radiotherapy can be omitted in PET patients with residual tissue of ≥2.5 cm without increasing the risk for progression or early relapse as compared to patients in complete remission. The impact of this finding on the overall survival at 5 years must be awaited. However, such therapy consequences must always be oriented to the intensity of the preceding chemotherapy.

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Authors and Affiliations

  1. Klinik und Poliklinik für Nuklearmedizin, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    M. Dietlein & C. Kobe

  2. Klinik und Poliklinik für Strahlentherapie, Universität zu Köln, Köln, Deutschland

    H.T. Eich

  3. German Hodgkin Study Group (GHSG), Köln, Deutschland

    M. Fuchs, P. Borchmann & A. Engert

  4. Klinik I für Innere Medizin, Universität zu Köln, Köln, Deutschland

    M. Fuchs, P. Borchmann & A. Engert

Authors
  1. M. Dietlein
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  2. H.T. Eich
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  3. M. Fuchs
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  4. P. Borchmann
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  5. A. Engert
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  6. C. Kobe
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Correspondence to M. Dietlein.

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Dietlein, M., Eich, H., Fuchs, M. et al. PET beim Hodgkin-Lymphom. Onkologe 16, 18–27 (2010). https://doi.org/10.1007/s00761-009-1767-0

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  • DOI: https://doi.org/10.1007/s00761-009-1767-0

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