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PET Predicts Prognosis After 1 Cycle of Chemotherapy in Aggressive Lymphoma and Hodgkin’s Disease

¹ Division of Nuclear Medicine, Department of Radiology, Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, New York
² Center for Lymphoma and Myeloma, Division of Hematology and Oncology, Department of Medicine, Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, New York

View larger version (18K): [in a new window]   FIGURE 1. In entire group of patients who underwent 18F-FDG PET after first cycle of chemotherapy (30 patients), Kaplan-Meier estimate of PFS for 15 patients with positive 18F-FDG PET results is compared with that for 15 patients with negative 18F-FDG PET results after first cycle of chemotherapy. Statistically significant difference in PFS was found between positive and negative 18F-FDG PET results (P < 0.001).

View larger version (18K): [in a new window]   FIGURE 2. In group of patients who underwent both early and late 18F-FDG PET (23 patients), Kaplan-Meier estimate of PFS for 6 patients with positive 18F-FDG PET results is compared with that for 17 patients with negative 18F-FDG PET results at completion of chemotherapy. Statistically significant difference in PFS was found between positive and negative 18F-FDG PET results (P = 0.001).

View larger version (64K): [in a new window]   FIGURE 3. A 35-y-old man with bulky HD underwent 18F-FDG PET before (A), after first cycle of (B), and at completion of (C) chemotherapy. Pretherapy 18F-FDG PET images reveal radiotracer uptake in anterior mediastinum involving both hilar regions and extending into left supraclavicular region. Patient underwent chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine. 18F-FDG PET after first cycle of chemotherapy reveals residual disease in right anterior mediastinum, whereas 18F-FDG PET at completion of chemotherapy shows no evidence of residual lymphoma in corresponding regions. Disease relapsed in mediastinum after PFS of 6 mo. Images obtained after first cycle show physiologic uptake in salivary glands, oral mucosa, right shoulder (trapezius muscle), and heart.

View larger version (60K): [in a new window]   FIGURE 4. A 45-y-old man with NHL underwent 18F-FDG PET before (A), after first cycle of (B), and at completion of (C) chemotherapy. Pretherapy 18F-FDG PET images reveal radiotracer uptake in nasopharynx and left cervical lymph nodes. Patient underwent chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone. Both after first cycle and at completion of chemotherapy, 18F-FDG PET reveals no evidence of residual disease. Disease was still in remission after PFS of 18 mo. All images show physiologic uptake in heart.

View larger version (17K): [in a new window]   FIGURE 5. In group of patients who underwent both early and late 18F-FDG PET (23 patients), Kaplan-Meier estimate of PFS for 10 patients with positive 18F-FDG PET results is compared with that for 13 patients with negative 18F-FDG PET results after first cycle of chemotherapy. Statistically significant difference in PFS was found between positive and negative 18F-FDG PET results (P < 0.001).