Impact of PET on the Radiation Treatment of Hodgkins Lymphoma

Annibale      Versari; Cinzia      Iotti; Francesco      Merli

Abstract

Hodgkins lymphoma (HL) is a lymphoproliferative malignancy that frequently affects young people. Because patients with HL are often cured, this neoplasm serves as a clinical laboratory for investigating the late effects of cancer therapy. The “hot” issues today are, in advanced stages, how to identify the best strategy to reduce the rate of resistant diseases and, in the early stages, how to minimize late toxicity due to both chemotherapy and radiotherapy (RT). Literature data revealed that PET as a very promising tool in the management of HL. The main applications of FDG-PET in HL are in staging, therapy monitoring, response assessing and follow-up. Recent data show that early PET seems to play a role in predicting the treatment outcome. In RT FDG-PET improves the accuracy in the disease localization and staging with changes in radiation treatment planning in one third of patients with early-stage HL. It also reduces the subjectivity in lymphoma RT field determination, one of the major causes of uncertainty in radiation treatments. The impact of FDGPET will be greater as more conformal RT is planned. In conclusion, the highly curable early stage Hodgkin lymphomas require careful evaluation and balance of the available treatments, in order to achieve a really individualized solution, reducing radiation doses and/or fields dimension and using new advanced techniques.

Keywords: FDG-PET, hodgkin's lymphoma, radiation therapy, IMRT

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