DOI: 10.1007/s00259-018-4112-2Pages: 80-86

Outcome of patients with early-stage follicular lymphoma staged with 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) and treated with radiotherapy alone

1. Peter MacCallum Cancer Centre, Department of Radiation Oncology

2. MD Anderson Cancer Center, Department of Radiation Oncology

3. Olivia Newton John Cancer Centre/ Austin Health, Department of Radiation Oncology

4. the University of Melbourne, The Sir Peter MacCallum Department of Oncology

5. Peter MacCallum Cancer Centre, Centre for Biostatistics and Clinical Trials

6. University of Melbourne, Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital

7. Peter MacCallum Cancer Centre, Centre for Molecular Imaging

Correspondence to:
Rodney J. Hicks
Tel: (+61) 3-8559 6620
Email: rod.hicks@petermac.org

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Abstract

Purpose/objective(s)

To evaluate the impact of positron emission tomography (PET) staging on overall survival (OS) and progression-free survival (PFS) in patients with early-stage (stages I and II) follicular lymphoma (ESFL) treated with radiation therapy alone.

Materials/methods

Eighty-five patients with ESFL treated with curative-intent radiation therapy (RT) between December 2000 and May 2011 were identified. Of those, 13 who had no PET staging and 25 who received additional systemic therapy were excluded from the analysis. Thus, we analyzed 47 patients with PET-staged ESFL treated with definitive radiation therapy alone (dose > 23Gy). Tumour features, pre-treatment computed tomography (CT) and PET stage, dose fractionation, and radiation therapy field extent were recorded. The Kaplan–Meier method was used to estimate the OS and PFS. Patterns of failure were assessed as cumulative incidences assuming competing risks.

Results

Median age was 57 years (range 24–83); 43% were females. Most were PET stage 1 (76.6%). Median maximum nodal diameter was 3 cm. Median pre-treatment lactate dehydrogenase (LDH) was 327.5 (range 123–607, upper normal limit = 220). Twenty-six patients (55.3%) had infra-diaphragmatic disease. All received 30–36Gy in 15–24 fractions, with 59.6% treated with involved-field radiation therapy (IFRT) techniques. There was no significant difference in PFS between CT stage I and stage II (HR 1.30 95% CI [0.25–6.72], p = 0.75) with a 5-year PFS of 77% and 78% respectively. However, stage I on PET staging had a significantly better PFS than stage II (HR 4.66 95% CI [1.15–18.8], p = 0.038), with 5-year PFS of 84% and 60% respectively. Ten patients had recurrent disease, with distant disease being the first site of failure in seven patients. Seven-year OS was 91% (95% CI 79–100) for the whole cohort.

Conclusion

FDG-PET should be considered an essential element in the evaluation of patients with ESFL being considered for RT.

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  • Accepted: Jul 26, 2018
  • Online: Aug 7, 2018

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