Brief Article
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World J Radiol. Dec 28, 2013; 5(12): 484-490
Published online Dec 28, 2013. doi: 10.4329/wjr.v5.i12.484
2-[18F]-fluoro-2-desoxy-D-glucose positron emission tomography initial staging impacts on survival in Hodgkin lymphoma
Juliano J Cerci, Camila C G Linardi, Luís F Pracchia, José Soares Junior, Evelinda Trindade, Dominique Delbeke, Rodrigo J Cerci, Robert Carr, José C Meneghetti, Valeria Buccheri
Juliano J Cerci, José Soares Junior, José C Meneghetti, Department of Nuclear Medicine, Heart Institute (InCor), University of São Paulo Medical School, São Paulo 05403-900, Brazil
Juliano J Cerci, Rodrigo J Cerci, Division of PET/CT, Quanta – Diagnóstico Nuclear, Curitiba 80045-170, Brazil
Camila C G Linardi, Luís F Pracchia, Valeria Buccheri, Division of Hematology, Clinical Hospital of the University of São Paulo Medical School, São Paulo 05403-900, Brazil
Evelinda Trindade, Health Technology Assessment/Executive Direction, Heart Institute (InCor), University of São Paulo Medical School, São Paulo 05403-900, Brazil
Dominique Delbeke, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, United States
Robert Carr, Department of Haematology, St Thomas’ Hospital, London SE1 7EH, United Kingdom
Author contributions: Cerci JJ, Linardi CCG, Pracchia LF and Buccheri V contributed equally to this work performing research, study design, results analysis and writing the paper; Soares Junior J, Trindade E, Cerci RJ, Carr R, Delbeke D and Meneghetti JC contributed to design, analyze and write the paper.
Supported by The Brazilian Ministry of Health
Correspondence to: Juliano Julio Cerci, MD, PhD, Division of PET/CT, Quanta-Diagnóstico Nuclear, R. Almirante Tamandaré, 1000. Curitiba (PR), 80045-170, Brazil.
Telephone: +55-41-33629778 Fax: +55-41-33629778
Received: September 4, 2013
Revised: October 17, 2013
Accepted: December 9, 2013
Published online: December 28, 2013

AIM: To assess the prognostic value and risk classification improvement of metabolic staging (MS) with Initial 2-[18F]-fluoro-2-desoxy-D-glucose positron emission tomography (FDG-PET) in initial staging of Hodgkin’s Lymphoma (HL) patients to predict 5 years overall survival (5y-OS) and event free survival (EFS).

METHODS: A total of 275 patients were included in this retrospective study, 155 patients were staged with conventional anatomical staging (AS), and 120 also submitted to MS (FDG-PET). Prognostic analysis compared 5y-OS and 5y-EFS of patients staged with AS and MS. Risk-adjusted models incorporated clinical risk factors, computed tomography and FDG-PET staging.

RESULTS: During the follow up of 267 evaluated patients, 220 (122 AS and 98 MS) achieved complete remission after first-line therapy (median follow-up: 70 ± 29 mo), treatment failure occurred in 79 patients and 34 died. The 5y-EFS for early vs advanced disease in AS patients was 79.3% and 66.7%, and 85.6% and 53.6% in MS patients, respectively (P < 0.01). The 5y-OS for early and advanced disease with AS was 91.3% and 81.5%, and 97.5% and 80.7% for patients staged with MS, respectively. Cox proportional hazards analysis demonstrated that FDG-PET added significant prognostic information and improved risk prediction (P = 0.02).

CONCLUSION: Initial staging FDG-PET could be used as an accurate and independent predictor of OS and EFS in HL, with impact in 5y-EFS and OS.

Keywords: Hodgkin disease, Positron-emission tomography, 2-[18F]-fluoro-2-desoxy-D-glucose positron emission tomography, Neoplasm staging, Prognosis

Core tip: Initial 2-[18F]-fluoro-2-desoxy-D-glucose positron emission tomography (FDG-PET) has impact in the determination of the event free survival and overall survival (OS) in Hodgkin’s Lymphoma patients, also initial staging with FDG-PET was the strongest predictor of OS and event free survival of the evaluated variables analyzed. In the currently era of tailoring therapy to an individual level, initial staging might play an even more important role.