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IMAGINOLGICA EN HEMATOLOGA
PET/CT-CHESON
DIEGO A. AGUIRRE
MD RADILOGO
FUNDACIN SANTA FE DE BOGOT
OBJETIVOS
Criterios de Respuesta
Abstract: Standardized guidelines for response as- emission computed tomography gallium scans are en-
! NUMBER 5 ! FEBRUA
Journal of C linical O ncology, Vol 17, Ncouraged
sessment are needed to ensure comparability among
R Y trials
1 0 in2 non-Hodgkins
007
o 4 (A pril), 1999:
as a valuable pp 1244-1253
adjunct to assessment of pa-
clinical lymphomas (NHL). To tients with large-cell NHL, but such scans require appro-
achieve this, two meetings were convened among United priate ex pertise. Flo w cytometric, cytogenetic, and
States and international lymphoma experts represent- molecular studies are not currently included in response
OF CLINICAL ONCOLOGY
ing medical hematology / oncology, radiology, radiation definitions. Response rates may be the most important
L
co.ascopubs.org and provided by at University of Ca SanSDiego
P EonCMarch
I A 1,L2013
A from
R T I C L E
oncology, and pathology to review currently used re-
sponse definitions and to develop a uniform set of
objective in phase II trials where the activity of a new
agent is important and may provide support for ap-
VOLUME 25 ! NUMBER 5 ! FEBRUARY 10 2007
1999 American Society
132.239.1.231
of Clinical Oncology. All rights reserved.
criteria for assessing response in clinical trials. The proval by regulatory agencies. However, the goals of
criteria that were developed include anatomic defini- most phase III trials are to identify therapies that will
Abbreviations: PET, positron emission tomography; CT, computed tomography; FDG, [18F]fluorodeoxyglucose; DLBCL, diffuse large B-cell lymphoma; HL,
Hodgkins lymphoma; NHL, non-Hodgkins lymphoma; MCL, mantle-cell lymphoma; ORR, overall response rate; CR, complete remission.
!
Recommended but not required pretreatment.
Recommended only if ORR/CR is a primary study end point.
Recommended only if PET is positive pretreatment.
11
Recomendaciones PET-CT
1. Antes del tratamiento en linfomas potencialmente
curables (FDG-avid: difuso de clulas B grandes,
Hodgkin)
1. Evaluar extensin
Mediastino
Variantes
Respuesta Completa
Respuesta Parcial
Enfermedad Estable
Recaida o Progresin de Enfermedad
20
Cmo se mide la enfermedad
Cheson et al
CR Disappearance of all evidence (a) FDG-avid or PET positive prior to therapy; mass Not palpable, nodules Infiltrate cleared on repeat
of disease of any size permitted if PET negative disappeared biopsy; if indeterminate
(b) Variably FDG-avid or PET negative; regression to by morphology,
normal size on CT immunohistochemistry
should be negative
PR Regression of measuable ! 50% decrease in SPD of up to 6 largest dominant ! 50% decrease in Irrelevant if positive prior
disease and no new sites masses; no increase in size of other nodes SPD of nodules (for to therapy; cell type
(a) FDG-avid or PET positive prior to therapy; one or single nodule in should be specified
more PET positive at previously involved site greatest transverse
(b) Variably FDG-avid or PET negative; regression on diameter); no
CT increase in size of
liver or spleen
SD Failure to attain CR/PR or PD (a) FDG-avid or PET positive prior to therapy; PET
positive at prior sites of disease and no new sites
on CT or PET
(b) Variably FDG-avid or PET negative; no change in
size of previous lesions on CT
Relapsed disease Any new lesion or increase Appearance of a new lesion(s) ! 1.5 cm in any axis, ! 50% increase from New or recurrent
or PD by ! 50% of previously ! 50% increase in SPD of more than one node, nadir in the SPD of involvement
involved sites from nadir or ! 50% increase in longest diameter of a any previous
previously identifed node ! 1 cm in short axis lesions
Lesions PET positive if FDG-avid lymphoma or PET
positive prior to therapy
Abbreviations: CR, complete remission; FDG, [18F]fluorodeoxyglucose; PET, positron emission tomography; CT, computed tomography; PR, partial remission; SPD,
sum of the product of the diameters; SD, stable disease; PD, progressive disease.
21
4. If the bone marrow was involved by lymphoma before treat- who have persistent morphologic bone marrow involvement will be
ment, the infiltrate must have cleared on repeat bone marrow biopsy. considered partial responders.
Respuesta completa
PET PET
INICIAL CONTROL
Mesotelioma
Peritoneal
23
Respuesta completa
24
Respuesta Completa CT
25
Respuesta completa
27
Respuesta completa no confirmada
Categora eliminada.
31
Respuesta parcial
Respuesta Desaparicin FDG avid / PET (+) PET No Palpable Normal en nueva
Evidencia Negativo Desapacin de biopsia Inmuno-
Completa Enfermedad FDG variable o PET (-) Tamao lesiones histoqumica
normal en CT negativa
2. Hoffman JM, Gambhir S: Molecular Imaging: The Vision and Opportunity for Radiology in the Future. Radiology: 244: 2007
3. Rmer W, Hanauske AR, Ziegler S, et al: Positron emission tomography in non Hodgkins lymphoma: Assessment of chemotherapy
with fluorodeoxyglucose. Blood 91:4464-4471, 1998
4. Hutchings M, Loft A, Hansen M, et al: FDGPET after two cycles of chemotherapy predicts treatment failure and progression-free
survival in Hodgkin lymphoma. Blood 107:52-59, 2007
5. PET scans in staging of lymphoma current status Friedberg J. W., Chengazi V. The oncologist 2003; 8: 438-447
6. Schoder H, Noy A, Gonen M, et al. Intensity of 18fluorodeoxyglucose uptake in positron emission tomography distinguishes between
indolent and aggressive non-Hodgkins lymphoma. J Clin Oncol. 2005;23:46434651.
7. Cheson BD, Horning SJ, Coiffier B et al. Report of an International Workshop to standardize response criteria for non-Hodgkins
lymphoma. J Clin Oncol 1999;17:1244-1253.
8. Juweid ME, Stroobants S, Hoekstra OS et al. Use of positron emission tomography for response assessment of lymhoma: consensus
recommendations of the Imagining Subcommittee of the International Harmonization Project in Lymphoma: J Clin Oncol 2007; 25:
571-578
9. Delbeke D, Coleman RE, Guiberteau MJ, et al: Procedure guidelines for tumor imaging with FDGPET/ CT 1.0. J Nucl Med 47:885-894,
2006
10. Guermazi A, Juweid ME, PET poised to alter de current paradigm for response assessment of non Hodgkins Lynphoma. The British
Journal of Radiology 79 (2006), 365-367
11. Olsen K, Sohi J, Abraham T, Juweid M: Initial validation of standardized qualitative (visual) criteria for FDG-PET assessment of
residual masses followinglymphoma therapy. Radiological Society of North America 92nd Scientific Assembly and Annual Meeting
Program, 2006, pp 323 (abstr. 55:E23-02)
12. Kostakoglu L. Comparison of FDG PET and Ga-67 in lymphoma. Cancer 2002; 94:879-888
47
Conclusiones