恶性淋巴瘤疗效评价标准

Cliccate per modificare il formato del testo del titolo,Cliccate per modificare il formato del testo della struttura,Secondo livello struttura,Terzo livello struttura,Quarto livello struttura,Quinto livello struttura,Sesto livello struttura,Settimo livello struttura,Ottavo livello struttura,Nono livello struttura,*,“REVISED RESPONSE CRITERIA FOR MALIGNANT LYMPHOMA”,J Clin Oncol 25:579-586.2007 by American Society of Clinical Oncology,Cheson et al,J Clin Oncol 17:1244,1999,In 1999,an International Working Group(IWG)of clinicians,radiologists,and pathologists with expertise in the evaluation and management of patients with Lymphoma published guidelines for response assessment and outcomes measurement.,Response Criteria for Lymphoma,Reappearance,New or increased,New or increased,Enlarging liver/spleen;new sites,Relapse/,progression,Irrelevant,50%decrease,50%decrease,Decrease in liver/spleen,Irrelevant,50%decrease,50%decrease,Normal,Positive,Normal,Normal,Normal,PR,Normal or indeterminate,75%decrease,Normal,Normal,Indeterminate,Normal,Normal,Normal,CRu,Normal,Normal,Normal,Normal,CR,Bone Marrow,Lymph Node Masses,Lymph Nodes,Physical Examination,Response Category,Definitions of End Points for Clinical Trials,Death,Death related to NHL,All patients,Cause-specific death,Entry onto trial,Time when new treatment is needed,All patients,Time to next treatment,First documentation of response,Time to relapse or progression,CR,CRu,PR,Response duration,First documentation of response,Time to relapse,CR,CRu,Disease-free survival,Entry onto trial,Disease progression or death from NHL,All patients,Progression-free survival,Entry onto trial,Failure or death from any cause,CR,CRu,PR,Event-free survival,Entry onto trial,Death from any cause,All patients,Overall survival,Point of Measurement,Definition,Response Category,End Point,Standardized response criteria provide uniform end points for clinical trials:,Allowing for comparisons among studies,Facilitating the identification of more,effective therapies,The widely used IWG criteria for response assessment of lymphoma are based predominantly on CT.,It became clear that the International Working Group criteria warranted revision,because of identified limitations and the increased use of:,18F fluorodeoxyglucose-positron emission tomography(PET),immunohistochemistry(IHC),flow cytometry,molecular biology,“REVISED RESPONSE CRITERIA FOR MALIGNANT LYMPHOMA”,J Clin Oncol 25:579-586.2007 by American Society of Clinical Oncology,The Competence Network Malignant Lymphoma convened an,International Harmonization Project,at which 5 subcommittees were formed:,Response Criteria,End Points for Clinical Trials,Imaging,Clinical Features,Pathology/Biology,Use of Positron Emission Tomography for Response Assessment of Lymphoma:Consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma,J Clin Oncol 25:571-578.2007 by American Society of Clinical Oncology,PET-PET/CT,PET using,18,Ffluorodeoxyglucose(FDG,a radioactive derivative of glucose,is an advanced imaging tool,based on the increased glucose consumption of cancer cells),has emerged as a powerful functional imaging tool for staging,restaging,and response assessment of lymphomas.,The advantage of PET over conventional imaging techniques,such as TC or RMN,is its ability to distinguish between viable tumor and necrosis or fibrosis in residual mass(es)often present after treatment.,A recently developed integrated PET/CT system,which combines a PET camera and CT scanner in a single session,has overcome these drawbacks by providing both anatomical and functional imaging at the same position.PET/CT has become the new standard approach to imaging in the diagnosis and management of many cancer patients.,Standardization of PET and CT Imaging Parameters,Patients undergoing PET imaging should receive an FDG dose of 3.5 to 8 MBq/kg of body weight,with a minimum dose of 185 MBq in adults(5 mCi)and 18.5 MBq(0.5 mCi)in children.,Patients should have fasted for at least 4 hours before FDG injection.,Blood glucose level should not exceed 200 mg/dL at the time of FDG injection.If the blood glucose exceeds this level,the FDG-PET study should be rescheduled and an attempt made to control the blood sugar.,Whole-body acquisition using a PET or PET/CT system should encompass at least the region between the base of the skull and themed thigh,and can be acquired in either two-or three-dimensional mode.,Whole-body imaging should begin 50-70 minutes after the administration of FDG.,The reconstructed PET or PET/CT images must be displayed on a computer workstation so that transaxial,sagittal,and coronal images can be viewed simultaneously.,PET,False-positive,:,-Thymic hyperplasia,-Infection,-Inflammation,-Sarcoidosis,-Brown fat,Other causes of false-positive scans should be ruled out.,False-negative,:,-Resolution of the equipment and technique,-Variability of FDG avidity among histologic subtypes,Juweid et al.,evaluated the impact of integrating P