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目的 探讨18F-氟脱氧葡萄糖(FDG) PET/CT对淋巴瘤放化疗后疗效评估及无进展生存期(PFS)的预测价值.方法 回顾性分析85例淋巴瘤患者的临床资料.所有病例接受4~8个周期标准化化疗,前后均行18F-FDG PET/CT检查,比较2年PFS率,评价其对接受放化疗的淋巴瘤患者疗效评估及PFS率预测的价值.结果 本组病例发病以非霍奇金淋巴瘤(NHL)类型为主,发病部位以头颈淋巴结、纵隔、腹膜后为主.多数患者伴有脾脏肿大和局部病灶高代谢.霍奇金淋巴瘤(HL)PET/CT阴性组治疗完全缓解(CR)率明显高于阳性组(86.4%:42.9%,P =0.038),且PET/CT阳性组与阴性组2年PFS率分别为42.9%和81.8%,差异具有统计学意义(x2=7.70,P=0.006).56例NHL患者治疗后35例达CR,13例达部分缓解(PR),8例达病情稳定(SD)或病情进展(PD),CR组、PR组、SD或PD组患者2年PFS率分别为89.7%、65.3%和19.4%,差异有统计学意义(x2=12.41,P=0.002).PET/CT显像对治疗后T细胞淋巴瘤(TCL)患者(x2=13.85,P=0.001)、弥漫大B细胞淋巴瘤(DLBCL)患者(x2=13.51,P=0.001)有很强的PFS率预测作用,对滤泡淋巴瘤(FL)患者(x2=4.63,P=0.099)无预后预测作用.结论 18F-FDG PET/CT显像能很好地评价淋巴瘤的疗效,可早期预测预后,对治疗方案的选择具有一定的指导意义. 相似文献
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目的 探讨18氟-脱氧葡萄糖(18F-FDG)正电子发射计算机断层显像(PET)在儿童恶性淋巴瘤分期、疗效评估及随诊中的意义。方法 回顾性分析了88例儿童恶性淋巴瘤初诊时、化疗中期以及停药后随诊过程中18F-FDG-PET扫描结果,并与同期的CT扫描相比较。结果 67例初诊儿童淋巴瘤患者,化疗前共评估了1072个解剖部位,PET和CT均提示瘤灶阳性及阴性部位分别为11.10 %和77.52 %,PET阳性CT阴性的部位占6.81 %,而PET阴性CT阳性的占4.57 %,PET在化疗前受累部位的诊断方面优于CT扫描。对26例随诊患者,在治疗中期、停药时及停药后进行了35次PET检查,32例患儿瘤灶为阴性,PET扫描瘤灶真阴性为28例(87.50 %),CT为16例(57.14 %),在假阳性方面,CT比较高,为16例(50%),而PET仅为4例(14.29 %),临床吻合度PET大于CT。结论 PET对于儿童恶性淋巴瘤的临床分期、鉴别残余病灶的性质以避免不必要的过度治疗或二次活检,以及发现肿瘤的早期复发具有一定的意义。 相似文献
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【摘要】 在近十年里,霍奇金淋巴瘤(HL)对大多数患者而言已成为可治愈的恶性肿瘤。目前的一线治疗通常采用ABVD方案化疗或联合其他药物和放疗。为了更好地控制疾病,ABVD方案一直受到强度更大的治疗如 Stanford V和BEACOPP 化疗方案的挑战。在第53届美国血液学会(ASH)年会报告中,ABVD方案作为治疗包括人类免疫缺陷病毒(HIV)感染者及老年HL患者的标准方案仍广为大家接受,但对一线临床医生来说,治疗复发难治HL还是一个具有挑战性的任务,大剂量化疗序贯自体造血干细胞移植(HDC/ASCT)对此类患者最为有益,同时用于这部分患者治疗的许多新药也在研发中。正电子发射计算机断层扫描(PET)能为接受化疗或移植前后的HL患者提供重要的预后信息,但在会议报道中对治疗后患者进行影像学的长期监测并不被推荐。 相似文献
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目的探讨18F-氟代脱氧葡萄糖(18F-FDG)正电子发射断层显像/计算机断层扫描(PET/CT)对恶性肿瘤神经浸润的诊断价值。方法对50例经病理检查证实的恶性肿瘤患者行18F-FDG PET/CT检查,将病理组织学结果、抗炎治疗后1个月随访结果、化疗后临床随访结果作为诊断神经浸润的金标准,评估18F-FDG PET/CT的诊断价值。结果50例恶性肿瘤患者中,PET/CT检查神经浸润阳性14例,其中真阳性10例,假阳性4例;PET/CT检查显示沿受累神经走形的线性代谢活动,最大标准摄取值(SUVmax)为2.5~25.2,平均(7.6±6.5)。18F-FDG PET/CT检查诊断恶性肿瘤神经浸润的灵敏度为83.33%,特异度为89.47%,阳性预测值为71.43%,阴性预测值为94.44%,准确度为88.00%。结论18F-FDG PET/CT有助于早期诊断恶性肿瘤患者的神经浸润情况,从而对患者进行针对性的干预。 相似文献
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目的 研究PET对恶性淋巴瘤分期和治疗后评估的临床价值。方法 在初诊时或复发治疗前对 35例恶性淋巴瘤 ,包括霍奇金式淋巴瘤和非何杰金式淋巴瘤进行PET检查 ,部分病例尚进行全身CT扫描 ,WHO分类标准进行诊断。结果 PET对初诊淋巴瘤患者的敏感性为 93.5 % (2 9/ 31) ,PET与CT的一致性为 70 % (12 / 17) ;另有 5例患者的分期结果不一致 ,不一致性为 2 9%。追踪检查发现 ,PET检测复发或微小残留病的敏感率 88% (8/ 9) ,准确性 75 % (6 / 8)。在经过 6~ 8个周期的CHOP方案化疗后 ,5 0 % (4/ 8)的进展期NHL患者仍有残留病灶。结论 PET在恶性淋巴瘤的诊断 ,分期和治疗后评估比CT敏感 ,尤其是在微小残留病方面 相似文献
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《Annals of oncology》2011,22(3):671-680
BackgroundSpleen and liver assessment for occult involvement of Hodgkin's lymphoma (HL) challenges current staging procedures.Patients and methodsWe prospectively evaluated event-free survival (EFS) in 103 HL patients staged with fused 2-[fluorine-18]fluoro-2-deoxy-D-glucose–positron emission tomography (FDG–PET)/contrast-enhanced computed tomography (CT) to identify those at greatest risk for abdominal relapse. The EFS of this series was compared with that of a historical cohort of 100 HL patients staged with separate FDG–PET and diagnostic CT acquisitions.ResultsThirty-one of the 103 patients staged with FDG–PET/contrast-enhanced CT were found to have spleen involvement and 10 patients liver involvement, whereas 14 of the 100 patients staged with separate procedures were found to have spleen involvement and 3 patients liver involvement. There were significantly more intensive treatments (six courses of anthracycline-containing chemotherapy and spleen radiation) in the fused PET/CT group than in the historical cohort (P ≤ 0.04). At a median follow-up of 27 months, five events occurred in the fused PET/CT group (HL relapse, 4 patients; carcinoma, 1 patient) and 19 events in the historical cohort (HL relapse, 18 patients; acute promyelocytic leukemia, 1 patient). Ten of the 18 relapses in the historical cohort were localized in the spleen and/or liver area. None of the four relapses in the fused PET/CT group was localized below the diaphragm. Thus, FDG–PET/contrast-enhanced CT-guided treatment resulted in a 95% EFS, whereas separate FDG–PET and diagnostic CT-guided treatment resulted in an 81% EFS (P = 0.002).ConclusionFDG–PET/contrast-enhanced CT is an accurate frontline single imaging diagnostic tool enabling effective tailored treatment in HL patients. 相似文献
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《Annals of oncology》2015,26(6):1170-1174
BackgroundCombination chemotherapy ABVD (doxorubicin, bleomycin, vinblastine and dacarabazine) cures ∼70% of patients with advanced Hodgkin's lymphoma (aHL, stages IIB, III and IV) while more toxic escalated BEACOPP (EB, combination of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone) increases cure rates to 85%. Patients with a positive interim positron emission tomography–computerized tomography (PET–CT) scan after two cycles (PET-2) of ABVD have very poor outcomes with continued ABVD. Intensifying therapy with EB in PET-2-positive patients (‘response-adapted therapy’) may improve cure rates, whereas the negative patients can continue ABVD alone.Patients and methodsEligible patients with newly diagnosed aHL received two cycles of ABVD and underwent PET-2 (scored with semi-quantitative 5-point visual criteria, ‘Deauville score’). PET-2-negative patients continued four additional cycles of ABVD, whereas PET-2-positive patients received four cycles of EB. A phase II sample size of 50 was estimated keeping the lower and higher proportion of rejection of the event-free survival (EFS) as 70% and 85%, respectively.ResultsFifty patients [median age 28 (12–60) years; male: female: 39: 11; stages: IIB—3 (6%), III—29 (58%) and IV—18 (36%); International Prognostic Score (IPS): 0–3: 34 (68%); 4–7: 16 (32%)] were enrolled; 49 underwent PET-2. Eight (16%) were PET-2-positive, whereas 41 (84%) were negative. Forty-seven were evaluable for EFS and all 50 for overall survival (OS). The 2-year EFS was 76% (95% CI: 68–83) and OS was 88% (95% CI: 82–94). PET-2 was strongly prognostic-2-year EFS, negative versus positive: 82% versus 50%; P = 0.013.ConclusionPET-2 response-adapted strategy could not achieve EFS of 85% in aHL. However, escalated therapy improved outcomes in PET-2-positive patients compared with historical data.Trial registrationCTRI/2012/06/002741 (http://www.ctri.nic.in) and NCT01304849 (http://www.clinicaltrials.gov). 相似文献
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Angelina Cistaro Laura Cassalia Cinzia Ferrara Natale Quartuccio Laura Evangelista Maurizio Bianchi Franca Fagioli Gianni Bisi Sergio Baldari Alessandro Zanella Marta Pillon Pietro Zucchetta Marta Burei Alessandra Sala Luca Guerra Priscilla Guglielmo Roberta Burnelli Stefano Panareo Giuseppe Rubini 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(6):e267-e273
Introduction
The present study investigated the utility of fluorine-18 (18F) fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing bone marrow involvement (BMI) compared with bone marrow biopsy (BMB) in newly diagnosed pediatric Hodgkin lymphoma (HL).Patients and Methods
A total of 224 pediatric patients with HL underwent 18F-FDG PET/CT at staging. BMB or follow-up imaging was used as the standard of reference for the evaluation of BMI.Results
18F-FDG PET/CT was negative for BMI in 193 cases. Of the 193 patients, the findings for 16 were originally reported as doubtful and later interpreted as negative for BMI, with negative findings on follow-up imaging and BMB. At BMB, 1 of the 16 patients (6.25%) had BMI. Of the 193 patients, 192 (99.48%) had negative BMB findings. Thus, the 18F-FDG PET/CT findings were truly negative for 192 patients and falsely negative for 1 patient for BMI.Conclusion
18F-FDG PET/CT showed high diagnostic performance in the evaluation of BMI in pediatric HL. Thus, BMB should be ideally reserved for patients presenting with doubtful 18F-FDG PET/CT findings for BMI. 相似文献18.
《Annals of oncology》2009,20(11):1848-1853
BackgroundAlthough positron emission tomography (PET) response to chemotherapy (CT) has prognostic significance in Hodgkin's lymphoma (HL), it is unclear whether patients with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG)–PET positivity during and/or after CT can be rendered disease free with consolidative involved-field radiotherapy (IFRT).MethodsPatients with HL treated with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD)-based CT and radiotherapy (RT) at our institution from January 2000 to March 2007 were eligible. All patients had either a post-treatment PET or PET–CT before initiation of RT or a negative midtreatment PET or PET–CT. The primary end point was failure-free survival (FFS) for patients with and without residual FDG avidity after ABVD. The treatment outcome of patients with interim PET positivity during CT was also reported.ResultsSeventy-three patients were included in this study. Twenty patients (out of 46) were PET positive on interim PET, and 13 patients (out of 73) were PET positive at the conclusion of CT. At a median follow-up of 3.4 years for surviving patients, the 2-year FFSs for patients PET-negative versus PET-positive disease after ABVD were 95% and 69%, respectively (P < 0.01). On bivariable Cox regression, post-ABVD positivity (hazard ratio 4.8, P = 0.05) was predictive of disease recurrence after controlling for bulky disease. Of the 20 patients with interim PET positivity, three recurred, with a 2-year FFS of 85%. Among the 13 patients with interim PET positivity, but became PET negative at the completion of CT, the 2-year FFS was 92%.ConclusionSixty-nine per cent of patients with residual FDG avidity after ABVD were free of disease after consolidative RT, indicating a majority of patients with persistent lymphoma can be cured by sterilizing this PET-positive disease. 相似文献