Hodgkin lenfoma izleminde pozitron emisyon tomografisi (pet) kullanımının rolü
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Date
2007-11-22
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Uludağ Üniversitesi
Abstract
Bu çalışmanın amacı Hodgkin Lenfoma (HL) tanısıyla radyoterapi (RT) uygulanan hastalarda Fluorodeoksiglukoz-Pozitron Emisyon Tomografisi’nin (PET) tedavi cevabı ve nüks hastalığı belirlemedeki rolünü saptamaktır. Çalışmaya Nisan 2003-Ağustos 2005 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı’nda HL nedeniyle tedavi edilen ve takiplerinde PET kullanılan 15 hasta dahil edilmiştir. Hastaların ortanca yaşı 26 (10-52) yıldı. Üç hasta kadın, 12 hasta ise erkekti. Bir hasta evre I, 5 hasta evre II, 9 hasta evre III’dü. Beş hastada B semptomları bulunuyordu. Hastalara RT öncesi ortalama 6 (3-6) kür kemoterapi (KT) uygulanmıştı. RT alanları; 11 hastada mantle, 2 hastada mantle+paraaortik, 1 hastada tutulmuş alan, 1 hastada da subtotal nodal ışınlamadır. Ortanca toplam RT dozu 39,6 (30,6-45) Gy’dir. Hastalara RT sonrası ortalama 2. ayda (1-5) PET çekimi yapıldı. Takipte diğer konvansiyonel radyolojik görüntüleme yöntemleri de kullanıldı. Hastaların ortanca takip süresi 36 (21-49) aydır. KT ve RT sonrası iki hastanın PET tetkikinde mediastinal hiperaktivite saptandı. Diğer 13 hastanın konvansiyonel radyolojik görüntülemelerinde rezidü lenf nodu mevcut iken, PET incelemeleri normal sonuçlandı. PET’de mediastinal hiperaktivite saptanan iki hastaya mediastinoskopi ve lenf nodu örneklemesi yapıldı. Bir hastada hastalık yinelemesi, diğer hastada ise ksanto-granülomatöz reaksiyon saptandı. PET’in, HL hastalarında evreleme, tedavi cevabını değerlendirme ve takipte kullanılan değerli bir görüntüleme yöntemi olduğu ve lenf nodu tutulumunun değerlendirilmesinde duyarlılığının ve özgüllüğünün yüksek olduğu sonucuna varıldı.
The aim of this study is To evaluate the role of Positron Emission Tomography (PET) for the detection of treatment response and recurrent disease in patients with Hodgkin lymphoma (HL), who had been treated with radiotherapy (RT). A total of 15 patients with the diagnosis of HL, who had been treated and followed by PET scan in the Radiation Oncology Department of Uludag University between April 2003 and August 2005, were included in the study. The median age was 26 (10-52) years. Three patients were women and 12 patients were male. One patient had stage I disease, 5 patients were stage II disease, 9 patients had stage III disease. Five patients had B symptoms. The patients had undergone a median of 6 (3-6) cycles of chemotherapy (CT) before RT. RT areas were as follows; mantle in 11 patients, mantle+paraaortic in 2 patients, involved field in one patient, and subtotal nodal irradiation in one patient. The median total RT dose was 39,6 (30,6-45) Gy. PET scan was performed on a median 2 months (1-5) after RT. Conventional radiological examinations were also used for follow-up. The median follow-up period of the patients was 36 months (21-49). Mediastinal hyperactivity was found in two patients by PET scan that was performed after the completion of RT and CT. However other 13 patients exhibited residual lymph nodes by conventional radiological examinations, PET scan showed normal findings. Mediastinoscopy and lymph node sampling were carried out in two patients, who showed mediastinal hyperactivity by PET scan. One of these patients had disease recurrence, and the other had xanthogranulomatous reaction only. It is concluded that PET is a valuable scanning method for staging, response evaluation and follow-up of patients with HL. It has high sensitivity and specifity for the evaluation of lymph node involvement.
The aim of this study is To evaluate the role of Positron Emission Tomography (PET) for the detection of treatment response and recurrent disease in patients with Hodgkin lymphoma (HL), who had been treated with radiotherapy (RT). A total of 15 patients with the diagnosis of HL, who had been treated and followed by PET scan in the Radiation Oncology Department of Uludag University between April 2003 and August 2005, were included in the study. The median age was 26 (10-52) years. Three patients were women and 12 patients were male. One patient had stage I disease, 5 patients were stage II disease, 9 patients had stage III disease. Five patients had B symptoms. The patients had undergone a median of 6 (3-6) cycles of chemotherapy (CT) before RT. RT areas were as follows; mantle in 11 patients, mantle+paraaortic in 2 patients, involved field in one patient, and subtotal nodal irradiation in one patient. The median total RT dose was 39,6 (30,6-45) Gy. PET scan was performed on a median 2 months (1-5) after RT. Conventional radiological examinations were also used for follow-up. The median follow-up period of the patients was 36 months (21-49). Mediastinal hyperactivity was found in two patients by PET scan that was performed after the completion of RT and CT. However other 13 patients exhibited residual lymph nodes by conventional radiological examinations, PET scan showed normal findings. Mediastinoscopy and lymph node sampling were carried out in two patients, who showed mediastinal hyperactivity by PET scan. One of these patients had disease recurrence, and the other had xanthogranulomatous reaction only. It is concluded that PET is a valuable scanning method for staging, response evaluation and follow-up of patients with HL. It has high sensitivity and specifity for the evaluation of lymph node involvement.
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Keywords
Hodgkin lenfoma, Radyoterapi, Pozitron emisyon tomografisi, Hodgkin lymphoma, Radiotherapy, Positron emission tomography
Citation
Kurt, M. vd. (2007). "Hodgkin lenfoma izleminde pozitron emisyon tomografisi (pet) kullanımının rolü". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 33(2), 51-54.