Aplicación clínica de la [18F]FDG PET/TC en el linfoma folicular / Clinical application of [18F]FDG PET/CT in follicular lymphoma

El objetivo de este trabajo fue revisar el papel de la [18F]FDG PET/TC en el linfoma folicular (LF). Tras confirmarse que a pesar de su carácter indolente este tipo de linfoma habitualmente muestra avidez por el radiotrazador, la [18F]FDG PET/TC fue cobrando una importancia progresivamente mayor hasta ser considerada como la técnica de elección para su estadificación, re-estadificación y valoración de respuesta al tratamiento. Múltiples estudios han demostrado el impacto que supone en el manejo de estos pacientes (puede cambiar el estadio de la enfermedad en una proporción significativa de casos y condicionar modificaciones en el tratamiento), su superioridad respecto a la TC (principalmente por la capacidad para distinguir tejido tumoral viable de tejido fibrótico residual) y su valor pronóstico. Esto último se atribuyó inicialmente de forma exclusiva al grado de respuesta metabólica alcanzado tras el tratamiento, que ha probado ser un factor predictivo fuerte e independiente de supervivencia libre de progresión (SLP) y supervivencia global (SG), de modo que una [18F]FDG PET/TC negativa podría considerarse una garantía para los pacientes con LF con elevada carga tumoral. No obstante, la obtención de parámetros metabólicos semicuantitativos como el volumen metabólico tumoral o la glucólisis total de la lesión podría también aportar información a este respecto y ayudarnos potencialmente a identificar a los pacientes de mal pronóstico antes del inicio del tratamiento, de forma que se pueda adecuar el manejo y seguimiento al riesgo del paciente (AU)

The objective of the present paper was to review the clinical application of [18F]FDG PET/CT in follicular lymphoma (FL). Once it was clear that, despite it's characterized as indolent, this type of lymphoma usually shows a high [18F]FDG avidity, PET/CT became more important and it's now considered the standard technique in staging, re-staging and response evaluation. Many studies have shown its impact on the management of patients (as it can change the stage in a significant proportion of cases and lead to treatment modifications), its superiority over CT (mainly because it's able to distinguish fibrosis in residual masses from viable tumor) and its prognostic value. The latter was initially associated only to the degree of metabolic response, which has proved to be a strong and independent predictive factor in terms of disease-free survival (DFS) and overall survival (OS). Thus, a negative PET/CT scan could be considered a guarantee in high-tumor-burden follicular lymphoma patients. However, semiquantitative parameters such as metabolic tumor volume or total lesion glycolysis, may also provide useful information and help us to identify patients with poor prognosis, guiding a risk-adjusted management and follow-up (AU)

Clinical application of [18F]FDG PET/CT in follicular lymphoma.

The objective of the present paper was to review the clinical application of [18F]FDG PET/CT in follicular lymphoma (FL). Once it was clear that, despite it is characterized as indolent, this type of lymphoma usually shows a high [18F]FDG avidity, PET/CT became more important and it's now considered the standard technique in staging, re-staging and response evaluation. Many studies have shown its impact on the management of patients (as it can change the stage in a significant proportion of cases and lead to treatment modifications), its superiority over CT (mainly because it's able to distinguish fibrosis in residual masses from viable tumor) and its prognostic value. The latter was initially associated only to the degree of metabolic response, which has proved to be a strong and independent predictive factor in terms of disease-free survival (DFS) and overall survival (OS). Thus, a negative PET/CT scan could be considered a guarantee in high-tumor-burden follicular lymphoma patients. However, semiquantitative parameters such as metabolic tumor volume or total lesion glycolysis, may also provide useful information and help us to identify patients with poor prognosis, guiding a risk-adjusted management and follow-up.

18F-FDG PET/CT in locally advanced cervical cancer: A review. / PET/TC con 18F-FDG en cáncer de cérvix localmente avanzado.

Cervical cancer is the second most common gynecological cancer worldwide. In locally advanced cervical cancer, 18F-FDG PET/CT has become important in the initial staging, particularly in the detection of nodal and distant metastasis, aspects with treatment implications and prognostic value. The aims of this study were to review the role of 18F-FDG PET/CT in uterine cervical cancer, according to the guidelines of the main scientific institutions (FIGO, NCCN, SEGO, SEOM, ESGO, and ESMO) and its diagnostic accuracy compared to conventional radiological techniques, as well as to review the acquisition protocol and its utility in radiotherapy planning, response assessment and detection of recurrence.

Radium-223 in the treatment of bone metastasis in patients with castration-resistant prostate cancer. Review and procedure. / Radio-223 en el tratamiento de metástasis óseas en pacientes con cáncer de próstata resistente a la castración. Revisión de la literatura y procedimiento.

Bone metastatic disease is the main cause of morbidity / mortality in patients with prostate cancer, presenting frequently as bone pain, pathological fractures or spinal cord compression, which requires early and timely therapy. Although, for the moment, the therapeutic window for its use has not been definitively established, radium-223 (223Ra), an alpha particle emitter, has proved to be an effective therapeutic tool, pre or post-chemotherapy, in patients with castration-resistant prostate cancer with symptomatic bone metastases and absence of visceral metastases, significantly modifying the prognosis of the disease. It is therefore imperative to define the ideal scenarios and the correct protocol for the use of this therapy and thus offer the greatest possible clinical benefit to the patient.

Optimisation of metabolic criteria in the prognostic assessment in patients with lymphoma. A multicentre study. / Optimización de los criterios metabólicos en la valoración pronóstica de los pacientes con linfoma. Estudio multicéntrico.

OBJECTIVE: To compare sensitivity, specificity and predictive value of Deauville score (DS) vs. ΔSUVmax in interim-treatment PET (iPET) and end-treatment PET (ePET), in patients with diffuse large B cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and follicular lymphoma (FL). METHOD: Retrospective longitudinal multicentre study including 138 patients (46 DLBCL, 46 HL, 46 FL), on whom 3 18F-FDG PET/CT were performed: baseline, iPET, and ePET. Visual (DS) and semi-quantitative (ΔSUVmax) parameters were determined for iPET and ePET. Predictive value was determined in relation to disease-free interval. RESULTS: Statistical analysis. iPET for DLBCL, HL, and FL: 1) sensitivity of DS: 76.92/83.33/61.53%; specificity: 78.78/85/81.81%; 2) sensitivity of ΔSUVmax: 53.84/83.33/61.53%; specificity: 87.87/87.50/78.78%. ePET for DLBCL, HL and FL: 1) sensitivity of DS: 61.53/83.33/69.23%; specificity: 90.90/85/87.87%; 2) sensitivity of ΔSUVmax: 69.23/83.33/69.23%; specificity: 90.90/87.50/84.84%. Predictive assessment. iPET study: in DLBCL, DS resulted in 10.3% recurrence of negative iPET, and 17.1% in ΔSUVmax at disease-free interval; in HL, both parameters showed a 2.8% recurrence of negative iPET; in FL, DS resulted in 15.6% recurrence of negative iPET, and 16.1% in ΔSUVmax, with no statistical significance. ePET study: in DLBCL, DS resulted in 14.3% recurrence of negative ePET, and 11.8% in ΔSUVmax at disease-free interval; in HL and FL, both methods showed 2.8 and 12.5% recurrence in negative ePET, respectively. CONCLUSION: DS and ΔSUVmax did not show significant differences in DLBCL, HL and FL. Their predictive value also did not show significant differences in HL and FL. In DLBCL, DS was higher in iPET, and ΔSUVmax in ePET.