Blinded Mid-Treatment FDG-PET in Newly Diagnosed Aggressive Non-Hodgkin Lymphoma (NHL): First Results of a Prospective Multicenter Study.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2400-2400 ◽  
Author(s):  
Bart W. Schot ◽  
Josée Zijlstra ◽  
Otto S. Hoekstra ◽  
Jan Pruim ◽  
Gustaaf W. van Imhoff ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Prospective Trial ◽  
Progression Free Survival ◽  
Early Response ◽  
Diagnostic Methods ◽  
Improve Risk Stratification ◽  
Non Hodgkin Lymphoma ◽  
First Results

Abstract In aggressive B-cell NHL, determination of early response to induction therapy by FDG-PET may improve risk stratification. In a multicenter prospective trial in patients with aggressive NHL (stage II–IV) treated with 2 or 3 weekly (R)CHOP chemotherapy, FDG-PET was performed after the third cycle of chemotherapy. Both clinicians and nuclear medicine physicians were blinded for PET and clinical outcome, respectively. Clinical decisions were based on conventional diagnostic methods (CDM) only. In total 114 patients were included of which 95 were evaluable. 19 patients were excluded because of patient refusal (n=7), early progression (n=7) or logistical reasons (n=5). Median age was 55 yrs (range 20–82), 72% had DLBC-NHL, 76% IPI<3. The majority (85%) of patients completed chemotherapy according to protocol. 14(15%) went off protocol because of less than PR after 3 cycles of (R)CHOP or progression on treatment based on CDM or excess toxicity. CR(u) was reached in 60% of the patients. 34 (36%) patients relapsed and 2 patients died of NHL after a median follow-up of 26 months. PET was scored qualitatively using a Likert scale. PET after 3 courses was negative in 45 patients and positive in 50. 24/50 (48%) PET positive patients progressed or relapsed as compared to 10/45 (22%) PET negative patients. Median progression free survival (PFS) for PET positive versus PET negative patients was 19.8 months versus not yet reached (p=.0087). In a multivariate analysis, IPI and PET were independent predictors for PFS. These results corroborate and extend the evidence that mid-treatment FDG-PET is highly predictive for PFS and may be a useful tool for risk-adapted management of aggressive NHL.

scholarly journals Effectiveness of a serious game addressing guideline adherence: cohort study with 1.5-year follow-up

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tobias Raupach ◽  
Insa de Temple ◽  
Angélina Middeke ◽  
Sven Anders ◽  
Caroline Morton ◽  
...  
Keyword(s):  
Effect Size ◽  
Clinical Decision Making ◽  
Hypertensive Crisis ◽  
Prospective Trial ◽  
Virtual Patient ◽  
Serious Game ◽  
Diagnostic Methods ◽  
Strong Impact ◽  
Training Phase

Abstract Background Patients presenting with acute shortness of breath and chest pain should be managed according to guideline recommendations. Serious games can be used to train clinical reasoning. However, only few studies have used outcomes beyond student satisfaction, and most of the published evidence is based on short-term follow-up. This study investigated the effectiveness of a digital simulation of an emergency ward regarding appropriate clinical decision-making. Methods In this prospective trial that ran from summer 2017 to winter 2018/19 at Göttingen Medical University Centre, a total of 178 students enrolled in either the fourth or the fifth year of undergraduate medical education took six 90-min sessions of playing a serious game (‘training phase’) in which they managed virtual patients presenting with various conditions. Learning outcome was assessed by analysing log-files of in-game activity (including choice of diagnostic methods, differential diagnosis and treatment initiation) with regard to history taking and patient management in three virtual patient cases: Non-ST segment elevation myocardial infarction (NSTEMI), pulmonary embolism (PE) and hypertensive crisis. Fourth-year students were followed up for 1.5 years, and their final performance was compared to the performance of students who had never been exposed to the game but had otherwise taken the same five-year undergraduate course. Results During the training phase, overall performance scores increased from 57.6 ± 1.1% to 65.5 ± 1.2% (p < 0.001; effect size 0.656). Performance remained stable over 1.5 years, and the final assessment revealed a strong impact of ever-exposure to the game on management scores (72.6 ± 1.2% vs. 63.5 ± 2.1%, p < 0.001; effect size 0.811). Pre-exposed students were more than twice as likely to correctly diagnose NSTEMI and PE and showed significantly greater adherence to guideline recommendations (e.g., troponin measurement and D-dimer testing in suspected PE). Conclusions The considerable difference observed between previously exposed and unexposed students suggests a long-term effect of using the game although retention of specific virtual patient cases rather than general principles might partially account for this effect. Thus, the game may foster the implementation of guideline recommendations.

scholarly journals Predictive value of integrated18F-FDG PET/MRI in the early response to nivolumab in patients with previously treated non-small cell lung cancer

2020 ◽  
Vol 8 (1) ◽  
pp. e000349 ◽  
Author(s):  
Yukihiro Umeda ◽  
Miwa Morikawa ◽  
Masaki Anzai ◽  
Shingo Ameshima ◽  
Maiko Kadowaki ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Fdg Pet ◽  
Progression Free Survival ◽  
Early Response ◽  
Small Cell ◽  
Small Cell Lung ◽  
Free Survival ◽  
Previously Treated

BackgroundThe early response to treatment with immune-checkpoint inhibitors is difficult to evaluate. We determined whether changes in integrated [18F]-fluoro-2-deoxy-D-glucose positron emission tomography/MRI (18F-FDG PET/MRI) parameters after the first 2 weeks of antiprogrammed death-1 antibody nivolumab therapy could predict the response of patients with non-small cell lung cancer (NSCLC).MethodsTwenty-five patients with previously treated NSCLC were enrolled prospectively and underwent18F-FDG PET/MRI before and at 2 weeks after nivolumab therapy. Changes in maximal standardized uptake value, total lesion glycolysis (ΔTLG) and apparent diffusion coefficient (ΔADC) between the two scans were calculated and evaluated for their associations with the clinical response to therapy.ResultsThe disease control rate was 64%. Patients with non-progressive disease (non-PD) had significantly decreased TLG, increased ADCmean(ie, negative ΔADCmean) and lower ΔTLG+ΔADCmeanthan patients with PD. Among the parameters tested, receiver operating characteristic curve analysis revealed that a cut-off value of 16.5 for ΔTLG+ΔADCmeanhad the highest accuracy (92%) for distinguishing between patients with non-PD and PD. A ΔTLG+ΔADCmeanvalue <16.5 was significantly associated with longer median progression-free survival (9.0 vs 1.8 months, p<0.00001) and overall survival (23.6 vs 4.7 months, p=0.0001) compared with ΔTLG+ΔADCmeanvalue ≥16.5. A multivariate Cox model revealed that ≥16.5 ΔTLG+ΔADCmeanwas an independent predictor of shorter progression-free survival (HR 37.7) and overall survival (HR 9.29).ConclusionsA combination of ΔTLG and ΔADCmeanmeasured by integrated18F-FDG PET/MRI may have value as a predictor of the response and survival of patients with NSCLC following nivolumab therapy.Trial registration numberUMIN 000020707.

Utility of FDG-PET/CT in Follow-Up of Children Treated for Hodgkin and Non-Hodgkin Lymphoma

2006 ◽  
Vol 28 (5) ◽  
pp. 300-306 ◽  
Author(s):  
Melissa M. Rhodes ◽  
Dominique Delbeke ◽  
James A. Whitlock ◽  
William Martin ◽  
John F. Kuttesch ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Fdg Pet ◽  
Non Hodgkin Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct

scholarly journals Brain and whole-body FDG-PET in diagnosis, treatment monitoring and long-term follow-up of primary CNS lymphoma

2013 ◽  
Vol 47 (2) ◽  
pp. 103-110 ◽  
Author(s):  
Sofiane Maza ◽  
Ralph Buchert ◽  
Winfried Brenner ◽  
Dieter Ludwig Munz ◽  
Eckhard Thiel ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Brain Mri ◽  
Prospective Trial ◽  
Primary Cns Lymphoma ◽  
Treatment Monitoring ◽  
Whole Body ◽  
Fdg Uptake ◽  
Long Term Follow Up

Background. Positron emission tomography (PET) with F-18-labeled fluorodeoxyglucose (FDG) provides remarkable accuracy in detection, treatment monitoring and follow-up of systemic malignant lymphoma. Its value in the management of patients with primary central nervous system lymphoma (PCNSL) is less clear. Patients and methods. In a prospective trial, 42 FDG-PET examinations were performed in ten immunocompetent patients with newly diagnosed or recurrent PCNSL before and repeatedly during and after the treatment. Brain and whole body FDG-PET were compared to brain MRI and extra-cerebral CT, respectively. Results. Before the treatment, 6 of 10 patients had congruent findings on FDG-PET and MRI of the brain. Three patients had lesions on brain MRI, not detected by FDG-PET. One patient had additional FDG-PET positive lesions inconspicuous in MRI. The follow-up suggested FDG-PET to be false positive in these lesions. After the treatment, brain PET was in agreement with MRI in 6 of 8 patients. In the remaining 2 patients there were persistent lesions in brain MRI whereas FDG-uptake was reduced to normal values. In the long-term follow-up of 5 patients (63-169 weeks), 3 patients retained normal in both PET and MRI. In 2 patients a new focal pathologic FDG-uptake was detected 69 and 52 weeks after the end of the treatment. In one of these patients, recurrence was confirmed by MRI not until 9 weeks after PET. Conclusions. Brain FDG-PET may contribute valuable information for the management of PCNSL, particularly in the assessment of the treatment response. Integration of FDG-PET into prospective interventional trials is warranted to investigate prognostic and therapeutic implications.

FDG-PET in the Serial Assessment of Patients with Lymphoma in Complete Remission.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 216-216 ◽  
Author(s):  
Pier Luigi Zinzani ◽  
Vittorio Stefoni ◽  
Valentina Ambrosini ◽  
Enrico Derenzini ◽  
Gerardo Musuraca ◽  
...  
Keyword(s):  
Complete Remission ◽  
Fdg Pet ◽  
False Negative ◽  
Great Majority ◽  
True Negative ◽  
Non Hodgkin Lymphoma ◽  
Pet Scans ◽  
Negative Scan

Abstract FDG-PET role in the assessment of lymphoma patients is well established but only few papers evaluated the usefulness of FDG-PET during follow up. Aim: to prospectively investigate the value of serial FDG-PET scans in the follow up of lymphoma patients in complete remission. All lymphoma patients who achieved a complete remission were prospectively enrolled in the study and scheduled for serial FDG-PET scans at 6, 12, 18 and 24 months; further scans were then carried out on annual basis (overall 421 pts, 160 pts with Hodgkin’s Disease (HD) and 261 pts with non-Hodgkin Lymphoma (NHL) were studied). All patients had a final assessment using other imaging procedures and/or biopsy and/or clinical evolution. FDG-PET findings were reported as positive, indeterminate or negative for relapse; after comparison with all available data, PET results were categorized as true positive (TP), true negative (TN), false positive (FP), indeterminate turned out to be relapse (I+) and indeterminate turned out to be complete remission (I-). Results: PET documented relapse in 42 cases at 6 mo (14 HD (8.8%) and 28 NHL (10.7%); in 31 cases at 12 mo (14 HD (9.5%) and 17 NHL (7.3%); in 27 cases at 18 mo (6 HD (4.5%) and 21 NHL (3.2%); in 9 cases at 24 mo (3 HD (2.4%) and 6 NHL (3.2%); and in 5 cases at &gt; 36 mo (2 HD (2.8%) and 3 NHL (6.5%). Out of 125 scans reported as positive for relapse, 109 turned out to be TP (PPV of 87%); no false negative scan was recorded, and in the great majority of cases PET detected the presence of relapse before clinical evidence. Our results confirm that FDG-PET is a valid tool for lymphoma patients follow-up. The higher incidence of relapse occurred in both HD and NHL quite early after complete remission (at 6 and 12 months for HD and at 6, 12 and 18 months for NHD), thus confirming the usefulness of performing FDG-PET scans at these times in order to identify recurrence. The role of serial PET at later times (after 18 months for HD and 24 months for NHL) was found less relevant.

Effect of an individualized dose/schedule strategy for sunitinib in metastatic renal cell cancer (mRCC) on progression-free survival (PFS): Correlation with dynamic microbubble ultrasound (DCE-US) data.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 356-356 ◽  
Author(s):  
G. A. Bjarnason ◽  
B. Khalil ◽  
R. Williams ◽  
J. M. Hudson ◽  
B. Lloyd ◽  
...  
Keyword(s):  
Clear Cell ◽  
Cell Cancer ◽  
Prospective Trial ◽  
Area Under The Curve ◽  
Progression Free Survival ◽  
Dose Schedule ◽  
Pharmacokinetic Data ◽  
Free Survival ◽  
D 43

356 Background: Sunitinib area under the curve (AUC) correlates with response and PFS (Houk et al). Current recommendations for dose modification do not take this into account. Methods: A single center retrospective review identified mRCC patients (pts) where individualized (individ) sunitinib dose/schedule modifications (DSM) were used to maximize dose and minimize time off therapy (Rx). Pts were started on 50 mg 28 days (d) on/14 d off. DSM were done to keep toxicity (fatigue, skin, GI) at ≤ grade-2. DSM-1 was 50 mg 14 d/7 d with individ increases in d on Rx based on toxicity. DSM-2 was 50 mg 7 d/7 d with individ increases in d on Rx. DSM-3 was 37.5 mg continuously with individ 7 d breaks. DSM-4 was 25 mg continuously with individ 7 d breaks. Results: In 171 pts; median age was 60y; 20% good, 60% intermediate, 20% poor prognosis by Heng criteria; 80% had nephrectomy; 79% clear cell histology; 60% were previously untreated. At a median follow-up of 10.7 months (mo), overall median PFS was 7.9 mo. Of 39 pts still on therapy, 37 were on a DSM Rx. Pts were allocated to three groups based on the dose/schedule used for the longest time. The PFS/response% (PR+SD) for each group was 4.4 mo/65.6% (standard 50 mg 28 d/14 d; 43 pts), 8.0 mo/78.2% (DSM-1/DSM-2; 69 pts) and 10.4 mo/81.3% (DSM-3/DSM-4; 59 pts) with improved PFS (p=0.001) in both DSM groups vs. the standard schedule but no difference in response. 30 pts were studied by DCE-US at baseline, and after 7 d and 14 d on Rx or after 14 d and 28 d on Rx. In responding pts, tumor blood volume decreased at d 7 and again at d 14 vs. baseline but was stable or increased at d 28 vs. d 14. A rebound was seen after 14 d off Rx. Conclusions: Based on the U.S. data, previous pharmacokinetic data (steady state at 10-14 d) and this clinical data, starting pts on 50 mg 14 d/7 d followed by individ DSM may be safe and active. This DSM strategy, was associated with a favorable toxicity profile, apparent improvement in PFS and a good PR+SD rate in a group of unselected mRCC pts, warranting confirmation in a prospective trial. Pts that tolerate 50 mg 28 d/14 d with minimum toxicity may need dose escalation and/or less time off therapy to optimize PFS. [Table: see text]

Proton radiotherapy for rhabomyosarcoma: Preliminary results from a multicenter prospective study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9585-9585
Author(s):  
Torunn I. Yock ◽  
Jackie Szymonifka ◽  
Alison M. Friedmann ◽  
Anita Mahajan ◽  
Beow Yong Yeap ◽  
...  
Keyword(s):  
Late Effects ◽  
Prospective Trial ◽  
Progression Free Survival ◽  
Stage I ◽  
Entire Group ◽  
Early Results ◽  
Group I ◽  
Oral Pain ◽  
Grade 3

9585 Background: Pediatric rhabdomyosarcoma (RMS) is commonly cured with chemotherapy and radiation. However, late effects of radiotherapy (RT) can be disabling. Proton RT irradiates less normal tissue, which should result in fewer late side effects of treatment. The purpose of this study was to describe the disease control and side effect profile of proton RT in RMS patients (pts). Methods: Eligible pts included those with localized disease and metastatic embryonal RMS if age 2-10. All pts were treated with VAC (vincristine, actinomycin, cyclophosphamide) based chemotherapy and proton RT, median dose 50.4 Gy (36-50.4 GyRBE). Concurrent enrollment in COG protocols was allowed. All pathology/imaging was reviewed at the treating institution. Results: 47 pts with RMS were prospectively enrolled from January 2005 to June 2011 and evaluable for analysis. Median age was 3.1 yrs, (range 0.6-15.6 years; M/F ratio 23:24). There were 1, 7, 37, and 2 Group I, II, III and IV and 14, 12, 19 and 2, Stage I-IV pts respectively, and 33 with embryonal 14 with alveolar/other. Most common sites included PM (48.9%), orbital (23.4%) bladder/prostate (6.4%), H&N non-PM (6.4%), extremities (4.3%), trunk/abdomen 2.1%), perineal/anal region (2.1%) and other (6.4%). Median follow-up is 15.2 months. One/two-year overall survival (OS) and progression-free survival (PFS) for the entire group is 94/81% (OS) and 79/73% (PFS). 2-year OS for stage I,II/III,IV pts is 91/66% (OS, p=0.114) and two-year PFS for these pts is 86/57%, respectively, (p=0.083. 16 (34%) had grade 3/4 acute toxicities attributable to the radiation during treatment, the most common of which was mucositis/oral pain (12.8%), anorexia (4.3%), and erythema (4.3%). Among the 24 pts analyzable for late toxicities with at least 2 yrs of follow up, there were no grade 3 or 4 late toxicities attributable to radiation. Conclusions: Early results of this prospective trial demonstrate comparable disease outcomes and thus far limited late effects in a young pediatric RMS population. However, additional follow up is needed to determine if protons truly reduce rates and severity of late effects compared with photon cohorts published in the literature.

Comparison of PSA, FDG-PET, and Prostate Cancer Working Group 2 (PCWG2) criteria to interpret apparent progression on first post-treatment bone scan.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 20-20
Author(s):  
Karen A. Autio ◽  
Josef J. Fox ◽  
Eric Conrad Haupt ◽  
Heiko Schöder ◽  
Howard I. Scher ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Fdg Pet ◽  
Bone Scan ◽  
Bone Lesion ◽  
Early Response ◽  
Post Treatment ◽  
Phase Iii ◽  
Flare Response ◽  
Group 2

20 Background: The risk of prematurely discontinuing effective therapy in patients with metastatic castrate resistant prostate cancer (mCRPC) because of apparent initial progression on bone scan has repercussions for drug development and clinical practice. We evaluated three methods to distinguish disease progression (POD) from non-progressive bone disease or flare response. Methods: The dataset was comprised of men with mCRPC enrolled in contemporary clinical trials using AR-directed or targeted therapy. To be included, a worsened bone scan (increased size, intensity, or number of lesions) at the time of initial follow-up at 8-12 wks (FU1), a concurrently performed FDG-PET and PSA, and a second follow-up bone scan (FU2) > 6 wks after FU1 were required. Pts were evaluated by three methods: 1) PSA-guided approach: POD was defined as a PSA increase >25% from baseline at FU1; for non-progressors, a special category was created for flare response defined as a PSA decline >50% and a FU2 bone scan documenting stability/improvement; 2) FDG-PET approach: POD was defined as a new bone lesion or increase in SUV >10% at FU1; 3) Bone scan only approach: POD was defined by PCWG2 requiring 2 new bone scan lesions at FU1 and 2 additional lesions at FU2. Results: 66 pts registered to trials conducted between 2007-2011 were examined; 38/66 (57.6%) pts had a worsened bone scan at FU1, 23 of whom had a FU2 bone scan and were considered evaluable for this analysis. Conclusions: Over half of mCRPC pts have a worsening bone scan during the first three months of therapy. PCWG2 controls for flare without use of PSA, confirms radiographic POD, and maintains pts on study longer than use of early post-treatment PSA changes. FDG-PET at first assessment appears to identify an identical percentage of progressors as PCWG2 did at the second assessment. PCWG2 is undergoing prospective validation in phase III trials; the use of FDG PET as an early response biomarker is currently under investigation. [Table: see text]

scholarly journals Phase III Randomized Intergroup Trial of CHOP Plus Rituximab Compared With CHOP Chemotherapy Plus 131Iodine-Tositumomab for Previously Untreated Follicular Non-Hodgkin Lymphoma: SWOG S0016

2013 ◽  
Vol 31 (3) ◽  
pp. 314-320 ◽  
Author(s):  
Oliver W. Press ◽  
Joseph M. Unger ◽  
Lisa M. Rimsza ◽  
Jonathan W. Friedberg ◽  
Michael LeBlanc ◽  
...  
Keyword(s):  
Progression Free Survival ◽  
Phase Iii ◽  
Advanced Stage ◽  
Chop Chemotherapy ◽  
Non Hodgkin Lymphoma ◽  
Potential Benefits ◽  
Group B ◽  
Follicular Lymphomas ◽  
Leukemia Group

Purpose Advanced follicular lymphomas (FL) are considered incurable with conventional chemotherapy and there is no consensus on the best treatment approach. Southwest Oncology Group (SWOG) and Cancer and Leukemia Group B compared the safety and efficacy of two immunochemotherapy regimens for FL in a phase III randomized intergroup protocol (SWOG S0016) that enrolled 554 patients with previously untreated, advanced-stage FL between March 1, 2001, and September 15, 2008. Patients and Methods Patients were eligible for the study if they had advanced-stage (bulky stage II, III, or IV) evaluable FL of any grade (1, 2, or 3) and had not received previous therapy. In one arm of the study, patients received six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy at 3-week intervals with six doses of rituximab (CHOP-R). In another arm of the study, patients received six cycles of CHOP followed by consolidation with tositumomab/iodine I-131 tositumomab radioimmunotherapy (RIT). Results After a median follow-up period of 4.9 years, the 2-year estimate of progression-free survival (PFS) was 76% on the CHOP-R arm and 80% on the CHOP-RIT arm (P = .11). The 2-year estimate of overall survival (OS) was 97% on the CHOP-R arm and 93% on the CHOP-RIT arm (P = .08). Conclusion There was no evidence of a significant improvement in PFS comparing CHOP-RIT with CHOP-R. However, PFS and OS were outstanding on both arms of the study. Future studies are needed to determine the potential benefits of combining CHOP-R induction chemotherapy with RIT consolidation and/or extended rituximab maintenance therapy.

scholarly journals Early response with dasatinib or imatinib in chronic myeloid leukemia: 3-year follow-up from a randomized phase 3 trial (DASISION)

Blood ◽  
2014 ◽  
Vol 123 (4) ◽  
pp. 494-500 ◽  
Author(s):  
Elias Jabbour ◽  
Hagop M. Kantarjian ◽  
Giuseppe Saglio ◽  
Juan Luis Steegmann ◽  
Neil P. Shah ◽  
...  
Keyword(s):  
Overall Survival ◽  
Myeloid Leukemia ◽  
Progression Free Survival ◽  
Early Response ◽  
First Line ◽  
Phase 3 ◽  
Free Survival ◽  
Key Points ◽  
Treatment Naïve

Key Points In a 3-year follow-up of the DASatinib versus Imatinib Study In treatment-Naive CML patients trial, first-line dasatinib resulted in faster and deeper responses compared with imatinib. Deeper responses at 3, 6, and 12 months were associated with better 3-year progression-free survival and overall survival.

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