恶性淋巴瘤疗效评价标准.ppt
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1、“REVISED RESPONSE CRITERIA FOR MALIGNANT LYMPHOMA”J Clin Oncol 25:579-586.2007 by American Society of Clinical OncologyCheson et al,J Clin Oncol 17:1244,1999In 1999,an International Working Group(IWG)of clinicians,radiologists,and pathologists with expertise in the evaluation and management of patie
2、nts with Lymphoma published guidelines for response assessment and outcomes measurement.Response Criteria for LymphomaReappearance New or increased New or increased Enlarging liver/spleen;new sites Relapse/progression Irrelevant 50%decrease 50%decrease Decrease in liver/spleen Irrelevant 50%decrease
3、 50%decrease Normal Positive NormalNormal Normal PRNormal or indeterminate 75%decrease Normal Normal Indeterminate Normal Normal Normal CRuNormal Normal Normal Normal CRBone Marrow Lymph Node Masses Lymph Nodes Physical Examination Response Category Definitions of End Points for Clinical Trials Deat
4、hDeath related to NHLAll patientsCause-specific death Entry onto trialTime when new treatment is neededAll patientsTime to next treatment First documentation of responseTime to relapse or progressionCR,CRu,PRResponse duration First documentation of responseTime to relapseCR,CRuDisease-free survival
5、Entry onto trialDisease progression or death from NHLAll patientsProgression-free survival Entry onto trialFailure or death from any causeCR,CRu,PREvent-free survival Entry onto trialDeath from any causeAll patientsOverall survival Point of Measurement Definition Response Category End Point Standard
6、ized response criteria provide uniform end points for clinical trials:Allowing for comparisons among studiesFacilitating the identification of more effective therapiesThe widely used IWG criteria for response assessment of lymphoma are based predominantly on CT.It became clear that the International
7、 Working Group criteria warranted revision,because of identified limitations and the increased use of:1.18F fluorodeoxyglucose-positron emission tomography(PET),2.immunohistochemistry(IHC),3.flow cytometry,4.molecular biology“REVISED RESPONSE CRITERIA FOR MALIGNANT LYMPHOMA”J Clin Oncol 25:579-586.2
8、007 by American Society of Clinical OncologyThe Competence Network Malignant Lymphoma convened an International Harmonization Project at which 5 subcommittees were formed:Response Criteria End Points for Clinical TrialsImagingClinical FeaturesPathology/BiologyUse of Positron Emission Tomography for
9、Response Assessment of Lymphoma:Consensus of the Imaging Subcommittee of International Harmonization Project in LymphomaJ Clin Oncol 25:571-578.2007 by American Society of Clinical OncologyPET-PET/CTPET using 18Ffluorodeoxyglucose(FDG,a radioactive derivative of glucose,is an advanced imaging tool,b
10、ased on the increased glucose consumption of cancer cells),has emerged as a powerful functional imaging tool for staging,restaging,and response assessment of lymphomas.The advantage of PET over conventional imaging techniques,such as TC or RMN,is its ability to distinguish between viable tumor and n
11、ecrosis or fibrosis in residual mass(es)often present after treatment.A recently developed integrated PET/CT system,which combines a PET camera and CT scanner in a single session,has overcome these drawbacks by providing both anatomical and functional imaging at the same position.PET/CT has become t
12、he new standard approach to imaging in the diagnosis and management of many cancer patients.Standardization of PET and CT Imaging ParametersPatients undergoing PET imaging should receive an FDG dose of 3.5 to 8 MBq/kg of body weight,with a minimum dose of 185 MBq in adults(5 mCi)and 18.5 MBq(0.5 mCi
13、)in children.Patients should have fasted for at least 4 hours before FDG injection.Blood glucose level should not exceed 200 mg/dL at the time of FDG injection.If the blood glucose exceeds this level,the FDG-PET study should be rescheduled and an attempt made to control the blood sugar.Whole-body ac
14、quisition using a PET or PET/CT system should encompass at least the region between the base of the skull and themed thigh,and can be acquired in either two-or three-dimensional mode.Whole-body imaging should begin 50-70 minutes after the administration of FDG.The reconstructed PET or PET/CT images
15、must be displayed on a computer workstation so that transaxial,sagittal,and coronal images can be viewed simultaneously.PETFalse-positive:-Thymic hyperplasia-Infection-Inflammation-Sarcoidosis-Brown fatOther causes of false-positive scans should be ruled out.False-negative:-Resolution of the equipme
16、nt and technique-Variability of FDG avidity among histologic subtypesJuweid et al.evaluated the impact of integrating PET into the IWG criteria in a retrospective study of 54 patients with diffuse large B-cell NHL who had been treated with an anthracycline-based regimen.PET:1.Increased the number of
17、 complete remission(CR)patients,2.Eliminated the CRu category3.Enhanced the ability to discern the difference in progression-free survival(PFS)between patients experiencing CR and PRRecommendations for the use of PET or PET/CT1.PET is strongly recommended before treatment for patients with routinely
18、 FDG-avid,potentially curable lymphomas(eg,diffuse large B-cell lymphoma DLBCL,Hodgkins lymphoma)to better delineate the extent of disease.2.PET is essential for the post-treatment assessment of DLBCL and Hodgkins lymphoma because a complete response is required for a curative outcome.Based on the“m
19、eta-analysis by Zijlstra et al”,pooled sensitivity and specificity of FDG-PET for detection of residual disease after completion of first-line therapy were 84%and 90%,respectively,for HL,and 72%and 100%,respectively,for aggressive NHL.Recommendations for the use of PET or PET/CT3.However,PET is reco
20、mmended in the other,incurable histologies only if they were PET positive before treatment and if response rate is a primary end point of a clinical study.4.Numerous studies have demonstrated that PET performed after 1 to 4 cycles of multiagent chemotherapy predicts therapeutic outcome;however,no cu
21、rrently available data demonstrate improvement in results by altering treatment based on this information.The role of PET for response assessment of aggressive NHL subtypes other than DLBCL and of indolent and mantle-cell lymphomas,is less clear.For these generally incurable NHLs,progression-free or
22、 overall survival is usually the primary end point in clinical trials evaluating their response to treatment.Requirement for Pretherapy PET Scan for Response Assessment of Lymphoma at the Conclusion of Therapynot obligatory for assessment of response after treatment of patients with HL,DLBCL,follicu
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