PETCT在淋巴瘤中的应用课件.pptVIP

疗效评估标准 1999年，IWG国际工作小组发布了《NHL疗效评估标准》 疗效 体格检查 淋巴结 淋巴结肿块 骨髓 CR 正常 正常 正常 正常 CRu 正常 正常 正常 不确定 正常 正常 缩小75% 正常或 不确定 PR 正常 正常 正常 阳性 正常 缩小≥50% 缩小≥50% 无关 肝/脾缩小 缩小≥50% 缩小≥50% 无关 Relapse/PD 肝/脾增大新病变 新病变或增大 新病变或增大 再发 Cheson BD, et al. J Clin Oncol 1999; 17:1244. IWG标准的缺点 无法区分肿瘤残留抑或纤维化 CRu的解读容易发生歧义 没有针对骨髓以外结外病变的评价 PET疗效评估的阳性和阴性预测值 基于PET的IHP标准 Cheson BD, et al. J Clin Oncol 2007; 25:579 2007年IHP制定了新的淋巴瘤疗效评价标准 IHP标准是对于IWG标准的改进和补充 IHP标准适用于以治愈为目的的淋巴瘤类型，特别是DLBCL和HL IHP标准的淋巴瘤类型推荐 Cheson BD, et al. J Clin Oncol 2007; 25:579 临床试验中的疗效定义 Cheson BD, et al. J Clin Oncol 2007; 25:579 新的PET疗效定义 CMR: complete metabolic response Score 1, 2, or 3 with or without a residual mass on 5PS PMR: partial metabolic response Score 4 or 5 with reduced uptake compared with baseline and residual mass(es) of any size At interim, these findings suggest responding disease At end of treatment, these findings indicate residual disease NMR: no metabolic response Score 4 or 5 with no significant change in FDG uptake from baseline at interim or end of treatment PMR: progressive metabolic disease Score 4 or 5 with an increase in intensity of uptake from baseline and/or New FDG-avid foci consistent with lymphoma at interim or end-of-treatment assessment Cheson BD, et al. J Clin Oncol 2014;32:3059 Role of PET at end of treatment PET-CT is standard of care for remission assessment in FDG-avid lymphoma; in presence of residual metabolically active tissue, where salvage treatment is being considered, biopsy is recommended (type 1) Investigation of significance of PET-negative residual masses should be collected prospectively in clinical trials; residual mass size and location should be recorded on end-of-treatment PET-CT reports where possible (type 3) Emerging data support use of PET-CT after rituximab-containing chemotherapy in high–tumor burden FL; studies are warranted to confirm this finding in patients receiving maintenance therapy (type 2) Assessment with PET-CT could be used to guide decisions before hi