Limited-stage Diffuse Large B-cell Lymphoma

Blood ◽  
2021 ◽  
Author(s):  
Eliza A. Hawkes ◽  
Allison Barraclough ◽  
Laurie H. Sehn
Keyword(s):  
Combined Modality Therapy ◽  
B Cell Lymphoma ◽  
Response Assessment ◽  
Late Complications ◽  
Limited Stage ◽  
Disease Biology ◽  
Positron Emission ◽  
Stage Disease ◽  
Ann Arbor ◽  
Definition Of

DLBCL, the most common lymphoma subtype, is localized in 25-30% of patients. Prognosis in patients with limited-stage DLBCL (LS-DLBCL) is excellent with 10-year overall survival of at least 70-80%. Improved insights into the disease biology, the availability of positron-emission tomography (PET) scans and recent dedicated clinical trials within this unique population, have led to evolving treatment paradigms. However, no standard definition of LS-DLBCL exists, and while generally defined as Ann Arbor stages I-II disease with largest mass size <10cm in diameter, variations across studies cause challenges in interpretation. Similar to advanced-stage disease, R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) immunochemotherapy forms the basis of treatment, with combined modality therapy including 3 cycles of systemic treatment and involved-site radiation therapy being a predominant historical standard. Yet the well-described continuous risk of relapse beyond 5 years and established late complications of radiotherapy have challenged previous strategies. More rigorous baseline staging and response assessment with PET may improve decision making. Recent clinical studies have focused on minimizing toxicities while maximizing disease outcomes using strategies such as abbreviated immunochemotherapy alone and PET-adapted radiotherapy delivery. This comprehensive review provides an update of recent literature with recommendations for integration into clinical practice for LS-DLBCL patients.

scholarly journals Positron Emission Tomography–Directed Therapy for Patients With Limited-Stage Diffuse Large B-Cell Lymphoma: Results of Intergroup National Clinical Trials Network Study S1001

2020 ◽  
Vol 38 (26) ◽  
pp. 3003-3011 ◽  
Author(s):  
Daniel O. Persky ◽  
Hongli Li ◽  
Deborah M. Stephens ◽  
Steven I. Park ◽  
Nancy L. Bartlett ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Clinical Trials ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Emission Tomography ◽  
Limited Stage ◽  
Large B Cell Lymphoma ◽  
Positron Emission ◽  
Stage Disease ◽  
Large B Cell

PURPOSE Diffuse large B-cell lymphoma (DLBCL) presents as a limited-stage disease in 25% to 30% of patients, with better overall survival (OS) than that for advanced-stage disease but with continuous relapse regardless of treatment approach. The preferred treatment is abbreviated rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and radiation therapy. On the basis of promising results of positron emission tomography (PET)–directed treatment approaches, we designed a National Clinical Trials Network (NCTN) study to improve outcomes and decrease toxicity. METHODS Patients with nonbulky (< 10 cm) stage I/II untreated DLBCL received 3 cycles of standard R-CHOP therapy and underwent a centrally reviewed interim PET/computed tomography scan (iPET). Those with a negative iPET proceeded with 1 additional cycle of R-CHOP, whereas those with a positive iPET received involved field radiation therapy followed by ibritumomab tiuxetan radioimmunotherapy. RESULTS Of 158 patients enrolled, 132 were eligible and 128 underwent iPET, which was positive in 14 (11%) of the patients. With a median follow-up of 4.92 years (range, 1.1-7.7 years), only 6 patients progressed and 3 died as a result of lymphoma. Eleven patients died as a result of nonlymphoma causes at a median age of 80 years. The 5-year progression-free survival estimate was 87% (95% CI, 79% to 92%) and the OS estimate was 89% (95% CI, 82% to 94%), with iPET-positive and iPET-negative patients having similar outcomes. CONCLUSION To our knowledge, S1001 is the largest prospective study in the United States of limited-stage DLBCL in the rituximab era, with the best NCTN results in this disease subset. With PET-directed therapy, 89% of the patients with a negative iPET received R-CHOP × 4, and only 11% had a positive iPET and required radiation, with both groups having excellent outcomes. The trial establishes R-CHOP × 4 alone as the new standard approach to limited-stage disease for the absolute majority of patients.

Cell Of Origin Does Not Affect Outcomes In Early Stage Non-Bulky Diffuse Large B-Cell Lymphoma Treated With Short-Course Combined Modality Therapy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3017-3017 ◽  
Author(s):  
Matthew A. Lunning ◽  
Jocelyn C. Maragulia ◽  
Anita Kumar ◽  
Martin Bast ◽  
Philip Bierman ◽  
...  
Keyword(s):  
B Cell ◽  
Early Stage ◽  
Combined Modality Therapy ◽  
B Cell Lymphoma ◽  
Cell Of Origin ◽  
Bulky Disease ◽  
Large B Cell Lymphoma ◽  
Short Course ◽  
Ann Arbor ◽  
Disease Free

Abstract Introduction Early stage non-bulky disease accounts for approximately 25% of all cases of diffuse large B-cell lymphoma (DLBCL). An effective treatment regimen for early stage non-bulky DLBCL is short-course combined modality therapy (CMT) as evidenced by the SWOG 0014 study that reported 4-year PFS and OS of 88% and 92%, respectively (Persky D et al. JCO 2008). The cell of origin (COO) of DLBCL can be classified based on immunohistochemistry (Hans criteria) and gene expression profiling (GEP) into two clinically recognized cohorts: germinal center B-cell-like (GCB) and non-GCB phenotypes. The Hans immunohistochemistry-based algorithm reproduced the GEP classification in 71% of GCB and 88% of non-GCB cases (Hans CP Blood 2004). In patients with advanced stage DLBCL, patients with a non-GCB phenotype had a significantly worse 5-year overall survival. There is a paucity of data regarding the prognostic significance of COO in early stage non-bulky DLBCL. In one report of early stage DLBCL by GEP, GCB phenotype accounts for approximately 77% of cases (Rosenwald et al. NEJM 2002). The outcomes of early stage non-bulky DLBCL patients treated with CMT segregated by COO is unknown. Methods To investigate the outcomes of early stage non-bulky DLBCL and impact of COO, we conducted a retrospective review of all patients with DLBCL or follicular lymphoma grade 3b treated with short-course rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy plus involved-field radiation therapy (IFRT) between 2000 and 2012 at Memorial Sloan-Kettering Cancer Center (MSKCC) and the University of Nebraska Medical Center (UNMC). Individual chart review was performed to extract the clinical presentation, pathological features, treatments, and outcomes. Early stage non-bulky DLBCL was defined as Ann Arbor stage I or stage II, non-bulky (without a mass ≥ 10 cm). The stage-modified international prognostic index (SM-IPI) defined as stage lI (vs.I), age>60, elevated LDH, and ECOG performance status ≥ 2 was calculated if all variables were available. The Hans algorithm and/or GEP were used to classify patients as either GCB or non-GCB. Short-course CMT was defined as R-CHOP for 3 or 4 cycles plus IFRT. Disease free survival and overall survival were calculated using Kaplan Meier analysis. Results In total 97 patients were evaluated with a median age of 58 (range 19 to 83) with 52% woman. The majority (90%) of patients had DLBCL (versus follicular lymphoma grade 3b) and 79% had Ann Arbor stage I/IE disease. There were no patients with bulky disease in this series. The SM-IPI characteristics are listed in Table 1a. COO was determined by the Hans algorithm in 94 of 97 cases (97%), by Hans and GEP in 2 cases, and by GEP alone in one case. A GCB phenotype was seen in 76% of the patients. In the 74 (76%) patients with all SM-IPI variables extracted, 31% patients had 0 risk factors, 50% had 1 risk factor, and 19% had 2 or 3 risk factors. The SM-IPI was not significant (p> 0.05; NS) between the GCB and non-GCB cohorts (See Table 1b). The majority (68%) received R-CHOP for 3 cycles with the remaining receiving 4 cycles. One patient had a contraindication to vincristine thus etoposide was substituted (R-CHEP). Subsequent IFRT was given to all patients. At a median follow-up among survivors of 52 months, 97% of patients remained alive and 94% remained disease free. At 52 months, all patients in the non-GCB cohort remained disease free and in the GCB cohort 92% were disease free (p=0.821). Overall, 6 deaths have occurred: 2 related to disease, 2 of unknown cause, and 2 unrelated to disease. Conclusions Patients with early stage non-bulky DLBCL treated with short-course CMT continue to have an excellent prognosis. Our data confirms prior GEP data that the GCB phenotype, by immunohistochemistry-based Hans algorithm, is predominantly seen in early stage non-bulky DLBCL. In contrast to advanced stage DLBCL, COO does not appear to influence outcomes in early stage non-bulky DLBCL with this treatment approach. Disclosures: Horwitz: Celgene, Allos, Seattle Genetics, Bristol-Myers Squibb, Genzyme, Kyowa, Janssen, Johnson & Johnson, Millenium: Consultancy; Celgene, Allos, Seattle Genetics, Kyowa, Infinty, Millenium: Research Funding.

scholarly journals A Retrospective Analysis of Outcomes of Diffuse Large B Cell Lymphoma (DLBCL) in the Elder Patients in China

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5410-5410
Author(s):  
Peng Liu ◽  
Ying Han ◽  
Jianliang Yang ◽  
Xiaohui He ◽  
Changgong Zhang ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Early Stage ◽  
B Cell Lymphoma ◽  
Disease Stage ◽  
Early Stage Disease ◽  
Large B Cell Lymphoma ◽  
Elder Patients ◽  
Stage Disease ◽  
Ann Arbor ◽  
Advanced Disease Stage

Abstract Background: Elderly patients with diffuse large B-cell lymphoma (DLBCL) have a worse prognosis compared to the younger population, since older age is associated with comorbidity and suboptimal performance status leading to intolerance of chemo-immunotherapy. The outcome of DLBCL in the older patients (> 60 years) was well described in clinical trials with reported 5-year overall survival (OS) of 50-80% (Coiffier et al., N Engl J Med 2002). Since this group is often precluded from clinical trials and population-based studies are limited, optimal treatment strategy for the old patients with DLBCL remains controversial. Here, we describe a Chinese real-world experience of management of elderly DLBCL patients treated at National Cancer Hospital, China. Methods: This is a single-center, retrospective analysis of consecutive DLBCL patients aged ≥60 who planned to receive chemotherapy +/- rituximab. The standard regimens included 3-4 cycles (early stage disease) or 6 cycles (advanced) of R-CHOP like regimens (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) followed by two rituximab doses in fit patients; R-miniCHOP for unfit and R-CE(etoposide)OP for frail elder patients. Patient data including baseline characteristics, histology, clinical parameters, and treatment outcomes were extracted from hospital medical records. The primary endpoint was progression-free survival (PFS); secondary endpoint was OS. Statistical analyses included descriptive statistics and Kaplan Meier estimates. Results: From June 2006 to December 2012, 349 patients aged ≥60 years were included, in which 204 patients were aged <70 years (Table 1). 326 patients received chemotherapy or chemo-immunotherapy with rituximab. Median follow up was 82 months. Five year PFS and OS of the elder patients were 45.8% and 51.9%, respectively. Significant difference was seen between patients < 70 years and those ≥70 years in terms of PFS (51.0% vs 38.6%, p=0.030) and OS (58.3% vs 42.8%, p=0.007) (Figure 1). Patients with early-stage disease (Ann Arbor StageⅠ/Ⅱ) had better 5-year PFS (60.1% vs 23.5%, p<0.001) and OS (65.3% vs 30.9%, p<0.001) than patients with advanced disease stage (Ann Arbor Stage III/IV) (Figure2). In addition, regimen including rituximab significantly improved the survival than chemotherapy alone (5-year PFS: 37.3% vs 64.0%, p<0.001; 5-year OS: 44.5% vs 69.3%, p<0.001), especially in patients ≥70 years, which almost doubled 5-year PFS and OS (5-year PFS: 25.4% vs 50.7%, p<0.001; 5-year OS: 28.8% vs 56.0%, p<0.001) (Figure3). Conclusions: Elder age (≥70 years) and advanced disease stage (Ann Arbor Stage III/IV) are associated with poor PFS and OS in Chinese elder DLBCL patients. The addition of rituximab significantly improves the survival compared to chemotherapy alone, especially in patients aged ≥70 years. These findings underscore the importance of personalized evaluation and treatment in elder patients with DLBCL. Disclosures No relevant conflicts of interest to declare.

scholarly journals R-CVP Chemoimmunotherapy for Limited-Stage Ocular Adnexal MALT Lymphoma with Adverse Factors: A Phase II Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2981-2981
Author(s):  
Sung-Yong Kim ◽  
Seok-Goo Cho ◽  
Won-Sik Lee ◽  
Suk-Woo Yang ◽  
Sung Yong Oh ◽  
...  
Keyword(s):  
Phase Ii ◽  
Relapse Rate ◽  
Malt Lymphoma ◽  
Phase Ii Study ◽  
Eastern Cooperative Oncology Group ◽  
B Cell Lymphoma ◽  
Advanced Stage ◽  
Limited Stage ◽  
End Point ◽  
Ann Arbor

Abstract Background: Ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML) has an indolent disease course and a generally good response to radiotherapy; hence, limited-stage disease is commonly treated with radiotherapy. However, after localized radiotherapy for limited-stage OAML, a relapse rate of up to 16% was reported and the main relapse sites observed in previous series were in nonirradiated areas. The relapse rate was higher if the disease involved bilateral conjunctivae or tissue beyond the conjunctiva. We designed a phase II study in which patients with newly diagnosed and limited-stage OAML with bilateral or beyond-conjunctival involvement were treated with a regimen of rituximab in combination with cyclophosphamide, vincristine, and prednisolone (R-CVP), which has been widely used for advanced-stage indolent CD20+ B cell lymphoma and in a previous trial has demonstrated efficacy in advanced-stage MALT lymphoma. Patients and methods: Thirty-three patients with Ann Arbor stage I OAML with the adverse factors were enrolled. Patients received six cycles of R-CVP followed by two cycles of rituximab therapy. The enrolment criteria for disease status were Ann Arbor stage IE OAML with bilateral or beyond-conjunctival involvement; bT1 or T>1 based on the tumor-node-metastasis (TNM) staging system for ocular adnexal lymphoma proposed by the American Joint Committee on Cancer. Patients were required to be ©ø18 years old, with Eastern Cooperative Oncology Group (ECOG) performance scores of 0-2, with no prior chemotherapy or radiation therapy. Exclusions were made for disease confined to unilateral conjunctiva (T1N0M0) or Ann Arbor stage III-IV disease. The primary end point of the study was response rate, defined as the CR and partial response (PR) rates, based on the revised response criteria for malignant lymphoma. The secondary end point was PFS and overall survival. Results: The median age of the patients was 49 years (range, 19-74 years). The anatomic location of disease was the conjunctiva in 12 patients (36.4%), the orbit in 13 (39.4%), the eyelid in five (15.2%), and the lacrimal duct or gland in three (9.1%). Fourteen patients (42.4%) had bilateral disease at presentation. All study patients (100%) responded to the treatment. After the treatment, 28 patients (84.8%) were in CR and five patients (15.2%) in PR. With the median follow up of 26.9 months (range, 7.4-41.0 months), the estimated cumulative CR rate was 93.9% at 3 years (Figure 1). The cumulative CR rate was significantly lower in the patients with beyond-conjunctival disease (T>1) than in the patients with bilateral conjunctiva-confined disease (bT1) (91.3% vs. 100%; P = 0.022). The cumulative CR rate was lower for patients aged ©ø49 than in patients younger than 49 years (90.4% vs. 100%; P = 0.034). Multivariate analysis indicated that in our study patients beyond-conjunctival involvement (T>1) was an independent predictor of cumulative CR rate (hazard ratio [HR] 0.424, P = 0.044). Among the study patients, one patient, who had bT1N0M0 disease, relapsed at the same location in the eye at 21.7 months after initiation of treatment. The estimated PFS at 3 years was 95.5 ¡¾ 4.4%. No death was observed and OS was 100%. No patients experienced ophthalmic complications (Figure2). Conclusions: The R-CVP regimen was efficient for disease control up to 3 years because all study patients responded, cumulative CR rate was 93.9% and the PFS was 95.9% at 3 years. The common relapse sites in patients who received radiotherapy were in nonirradiated areas, suggesting that the systemic antitumor coverage of this chemoimmunotherapy may contribute to lowering the risk of distant relapse in our patients. We conclude that the R-CVP regimen can be effective alternative treatment which avoids radiation hazards and efficiently achieves CR in patients with limited-stage OAML, even those with adverse factors of radiotherapy. Disclosures No relevant conflicts of interest to declare.

R-CHOP with Etoposide Substituted for Doxorubicin (R-CEOP): Excellent Outcome in Diffuse Large B Cell Lymphoma for Patients with a Contraindication to Anthracyclines.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 408-408 ◽  
Author(s):  
Alden A. Moccia ◽  
Kimberly Schaff ◽  
Paul Hoskins ◽  
Richard Klasa ◽  
Kerry J. Savage ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Control Group ◽  
Advanced Stage ◽  
Anthracycline Therapy ◽  
Limited Stage ◽  
Large B Cell Lymphoma ◽  
Stage Disease ◽  
Large B Cell

Abstract Abstract 408 Introduction: R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) is the current standard of care for the treatment of diffuse large B cell lymphoma (DLBCL). Doxorubicin has an integral role but is associated with significant toxicity. The omission of doxorubicin in patients who are frail, have poor baseline cardiac function or who have previously received anthracycline therapy may compromise outcome. However, the recent introduction of rituximab may allow for improved outcomes without the use of doxorubicin. We assessed the efficacy of substituting etoposide for doxorubicin for patients with a contraindication to anthracyclines. Patients and Methods: Treatment guidelines in British Columbia (BC) recommend the substitution of etoposide for doxorubicin in standard dose R-CHOP for patients with DLBCL who have a contraindication to anthracyclines (R-CEOP). Etoposide is administered at a dose of 50 mg/m2 IV on day 1 and 100 mg/m2 PO on days 2 and 3 of each cycle. Patients with limited stage disease receive 3-4 cycles of chemotherapy with or without radiation therapy; patients with advanced stage disease receive 6 cycles of chemotherapy. We performed a retrospective population-based analysis using the BC Cancer Agency Lymphoid Cancer and pharmacy databases and included all patients with newly diagnosed DLBCL who were treated with curative intent with R-CEOP from December 2000 to March 2009. Patients who began treatment with R-CHOP but then switched to R-CEOP (due to intolerance or because a maximum threshold of anthracycline dosing was reached) were also included in the analysis if R-CEOP was administered for more than 50% of cycles delivered. Outcome of this population was compared with a 2:1 control group treated with R-CHOP in the same time period and matched for age, clinical stage and International Prognostic Index (IPI). End points were time to progression (TTP) and overall survival (OS). Results: We identified 81 patients treated with R-CEOP who met the stated inclusion criteria. Clinical characteristics were as follows: median age 73 y (range 34-93), 55 (68%) male, 15 (18%) limited stage and 66 (82%) advanced stage. Adverse prognostic factors according to the IPI were as follows: 85% age > 60 y, 58% stage III/IV, 31% PS > 1, 43% elevated LDH, and 12% > 1 extranodal site. IPI score: 19 (23%) low risk, 33 (41%) low-intermediate, 18 (22%) high-intermediate, and 11 (14%) high risk. Reasons for etoposide substitution were: 71 (88%) cardiac contraindication, 7 (9%) prior exposure to anthracyclines and 3 (4%) other co-morbidities. 72 (89%) patients received rituximab as part of the treatment, 25 (31%) received partial treatment with R-CHOP and then switched to R-CEOP and 56 (69%) received no anthracycline therapy. The control group included 162 randomly chosen patients matched for age, stage and IPI score and treated with R-CHOP. At a median follow-up of 28 months (range 3-86), 33/81 (41%) R-CEOP patients had died (23 with lymphoma, 3 treatment toxicity, 7 unrelated causes). The 5-year TTP was similar for patients treated with R-CEOP compared to patients in the R-CHOP control group, 57% versus 62%, respectively (p=0.21). (Fig. 1) The 5-y OS was lower for patients receiving R-CEOP compared with the R-CHOP control group (49% versus 64%, p=0.02), reflecting the underlying co-morbidities and frailty of this population. Interestingly, the 5-y TTP and 5-y OS rates were similar for patients in the R-CEOP cohort who had received partial treatment with an anthracycline and those who had received no anthracycline treatment (p=0.49 and p=0.77, respectively). Conclusions: A significant proportion of patients with DLBCL who are unable to receive anthracycline-based therapy can be cured with the etoposide-substituted regimen R-CEOP. R-CEOP is well tolerated even by patients with numerous co-morbidities. Moreover, the outcome of these patients does not appear to be significantly different compared to a similar population treated with standard R-CHOP. Disclosures: No relevant conflicts of interest to declare.

scholarly journals FDG-PET Imaging for Hodgkin and Diffuse Large B-Cell Lymphoma—An Updated Overview

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 601 ◽  
Author(s):  
Conrad-Amadeus Voltin ◽  
Jasmin Mettler ◽  
Jirka Grosse ◽  
Markus Dietlein ◽  
Christian Baues ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Imaging Modality ◽  
High Sensitivity ◽  
B Cell Lymphoma ◽  
Response Assessment ◽  
Metabolic Tumor Volume ◽  
Total Lesion Glycolysis ◽  
Positron Emission ◽  
Working Groups ◽  
The Individual

Since the mid-1990s, 18F-fluorodeoxglucose (FDG)-positron emission tomography (PET) in combination with computed tomography has come to play a prominent role in the management of malignant lymphomas. One of the first PET applications in oncology was the detection of lymphoma manifestations at staging, where it has shown high sensitivity. Nowadays, this imaging modality is also used during treatment to evaluate the individual chemosensitivity and adapt further therapy accordingly. If the end-of-treatment PET is negative, irradiation in advanced-stage Hodgkin lymphoma patients can be safely omitted after highly effective chemotherapy. Thus far, lymphoma response assessment has mainly been performed using visual criteria, such as the Deauville five-point scale, which became the international standard in 2014. However, novel measures such as metabolic tumor volume or total lesion glycolysis have recently been recognized by several working groups and may further increase the diagnostic and prognostic value of FDG-PET in the future.

Positron Emission Tomography in Limited-Stage Small-Cell Lung Cancer: A Prospective Study

2004 ◽  
Vol 22 (16) ◽  
pp. 3248-3254 ◽  
Author(s):  
Jeffrey D. Bradley ◽  
Farrokh Dehdashti ◽  
Mark A. Mintun ◽  
Ramaswamy Govindan ◽  
Kim Trinkaus ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Fdg Pet ◽  
Small Cell ◽  
Emission Tomography ◽  
Small Cell Lung ◽  
Limited Stage ◽  
Positron Emission ◽  
Stage Disease ◽  
Extensive Stage ◽  
Conventional Staging

Purpose To determine how often positron emission tomography with [18F]fluoro-2-deoxy-D-glucose (FDG-PET) detects extensive-stage small-cell lung cancer (SCLC) in patients considered to have limited-stage disease based on conventional staging procedures, and to determine the impact of PET on treatment planning for presumed limited-stage SCLC. Patients and Methods We prospectively performed pretreatment FDG-PET on 24 patients determined by conventional staging methods to have limited-stage SCLC (defined as disease that could be encompassed within a reasonable radiotherapy portal, excluding bilateral supraclavicular disease). PET images were evaluated for evidence of extensive-stage disease. Tumor-node-metastasis system staging was also assigned for each patient, with and without PET information. Results FDG-PET demonstrated findings consistent with extensive-stage SCLC in three of 24 patients. FDG-PET correctly upstaged two (8.3%) of 24 patients to extensive-stage disease (95% CI, 1.03% to 27.0%). PET correctly identified tumor in each SCLC mass (primary or nodal) that was suspected on computed tomography (CT) imaging, thus giving a lesion-based sensitivity relative to CT of 100%. PET identified unsuspected regional nodal metastasis in six (25%) of 24 patients, and the radiation therapy plan was significantly altered to include the PET-positive/CT-negative nodes within the high-dose region in each of these patients. Brain PET images in 23 patients disclosed no evidence of brain metastasis. Conclusion FDG-PET has high sensitivity for SCLC and appears to be of value for initial staging and treatment planning of patients with presumed limited-stage disease.

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