PET for staging, risk stratification and guiding therapy in lymphoma


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Sally Barrington1
1King's College London

Abstract

Background

Positron Emission Tomography combined with X-ray Computed Tomography (PET-CT) is the standard imaging modality for assessment of patients with FDG-avid lymphomas.  PET-CT is recommended for staging and risk stratification in international guidelines and has reduced the requirement for invasive bone marrow biopsy in Hodgkin Lymphoma (HL) and Diffuse Large B cell lymphoma (DLBCL). Recent reports have indicated that more accurate staging in follicular lymphoma (FL) is associated with improved outcomes for patients with early stage disease treated with radiotherapy.  Metabolically active disease burden at baseline has been reported to be predictive of prognosis, with the potential to allow risk adapted treatment. 

Results from phase III trials have already changed practice in HL, permitting more selective use of chemotherapy and reduced use of radiotherapy, guided by PET.  The role of PET to select patients with DLBCL and primary mediastinal B Cell lymphoma for consolidation radiotherapy is currently being investigated.  In patients with FL, treated with rituximab and chemotherapy, PET predicts outcome better than CT and prospective trials are now being undertaken to test response adapted approaches in this setting.  The use of PET in the management of patients with lymphoma will be discussed as an exemplar of the use of molecular imaging to direct therapeutic algorithms.