Usefulness of 18F-fluorodeoxyglucose positron emission tomography in follicular lymphoma management

Purpose. - To assess the usefulness of positron emission tomography/computed tomography in staging, prognosis evaluation and restaging of patients with follicular lymphoma. Patients and methods. - a retrospective study was performed on 45 patients with untreated biopsy-proven follicular lymphoma who underwent FDG-PET/CT and CT before and after chemo-immunotherapy induction treatment (rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisone). Results. - PET/CT detected more nodal (+51%) and extranodal (+89%) lesions than CT PET/CT changed Ann Arbor stage in eight patients (18%). Five patients (11%) initially considered with early stage (I/II) were finally managed as advanced stage (III/IV). In this Study, initial PET/CT was significantly more accurate to identify patients with poor prognosis than FLIPI. Poor prognosis was defined as incomplete therapeutic response or early relapse. Accuracy of PET/CT for therapeutic response assessment was significantly higher than that of CT (0.97 vs 0.64), especially because of its ability to identify inactive residual masses. Beside, post-treatment PET/CT was able to predict patients' outcome. The median progression free survival (PFS) was 48 months in the PET/CT negative group as compared to 17.2 months for the group with residual uptake (P < 10(-4)). Conclusion. - FDG-PET/CT is a very useful tool for staging, assessing prognosis and therapeutic response of patients with follicular lymphoma. (C) 2009 Elsevier Masson SAS. All rights reserved.