Use Of Functional Imaging In Response Assessment In

The use of functional imaging techniques in response assessment in NHL has now been evaluated in several studies. The potential advantage of functional imaging in this context is based on the well-documented limitation of CT-based assessments of response to therapy in NHL. This is because CT is unable to differentiate between viable tumor, fibrosis, or necrosis in a residual mass at the completion of therapy. Initial data from studies in which functional imaging has been used as an adjunct to staging have suggested that this modality may have a higher specificity and sensitivity in patients with aggressive compared with indolent lymphomas. Consequently, most data so far has been collected for patients with aggressive subtypes of NHL, particularly DLBCL. Although gallium scintigraphy has been used previously in this context, most recent data has described the use of FDG-PET. Most studies have investigated the use of this technique separately from conventional imaging techniques such as CT scanning, although some recent studies have assessed the potential addition of FDG-PET to conventional response assessment. In all cases, the studies have determined the predictive value of FDG-PET in terms of subsequent relapse and survival.

Spaepen et al. have reported results for 96 patients with various subtypes of aggressive NHL undergoing PET scans at the completion of various combination chemotherapy regimens.2 Sixty-seven of these patients had negative PET scans at the completion of therapy, of which 80% remained in clinical CR with a median

Table 66.2 Definition of endpoints for clinical trials according to International Workshop
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