[18F-FDG positron emission tomography in the diagnosis and staging of marginal zone non-Hodgkin lymphomas].

OBJECTIVE: To investigate the diagnostic value of 18F-FDG positron emission tomography (PET) in the diagnosis and staging of marginal zone non-Hodgkin lymphomas (NHLs). MATERIAL AND METHODS: Twenty-four patients with new-onset NHLs were examined. Extranodal MALT lymphoma, splenic marginal zone lymphoma (MZL), and nodal MZL lymphoma were diagnosed in 18, 3, and 3 patients, respectively. 18F-FDG PET was carried out by the standard protocol via whole-body examination, by estimating the standardized tracer uptake value (SUV(max)) in the abnormal foci. RESULTS: Most (83.3%) of the examinees were found to have abnormal tracer hyperfixation foci. The mean SUV(max) was 5.05 ± 0.9. There was no correlation between SUV(max) in the tumor foci and their metabolic sizes (r = 0.1; p = 0.7). No significant differences between the mean SUV(max) were found in patients with different histological types of MZL (p > 0.05). Disease staging by PET and other diagnostic methods yielded contradictory results in three patients. The final analysis suggested that the stage had been correctly determined in all the 3 patients from PET findings. CONCLUSION: The results of 18F-FDG PET suggest that it is of high iagnostic value in imag-ng marginal zone NHLs. The major advantage of PET is that it can accu-ately stage the disease, which can provide a ra-ionale for optimal treat-ent policy.

[Prognostic value of 18F-FDG positron emission tomography in the early evaluation of the efficiency of treatment in patients with non-Hodgkin lymphomas].

OBJECTIVE: To define the role of 18F-FDG positron emission tomography (PET) performed after 2-3 chemotherapy cycles in the prediction of disease prognosis and to identify a group of patients requiring more intensive treatment. MATERIAL AND METHODS: Seventy-one patients with non-Hodgkin lymphoma of different histological types were examined. PET was carried out at different stages of diagnosis and primary treatment in the patients. RESULTS: The examinations made after 2-3 polychemotherapy (PCT) cycles indicated that 36 (50.7%) patients continued to have signs of metabolic activity of lymphoproliferative disease (a PET-positive group) and 35 (49.3%) patients were found to have no abnormal tracer accumulation foci (a PET-negative group). Twenty-nine (82.9%) patients from the PET-negative group continued to remain in complete remission throughout the follow-up (the median follow-up was 405 days). At late stages, 6 (17.1%) patients were identified to have abnormal tracer hyperfixation foci that were indicative of disease recurrence. Only 8 patients from the PET-positive group were observed to show a complete metabolic response to treatment at the end of first-line PCT. The metabolic activity of the disease was maintained in the remaining patients. The results of PET conducted at the late stages of the follow-up indicated that metabolically active tumor foci continued to be visualized in 20 (55.6%) patients and further treatment resulted in complete remission in 16 (44.4%) patients. CONCLUSION: PET findings could predict the further course of the disease and differentiate more intensive treatment-requiring patients at the early stages of chemotherapy.

[Current technologies in radiotherapy for non-Hodgkin lymphomas].

The clinical observations of 207 patients with non-Hodgkin's lymphomas, treated with radiotherapy and chemoradiotherapy at our institution in 1999-2012 years, were presented. 136 patients had the extranodal lymphomas, 40 patients had plasma cell tumors and 31 patients had follicular lymphoma. Complete regression of the lesions was observed in all 24 patients with a local lesion of the skin, an objective response of a variable degree was received in all 27 patients with generalized disease within skin. The radiation therapy of the stomach and perigastric lymph nodes led to complete remission in 100% cases. Conformal radiotherapy with 3D-planning in patients with a primary lesion of the orbit avoided irradiation of the intact eye. The 3 Gy fractionation mode was more effective in the treatment of myeloma and solitary plasmacytoma of bone, whereas the standard fractionation mode was more effective in patients with extraosseous plasmacytoma. Radiation therapy of follicular lymphoma has showed consistent results, which demonstrated by 100% of 5-year tumor-specific survival in the whole group, 100% disease-free survival in patients with stage II, the lack of recurrence in the irradiation fields.

[Attitude to the illness of patients with malignant lymphomas on various stages of disease].

In 138 patients with malignant lymphomas on different stages of the disease there were considered attitude to the illness and treatment, which included relation to the diagnosis, the subjective perception of the disease and attitude to treatment. Using a technique of studying psychological attitude to the disease there were studied details of personal response to the disease. Along with the general trends in relation to the disease, specific to cancer patients of different tumor sites, there have been identified particular features related to attitude of malignant lymphoma patients: a long period of denial of a malignant nature of the disease and their greatest psychological trauma during relapse. The necessity of professional psychological support was showed.

[Experience of local radiation therapy and total irradiation of the skin by electron beam in patients with primary B and T-cell lymphomas of the skin].

The problem of the treatment of primary malignant lymphomas of the skin is now becoming increasingly important due to the increase of cases among people of working age and disability of these patients. In most cases lymphomas of the skin have a T-cell origin, the most common of skin lymphoma is mycosis fungoides. It is poorly studied the role of electronic radiation therapy in local and systemic skin lymphomas as well as methodological questions of its application, so research in this field is actual. Therefore the aim of the study is improving of the efficiency of therapy in patients affected by non-Hodgkin's lymphoma with skin lesions by the use of local radiation therapy and total skin irradiation by electron beam.

[Combined therapy and radiotherapy in stage-II Hodgkin disease].

The aim of the study was to raise efficacy of combined treatment of stage II Hodgkin's disease by optimization of fractionation and volume of irradiation. It included 179 patients with involvement of supradiaphragmatic lymph nodes treated in 1986-2006. It was found that multi-fractionation was followed by lower frequency of relapse as compared with standard regimens as well as rates of early ones. The most efficient dosage was 30-36 Gy as far as frequency, term of relapse occurrence and recurrence-free survival were concerned.

[Role of modified radiotherapy in the combined treatment of orbital non-Hodgkin lymphoma].

The study included 36 patents (primary tumor--27, recurrent orbital lymphoma--9) with diagnosed non-Hodgkin's orbital or conjuctival lymphoma treated at the Center's Clinic (1999-2007). All patients received an average multifractionated dose of 34.5 Gy from the S1-75-5 linear electron accelerators (Philips) generating 6 MeV of braking radiation. Also, the Elekta Precise with a multi-lobe collimator (6 and 18 MeV of braking and 4-20 MeV of electron radiation) was used. Relevant radiotherapy was given to 3 patients while conventional one--to the rest of the group: CHOP chemoradiotherapy--24, R-CHOP--3. Complete local response was reported in all patients (100%). Early-onset radiation-related complications presented mainly as conjunctivitis (22). Late-onset ones were cataract and dry eye (5) (13.9%).

[Role of 18F-FDG PET in tumor grading and evaluating effectiveness of therapy in malignant lymphomas].

The report compares the results of (multi-layer spiral computed tomography) (MSCT), 67 Ga citrate lymph scintigraphy and 18FDG PET in patients with Hodgkin's disease. The predictive significance of the latter method exceeded that of MSCT and ultrasound in diagnosing lymph node neoplasia below the diaphragm. As far as peripheral and mediastinal lymph nodes are concerned, the MSCT efficiency of the three procedures was comparable. Advantage was offered by PET in early evaluation of therapeutic effectiveness. Moreover, its practical significance for assessing tumor sensitivity to therapy as well as differentiation between viable tumor tissue and fibrosis was demonstrated.

[20-year experience with modified dose fractionation of radiotherapy in primary Hodgkin's disease].

Significantly lower frequency of relapse, incidence of pulmonitis and pericarditis, leukopenia and thrombocytopenia stage IV and longer recurrence-free survival were reported after acceleration of multifractionation of STD of 1.35Gy was used for treatment of patients with primary Hodgkin's disease, as compared with standard fractionation. When STD was reduced to 1.2Gy (modified multifractionation), subtotal exposure of lymph nodes was followed by a significant drop in frequency and severity of leukopenia and thrombocytopenia stage III-IV. The latter complications, rates decreased further, with perspective response to therapy, as irradiation was limited to that of areas exposed during modified multifractionation.

[Clinical experience in using 18F-FDG PET in the staging and restaging of malignant lymphomas].

The present study was undertaken to determine the diagnostic accuracy of positron emission tomography (PET) in the staging and restaging of malignant lymphomas. For determination of the extent of a neoplastic process, complex radiation examination was conducted in 67 patients with malignant lymphomas. In 12 (17.9%) cases, the stage of the disease was changed, as evidenced by PET. There is evidence that the technique is of high diagnostic accuracy in detecting malignancies of l ymph nodes, skeletal system, and parenchymatous organs in lymphoproliferative diseases.