PET CT在淋巴瘤中的应用.ppt

PET分期评估的结果 Role of PET-CT for staging PET-CT should be used for staging in clinical practice and clinical trials but is not routinely recommended in lymphomas with low FDG avidity; PET-CT may be used to select best site to biopsy (type 1) Contrast-enhanced CT when used at staging or restaging should ideally occur during single visit combined with PET-CT, if not already performed; baseline findings will determine whether contrast-enhanced PET-CT or lower-dose unenhanced PET-CT will suffice for additional imaging examinations (type 2) Bulk remains an important prognostic factor in some lymphomas; volumetric measurement of tumor bulk and total tumor burden, including methods combining metabolic activity and anatomical size or volume, should be explored as potential prognosticators (type 3) Barrington S, et al. J Clin Oncol 2014;32:3048 内容 背景介绍 PET/CT用于淋巴瘤的分期评估 PET/CT用于淋巴瘤治疗后评估 PET/CT用于淋巴瘤治疗中期评估 基于CT的IWG标准 1999年IWG制定了淋巴瘤疗效评价和预后评估指南 IWG指南统一了原本各异的疗效评估标准 该指南得到了临床医生和监管机构的广泛认可，并用于大量新药的审批程序 Cheson BD, et al. J Clin Oncol 1999; 17:1244. 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》 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