2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography in primary extranodal lymphomas: treatment response evaluation and prognosis

BACKGROUND: We evaluated the role of [F-18]FDG PET/CT in tumor response assessment and prognosis of primary extranodal lymphoma (PEL) patients. METHODS: We examined retrospectively, 56 PEL patients: 31 with aggressive diffuse large B cell lymphoma (DLBCL) and 25 with indolent lymphoma (20 mucosa-associated lymphoid tissue lymphoma and five follicular lymphoma). All patients had undergone [F-18]FDG PET/CT at diagnosis (PET-I) and 50 of them also after therapy (PET-II). Moreover, 52 patients were subjected to a mean follow-up period of 76 months. RESULTS: PET-I was positive in 50 (89 parts per thousand) patients (mean SUVmax 10.3 +/- 6.7). In the assessment of tumor response, according to Lugano classification, 45 patients showed complete metabolic response (CMR), four patients had partial metabolic response (PMR) and one had progressive metabolic disease (PMD). Based on 66% Delta SUVmax cut-off, among CMR patients, 41 showed a Delta SUVmax > 66% whereas among non-responders, four patients showed a Delta SUVmax <= 66%. At follow-up, univariate analysis showed that age, performance status, prognostic index, Delta SUVmax and Lugano classification predicted progression-free survival (PFS) (P<0.05), while, performance status, prognostic index, Delta SUV(max )and Lugano classification predicted overall survival (OS) (P<0.05). At multivariate analysis only Lugano classification was retained in the model for prediction of both PFS (P<0.05) and OS (P<0.05). By Kaplan-Meier analysis and log-rank testing both PFS and OS were significantly better in patients in CMR as compared to patients in PMR or PMD according to Lugano classification (P<0.01). CONCLUSIONS: [F-18]FDG PET/CT represents a useful tool in the detection of disease response and in the evaluation of outcome in PEL patients.