Navigation/Menü: Links auf weitere Seiten dieser Website
|Entwicklung eines neuen diagnostischen Algorithmus bei Kindern mit malignen Lymphomen|
|Main title||Entwicklung eines neuen diagnostischen Algorithmus bei Kindern mit malignen Lymphomen|
|Subtitle||die Rolle der Positronen-Emissions-Tomographie mit 2-deoxy-2[18F]Fluoro-D-Glukose ; PET2003-Studie|
|Title variations||Development of a new diagnostic approach in paediatrics suffered by malignant
|Subtitle for translated title||the role of FDG-PET|
Place of birth: Prenzlau
|1. Referee||Prof. Dr. H. Amthauer|
|Further Referee(s)||Prof. Dr. J. Hierholzer
Prof. Dr. W. Brenner
|Keywords||PET; Lymphoma; Childhood; Staging; Response Assessment; Prognostic Value|
|Classification (DDC)||610 Medical sciences; Medicine|
|Summary||AIM: Prospective and multicenter evaluation of the value of positron emission tomography (PET) using the tracer 2-deoxy-2 [18F] Fluorine-D-Glucose (FDG) for staging, therapy monitoring and relapse prediction on children and adolescents suffering from Hodgkin- (HL) or Non-Hodgkin-Lymphoma (NHL).
Methods and Patients: 60 patients (> 1 year and < 18 years) suffered from HL (n=40, female, 20, male, 20; average age, 15.4 , range 4.0-17.9 years) or NHL (n=20, female, 6, male, 14; average age, 12.1, range, 2.8–17.6 years) were enrolled. Additive to the conventional imaging methods (CIM) scheduled according to the respective therapy optimization protocol (TOP) the patients received additional FDG-PET examinations for initial staging (PET-1) and an early PET during therapy (PET-2) after completion of the first two cycles of chemotherapy (CTx).
In addition patients with an intermediate and advanced stage (HL, NHL >IA/B/IIA) received a late PET examination (PET-3) after completion of entire CTx and before initiating radiotherapy (RTx). PET-analysis was carried out visually as well as semi-quantitative by means of the analysis of the maximum standardized uptake value (SUVmax) for parts of the examined collective. For each patient 21 nodal and 6 extra nodal sites have been analysed, documented and compared to results of CIM. To create a standard of reference (SOR) and for verification of lesion status, all
staging and follow-up examinations, histopathology of biopsies and clinical data
including the serial follow-up examinations were used.
Results: In the NHL subgroup the initial staging by means of PET resulted in an up-staging of 3 patients with a resulting change of the risk stratification and intensification of the planned CTx in two cases. For purposes of early response prediction PET-2 indicating absence of recurrence if negative after completion of the first two cycles of CTx. Patients with a positive PET-2 and / or PET-3 showed a higher risk of a relapse (n=1) or a progression (n=2).
For purposes of initial stage- and therapy group assignment in patients suffered by HL a nearly equal accuracy of CIM and PET (90%, 92%) has been achieved. By means of the side-by-side analysis (SBS) of CIM and PET image data the accuracy could be increased from 92% to 96%. The diagnostic reliability has been significantly improved (p <.024), when image data were retrospective fused (image fusion [IF]). A correctness of 98% has been accomplished. None of the HL-patients with a negative PET-2 and / or PET-3 revealed a relapse during further follow-up (sensitivity, 100%; negative predictive value [NPV], 100%) Two patients developed a relapse (PET-2/-3 positive). Only one patient could be depicted by CIM (CIM-2).
In conclusion PET-2/-3 were superior to CIM -2/-3 (specificity, 68% vs. 3% or 78% vs. 11%; p <.001). Specificity of early therapy response assessment by PET-2 was improved to 97% by quantitative analysis of SUVmax-reduction using a cut-off value of 58% (sensitivity, 100%; AUC .987; p <.024)
Conclusion: The initial stage- and therapy group assignment in both subgroups improves by means of PET. For therapy monitoring PET is superior to the hitherto applied diagnostic algorithm of respective TOP. Patients with a negative PET early during therapy have an excellent prognosis. Patients with positive PET examinations during and after the conclusion of chemotherapy show a higher risk of relapse of the underlying disease.
Dataobject from FUDISS_thesis_000000011272
|FU Department||Department of Medicine - Charité - University Medicine Berlin|
|Year of publication||2009|
|Document type||Doctoral thesis|
|Date of defense||2009-09-18|
|Created at||2009-07-22 : 06:50:24|
|Last changed||2010-02-19 : 10:34:39|