Positron Emission Tomography/Computed Tomography Assessment After Immunochemotherapy and Irradiation Using the Lugano Classification Criteria in the IELSG-26 Study of Primary Mediastinal B-Cell Lymphoma
- Nuclear Medicine and PET-CT Center, Oncology Institute of Southern Switzerland, Bellinzona (Switzerland)
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome (Italy)
- Radiation Oncology, University of Toronto, Toronto, Ontario (Canada)
- Department of Oncology, University of Torino, Torino (Italy)
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milano (Italy)
- Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino (Italy)
- Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria (Italy)
- Hematology, IRCCS Humanitas Cancer Center, Rozzano, Milan (Italy)
- Hematology, Hospital del Salvador, Universidad de Chile, Santiago (Chile)
- Department of Medicine, The Royal Marsden National Health Service Foundation Trust, London and Surrey (United Kingdom)
- Hematology Unit, Istituto Nazionale Tumori Giovanni Paolo II IRCCS, Bari (Italy)
- Institute of Hematology and Medical Oncology, Policlinico S.Orsola-Malpighi, Bologna (Italy)
- Cancer Research UK Centre, University of Southampton, Southampton (United Kingdom)
- Oncology Department, Oncology Institute of Southern Switzerland, Bellinzona (Switzerland)
Purpose: To assess the predictive value of {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for disease recurrence after immunochemotherapy (R-CHT) and mediastinal irradiation (RT), using the recently published criteria of the Lugano classification to predict outcomes for patients with primary mediastinal large B-cell lymphoma. Methods and Materials: Among 125 patients prospectively enrolled in the IELSG-26 study, 88 were eligible for central review of PET/CT scans after completion of RT. Responses were evaluated using the 5-point Deauville scale at the end of induction R-CHT and after consolidation RT. According to the Lugano classification, a complete metabolic response (CMR) was defined by a Deauville score (DS) ≤3. Results: The CMR (DS1, -2, or -3) rate increased from 74% (65 patients) after R-CHT to 89% (78 patients) after consolidation RT. Among the 10 patients (11%) with persistently positive scans, the residual uptake after RT was slightly higher than the liver uptake in 6 patients (DS4; 7%) and markedly higher in 4 patients (DS5; 4%): these patients had a significantly poorer 5-year progression-free survival and overall survival. At a median follow-up of 60 months (range, 35-107 months), no patients with a CMR after RT have relapsed. Among the 10 patients who did not reach a CMR, 3 of the 4 patients (positive predictive value, 75%) with DS5 after RT had subsequent disease progression (within the RT volume in all cases) and died. All patients with DS4 had good outcomes without recurrence. Conclusions: All the patients obtaining a CMR defined as DS ≤3 remained progression-free at 5 years, confirming the excellent negative predictive value of the Lugano classification criteria in primary mediastinal large B-cell lymphoma patients. The few patients with DS4 also had an excellent outcome, suggesting that they do not necessarily require additional therapy, because the residual {sup 18}F-fluorodeoxyglucose uptake may not reflect persistent lymphoma.
- OSTI ID:
- 22645739
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 97, Issue 1; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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