FDG-PET Scan Guided Consolidative Radiation Therapy Optimizes Outcome In Patients with Advanced-Stage Diffuse Large B-Cell Lymphoma (DLBCL) with Residual Abnormalities on CT Scan Following R-CHOP
Notice bibliographique
Résumé
Abstract Abstract 854 Background: Residual abnormalities of uncertain significance are frequently seen on post-therapy CT scans in patients (pts) with advanced-stage diffuse large B-cell lymphoma (DLBCL) following treatment with R-CHOP. However, the value of consolidative radiation therapy (XRT) to these sites is unknown. FDG-PET scanning may allow for the discriminate use of XRT to eradicate sites of residual disease. Method: Since 2005, pts with advanced-stage DLBCL in British Columbia (BC) have been treated with a systematic policy recommending a post-chemotherapy PET scan for pts with residual abnormalities ≥2cm on CT scan, followed by XRT to PET-positive sites that are amenable to radiation. Pts with a negative PET scan are observed (regardless of initial or residual bulk), while pts with a PET scan that is widely positive and not suitable for XRT are treated at the discretion of individual physicians. All PET scans are performed in a central location using a combined PET/CT scanner; staging PET scans are not routinely performed. Using the databases of the BC Cancer Agency Centre for Lymphoid Cancer and Department of Functional Imaging, we identified all pts with newly diagnosed advanced-stage DLBCL between January 2005 and June 2009 treated with R-CHOP who underwent a post-treatment PET scan based on this management algorithm. This analysis does not include pts with primary progressive disease; pts with a complete remission on post-treatment CT scan; pts who were HIV positive; or those with transformed lymphoma. Results: 196 pts were identified with the following baseline characteristics: median age 64 y (range 18–89 y); 61% male; 62% stage III/IV; 41% PS>1; 21% >1 extranodal site; 57% elevated LDH; 46% bulky site ≥10cm; 56% IPI 0–2, 44% IPI 3–5. All pts received 3-weekly R-CHOP (6-8 cycles) with curative intent. Median follow-up for living pts is 32 mos (range 5–65 mos). 121/196 (62%) had a negative post-therapy PET (PET-Neg), 66/196 (34%) had a positive PET (PET-Pos), and 9 (4%) were indeterminate. Median SUV of PET-Pos scans was 3.4 (range 1.8–25). None of the PET-Neg pts received XRT. 51/66 (77%) of PET-Pos pts received XRT (3000-4000 cGy) to sites of PET positivity (46 single field, 5 multiple fields), with only 7 relapses to date. 15/66 (23%) PET-Pos pts did not receive XRT due to: multiple sites not amenable to XRT 11; physician choice 3; biopsy negative 1. Only 3/9 pts (33%) with an indeterminate PET received XRT. There was no difference in the 3-y PFS (80% v 75%, p=0.41) and 3-y OS (84% v 77%, p=0.10) between the PET-Neg and PET-Pos pts, respectively. The 3-y PFS was similar for PET-Pos pts who received XRT (84%) and PET-Neg pts (80%) and was superior to PET-Pos pts who did not receive XRT (42%). Pts with an indeterminate scan had a favorable outcome with a 3-y PFS of 89%. Conclusion: Pts with advanced-stage DLBCL who have residual abnormalities on CT scan following R-CHOP and receive consolidative radiation to sites of PET positivity have an outcome similar to pts with a negative post-therapy PET. The favorable outcome observed in the PET-positive cohort treated with XRT is higher than expected from historical reports, suggesting a benefit for the rational use of PET-guided XRT following chemotherapy for DLBCL. Pts who have residual abnormalities on CT scan that are PET-negative should be spared indiscriminate exposure to radiation as the majority have been cured with systemic therapy. Disclosures: No relevant conflicts of interest to declare.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».