2019年恶性淋巴瘤疗效评价标准

“REVISEDRESPONSECRITERIAFORMALIGNANTLYMPHOMA”JClinOncol25:579-586.©2019byAmericanSocietyofClinicalOncologyChesonetal,JClinOncol17:1244,2019In2019,anInternationalWorkingGroup(IWG)ofclinicians,radiologists,andpathologistswithexpertiseintheevaluationandmanagementofpatientswithLymphomapublishedguidelinesforresponseassessmentandoutcomesmeasurement.ResponseCriteriaforLymphomaReappearanceNeworincreasedNeworincreasedEnlargingliver/spleen;newsitesRelapse/progressionIrrelevant≥50%decrease≥50%decreaseDecreaseinliver/spleenIrrelevant≥50%decrease≥50%decreaseNormalPositiveNormalNormalNormalPRNormalorindeterminate75%decreaseNormalNormalIndeterminateNormalNormalNormalCRuNormalNormalNormalNormalCRBoneMarrowLymphNodeMassesLymphNodesPhysicalExaminationResponseCategoryDefinitionsofEndPointsforClinicalTrialsDeathDeathrelatedtoNHLAllpatientsCause-specificdeathEntryontotrialTimewhennewtreatmentisneededAllpatientsTimetonexttreatmentFirstdocumentationofresponseTimetorelapseorprogressionCR,CRu,PRResponsedurationFirstdocumentationofresponseTimetorelapseCR,CRuDisease-freesurvivalEntryontotrialDiseaseprogressionordeathfromNHLAllpatientsProgression-freesurvivalEntryontotrialFailureordeathfromanycauseCR,CRu,PREvent-freesurvivalEntryontotrialDeathfromanycauseAllpatientsOverallsurvivalPointofMeasurementDefinitionResponseCategoryEndPointStandardizedresponsecriteriaprovideuniformendpointsforclinicaltrials:•Allowingforcomparisonsamongstudies•FacilitatingtheidentificationofmoreeffectivetherapiesThewidelyusedIWGcriteriaforresponseassessmentoflymphomaarebasedpredominantlyonCT.ItbecameclearthattheInternationalWorkingGroupcriteriawarrantedrevision,becauseofidentifiedlimitationsandtheincreaseduseof:1.[18F]fluorodeoxyglucose-positronemissiontomography(PET),2.immunohistochemistry(IHC),3.flowcytometry,4.molecularbiology“REVISEDRESPONSECRITERIAFORMALIGNANTLYMPHOMA”JClinOncol25:579-586.©2019byAmericanSocietyofClinicalOncologyTheCompetenceNetworkMalignantLymphomaconvenedanInternationalHarmonizationProjectatwhich5subcommitteeswereformed:•ResponseCriteria•EndPointsforClinicalTrials•Imaging•ClinicalFeatures•Pathology/BiologyUseofPositronEmissionTomographyforResponseAssessmentofLymphoma:ConsensusoftheImagingSubcommitteeofInternationalHarmonizationProjectinLymphomaJClinOncol25:571-578.©2019byAmericanSocietyofClinicalOncologyPET-PET/CT•PETusing[18F]fluorodeoxyglucose(FDG,aradioactivederivativeofglucose,isanadvancedimagingtool,basedontheincreasedglucoseconsumptionofcancercells),hasemergedasapowerfulfunctionalimagingtoolforstaging,restaging,andresponseassessmentoflymphomas.•TheadvantageofPEToverconventionalimagingtechniques,suchasTCorRMN,isitsabilitytodistinguishbetweenviabletumorandnecrosisorfibrosisinresidualmass(es)oftenpresentaftertreatment.ArecentlydevelopedintegratedPET/CTsystem,whichcombinesaPETcameraandCTscannerinasinglesession,hasovercomethesedrawbacksbyprovidingbothanatomicalandfunctionalimagingatthesameposition.PET/CThasbecomethenewstandardapproachtoimaginginthediagnosisandmanagementofmanycancerpatients.StandardizationofPETandCTImagingParametersPatientsundergoingPETimagingshouldreceiveanFDGdoseof3.5to8MBq/kgofbodyweight,withaminimumdoseof185MBqinadults(5mCi)and18.5MBq(0.5mCi)inchildren.Patientsshouldhavefastedforatleast4hoursbeforeFDGinjection.Bloodglucoselevelshouldnotexceed200mg/dLatthetimeofFDGinjection.Ifthebloodglucoseexceedsthislevel,theFDG-PETstudyshouldberescheduledandanattemptmadetocontrolthebloodsugar.Whole-bodyacquisitionusingaPETorPET/CTsystemshouldencompassatleasttheregionbetweenthebaseoftheskullandthemedthigh,andcanbeacquiredineithertwo-orthree-dimensionalmode.Whole-bodyimagingshouldbegin50-70minutesaftertheadministrationofFDG.ThereconstructedPETorPET/CTimagesmustbedisplayedonacomputerworkstationsothattransaxial,sagittal,andcoronalimagescanbeviewedsimultaneously.PET•False-positive:-Thymichyperplasia-Infection-Inflammation-Sarcoidosis-BrownfatOthercausesoffalse-positivescansshouldberuledout.•False-negative:-Resolutionoftheequipmentandtechnique-VariabilityofFDGavidityamonghistologicsubtypesJuweidetal.evaluatedtheimpactofintegratingPETintotheIWGcriteriainaretrospectivestudyof54patientswithdiffuselargeB-cellNHLwhohadbeentreatedwithananthracycline-basedregimen.PET:1.Increasedthenumberofcompleteremission(CR)patients,2.EliminatedtheCRucategory3.Enhancedtheabilitytodiscernthedifferenceinprogression-freesurvival(PFS)betweenpatientsexperiencingCRandPRRecommendationsfortheuseofPETorPET/CT1.PETisstronglyrecommendedbeforetreatmentforpatientswithroutinelyFDG-avid,potentiallycurablelymphomas(eg,diffuselargeB-celllymphoma[DLBCL],Hodgkin’slymphoma)tobetterdelineatetheextentofdisease.2.2.PETisessentialforthepost-treatmentassessmentofDLBCLandHodgkin’slymphomabecauseacompleteresponseisrequiredforacurativeoutcome.Basedonthe“meta-analysisbyZijlstraetal”,pooledsensitivityandspecificityofFDG-PETfordetectionofresidualdiseaseaftercompletionoffirst-linetherapywere84%and90%,respectively,forHL,and72%and100%,respectively,foraggressiveNHL.RecommendationsfortheuseofPE