Page 240 - 18F-FDG PET as biomarker in aggressive lymphoma; technical and clinical validation

Chapter 9
relatively large number of discrepancies between reviewers. In these tissues, the local background of [18F]FDG could vary over time due to intercurrent inflammation, healing of pathologic fractures or recent administration of granulocyte colony- stimulating factor. Adjustment for these factors is not mentioned in the current Lugano classification guidelines.
Chapter 5 describes a pilot study that was performed on optimization strategies for a fast and reliable assessment of metabolic tumor volume (MTV) using twelve baseline [18F]FDG PET scans [13]. An automated preselection strategy with a SUV of 4 or higher and a minimum volume of 3ml resulted in an improved interobserver reliability and ease of use compared to individual lesion selection.
Based on the 2 chapters in this part we concluded that a central review is an important prerequisite for use of visual interim [18F]FDG PET criteria in future trials and for potential use in clinical practice dual reads are recommended.Training of nuclear medicine physicians should pay extra attention to the extranodal site evaluation, because these tend to have a relatively large number of discrepancies. Based on these observations, we organized several hands-on workshops on the use of the Lugano classification guidelines for radiologists, hematologists and nuclear medicine physicians in the Netherlands.
For the baseline evaluation of MTV there is still no consensus on the evaluation method that should be used.The pilot study is a first step towards a more automated MTV evaluation strategy.
Part III Clinical validation of PET in lymphoma
Chapter 6a details the interim [18F]FDG PET results in the randomized clinical trial HOVON-84 in 513 newly diagnosed DLBCL patients. Chapter 6b describes the results of the original HOVON-84 trial aim of the randomization between standard R-CHOP14 and R-CHOP14 with rituximab intensification in the first 4 cycles. The complete remission rate, failure-free survival, progression-free and overall survival were not improved by the rituximab intensification strategy [14]. The HOVON-84 paper was added as part b of this chapter, because the complete metabolic response was determined by central review of the [18F]FDG PET scans
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