年惡性淋巴瘤療效評(píng)價(jià)標(biāo)準(zhǔn)

“REVISEDRESPONSECRITERIAFORMALIGNANTLYMPHOMA”JClinOncol25:579-586.?2007byAmericanSocietyofClinicalOncologyChesonetal,JClinOncol17:1244,1999 In1999,anInternationalWorkingGroup(IWG)ofclinicians,radiologists,andpathologistswithexpertiseintheevaluationandmanagementofpatientswithLymphomapublishedguidelinesforresponseassessmentandoutcomesmeasurement.ResponseCriteriaforLymphomaReappearanceNeworincreasedNeworincreasedEnlargingliver/spleen;newsitesRelapse/progressionIrrelevant

≥50%decrease

≥50%decreaseDecreaseinliver/spleenIrrelevant

≥50%decrease

≥50%decreaseNormalPositiveNormalNormalNormalPRNormalorindeterminate>75%decreaseNormalNormalIndeterminateNormalNormalNormalCRuNormalNormalNormalNormalCRBoneMarrowLymphNodeMassesLymphNodesPhysicalExaminationResponseCategoryDefinitionsofEndPointsforClinicalTrials

DeathDeathrelatedtoNHLAllpatientsCause-specificdeathEntryontotrialTimewhennewtreatmentisneededAllpatientsTimetonexttreatmentFirstdocumentationofresponseTimetorelapseorprogressionCR,CRu,PRResponsedurationFirstdocumentationofresponseTimetorelapseCR,CRuDisease-freesurvivalEntryontotrialDiseaseprogressionordeathfromNHLAllpatientsProgression-freesurvivalEntryontotrialFailureordeathfromanycauseCR,CRu,PREvent-freesurvivalEntryontotrialDeathfromanycauseAllpatientsOverallsurvivalPointofMeasurementDefinitionResponseCategoryEndPointStandardizedresponsecriteriaprovideuniformendpointsforclinicaltrials:AllowingforcomparisonsamongstudiesFacilitatingtheidentificationofmore effectivetherapiesThewidelyusedIWGcriteriaforresponseassessmentoflymphomaarebasedpredominantlyonCT.

ItbecameclearthattheInternationalWorkingGroupcriteriawarrantedrevision,becauseofidentifiedlimitationsandtheincreaseduseof:[18F]fluorodeoxyglucose-positronemissiontomography(PET),

immunohistochemistry(IHC),flowcytometry,molecularbiology“REVISEDRESPONSECRITERIAFORMALIGNANTLYMPHOMA”JClinOncol25:579-586.?2007byAmericanSocietyofClinicalOncologyTheCompetenceNetworkMalignantLymphomaconvenedanInternationalHarmonizationProjectatwhich5subcommitteeswereformed:ResponseCriteriaEndPointsforClinicalTrialsImagingClinicalFeaturesPathology/BiologyUseofPositronEmissionTomographyforResponseAssessmentofLymphoma:ConsensusoftheImagingSubcommitteeofInternationalHarmonizationProjectinLymphoma JClinOncol25:571-578.?2007byAmericanSocietyofClinicalOncologyPET-PET/CTPETusing[18F]fluorodeoxyglucose(FDG,aradioactivederivativeofglucose,isanadvancedimagingtool,basedontheincreasedglucoseconsumptionofcancercells),hasemergedasapowerfulfunctionalimagingtoolforstaging,restaging,andresponseassessmentoflymphomas.TheadvantageofPEToverconventionalimagingtechniques,suchasTCorRMN,isitsabilitytodistinguishbetweenviabletumorandnecrosisorfibrosisinresidualmass(es)oftenpresentaftertreatment.ArecentlydevelopedintegratedPET/CTsystem,whichcombinesaPETcameraandCTscannerinasinglesession,hasovercomethesedrawbacksbyprovidingbothanatomicalandfunctionalimagingatthesameposition.PET/CThasbecomethenewstandardapproachtoimaginginthediagnosisandmanagementofmanycancerpatients.StandardizationofPETandCTImagingParametersPatientsundergoingPETimagingshouldreceiveanFDGdoseof3.5to8MBq/kgofbodyweight,withaminimumdoseof185MBqinadults(5mCi)and18.5MBq(0.5mCi)inchildren.Patientsshouldhavefastedforatleast4hoursbeforeFDGinjection.Bloodglucoselevelshouldnotexceed200mg/dLatthetimeofFDGinjection.Ifthebloodglucoseexceedsthislevel,theFDG-PETstudyshouldberescheduledandanattemptmadetocontrolthebloodsugar.Whole-bodyacquisitionusingaPETorPET/CTsystemshouldencompassatleasttheregionbetweenthebaseoftheskullandthemedthigh,andcanbeacquiredineithertwo-orthree-dimensionalmode.Whole-bodyimagingshouldbegin50-70minutesaftertheadministrationofFDG.ThereconstructedPETorPET/CTimagesmustbedisplayedonacomputerworkstationsothattransaxial,sagittal,andcoronalimagescanbeviewedsimultaneously.PETFalse-positive: -Thymichyperplasia -Infection -Inflammation -Sarcoidosis -Brownfat Othercausesoffalse-positivescansshould beruledout.False-negative: -Resolutionoftheequipmentandtechnique 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