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Positronenemissionstomographie beim Hodgkin-Lymphom

Positron emission tomography in Hodgkin’s lymphoma

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die FDG-PET (Fluordesoxyglucose-Positronenemissionstomographie) ist eine Standarduntersuchung in der Bestimmung des Stadiums und des Therapieansprechens des Hodgkin-Lymphoms geworden.

Ergebnisse

Im initialen Staging erlaubt die PET eine sichere Stadienzuordnung und bei unauffälligem osteomedullärem Befund den Verzicht auf die Knochenmarkbiopsie. Der prädiktive Wert der FDG-PET während und nach der Chemotherapie bietet weiteren, deutlichen Zugewinn an Information. PET-gesteuerte Therapieregime wurden eingeführt, die die PET schon nach 2 Zyklen Chemotherapie zur weiteren Therapiestratifizierung einsetzen. Sowohl Protokolle, die eine Intensivierung der Therapie aufgrund einer positiven PET nutzen, als auch die Deeskalation der Therapie wegen einer unauffälligen, negativen PET haben Erfolge gezeigt. So kann z. B. bei negativer FDG-PET nach 2 Zyklen effektiver Chemotherapie für fortgeschrittene Stadien die Therapie von üblicherweise 6 auf insgesamt nur 4 Zyklen verkürzt werden. Nach Chemotherapie kann in fortgeschrittenen Stadien bei negativer FDG-PET außerdem ohne Verlust an Therapiesicherheit auf eine ergänzende Bestrahlung verzichtet werden.

Ausblick

Für frühe und mittlere Stadien ist die Möglichkeit des Verzichts auf die Bestrahlung noch nicht gezeigt, jedoch werden belastbare Daten erwartet. Robuste und reproduzierbare Beurteilungskriterien für die PET sind heute Standard bei der Interpretation der Untersuchung, sowohl in wissenschaftlichen Studien als auch in der täglichen klinischen Routine. Die sog. 5‑Punkte-Deauville-Skala ist derzeitiger Standard zur visuellen Analyse. Die Konsequenzen aus der jeweiligen Zuordnung berücksichtigen dabei sowohl die vorangegangene als auch die folgende Behandlung.

Abstract

Background

The FDG-PET method is a standard procedure in staging and response assessment of Hodgkin’s lymphoma patients.

Results

An accurate staging allows the bone marrow biopsy to be omitted if PET is negative concerning bone marrow involvement. An FDG-PET after induction therapy provides additional relevant prognostic information. The FDG-PET adapted therapy regimens have been introduced making use of the high predictive value of FDG PET early in the treatment course, e. g. after two cycles of chemotherapy. Success rates of treatment could be improved for both intensification and de-escalation of treatment on the basis of PET performed after two cycles of chemotherapy. In the case of a negative PET after two cycles of effective chemotherapy for advanced stages, chemotherapy can be restricted to a total of 4 cycles instead of 6 cycles. Furthermore, radiotherapy in advanced stages can be safely omitted in PET negative patients after effective chemotherapy.

Perspective

The reliability of end of treatment PET as a basis for omitting radiotherapy in early and intermediate stages of Hodgkin’s lymphoma is probably given, but remains to be documented. Robust and reproducible interpretation criteria are being used both in ongoing clinical trials and in the daily routine. The recommended five-point Deauville scale has become the standard in assessment of the response to PET treatment, with the caveat that the consequences of a PET scan may be influenced by previous and subsequent treatment.

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Authors and Affiliations

  1. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    Carsten Kobe, Alexander Drzezga & Markus Dietlein

  2. Klinik für Strahlentherapie, Universitätsklinikum Köln, Köln, Deutschland

    Christian Baues

  3. German Hodgkin Study Group, Universitätsklinikum Köln, Köln, Deutschland

    Michael Fuchs & Peter Borchmann

  4. Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland

    Peter Borchmann

Authors
  1. Carsten Kobe
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  2. Christian Baues
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  3. Michael Fuchs
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  4. Alexander Drzezga
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  5. Peter Borchmann
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  6. Markus Dietlein
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Corresponding author

Correspondence to Carsten Kobe.

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Interessenkonflikt

C. Kobe, C. Baues, M. Fuchs, A. Drzezga, P. Borchmann und M. Dietlein geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kobe, C., Baues, C., Fuchs, M. et al. Positronenemissionstomographie beim Hodgkin-Lymphom. Onkologe 24, 287–294 (2018). https://doi.org/10.1007/s00761-018-0341-z

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  • DOI: https://doi.org/10.1007/s00761-018-0341-z

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