Prognostic role of pretreatment 18F-FDG PET/CT in primary brain lymphoma
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ORIGINAL ARTICLE
Prognostic role of pretreatment 18F-FDG PET/CT in primary brain lymphoma Domenico Albano1 · Mattia Bertoli1 · Marco Battistotti1 · Carlo Rodella2 · Massimo Statuto1 · Raffaele Giubbini1 · Francesco Bertagna1 Received: 8 June 2018 / Accepted: 3 July 2018 © The Japanese Society of Nuclear Medicine 2018
Abstract Objective Primary brain lymphoma is an aggressive extranodal non-Hodgkin lymphoma with poor prognosis. Many possible prognostic factors are investigated with controversial results, but possible prognostic role of 18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) features remains unclear. Our aim was to study the metabolic behavior of brain lymphoma at 18F-FDG PET/CT and the prognostic impact of qualitative and semiquantitative PET/CT parameters. Methods Between 2006 and 2018, 52 patients (26 females and 26 males; mean age: 61 years) with histologically confirmed diagnosis of brain lymphoma who underwent 18F-FDG PET/CT for staging before any treatment were included. PET images were qualitatively and semiquantitatively analyzed by measuring the maximum standardized uptake value body weight (SUVbw), lean body mass (SUVlbm), body surface area (SUVbsa), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). The Kaplan–Meier method was used to estimate the progression-free survival (PFS) and overall survival (OS) times. Cox regression models were performed to determinate the relation between qualitative and semiquantitative PET/CT features and OS and PFS. Results Thirty-nine patients had positive 18F-FDG PET/CT showing 18F-FDG uptake (mean SUVbw of 18.2; SUVlbm of 13.9; SUVbsa of 5; MTV of 14.8; TLG of 153) at the corresponding cerebral lesion; the remaining 13 were not 18F-FDG avid. Relapse or progression of disease occurred in 22 patients with an average time of 9.7 months; death occurred in 18 patients with an average of 7.9 months. There was no difference in PFS and OS between baseline PET/CT positive and negative groups or considering SUVbw, SUVlbm, and SUVbsa. PFS and OS was significantly shorter in patients with MTV ≥ 9.8 cm3 (p = 0.037 and p = 0.022, respectively) and TLG ≥ 94 (p = 0.045 and p = 0.0430, respectively). Conclusions 18F-FDG avidity was noted in 75% of cases. Only metabolic tumor parameters (MTV and TLG) were independently correlated with PFS and OS. Keywords Brain lymphoma · 18F-FDG PET/CT · Prognosis · MTV · TLG
Introduction Primary central nervous system lymphoma (PCNSL) is an extranodal non-Hodgkin lymphoma (NHL) confined to the central nervous system (CNS) at diagnosis. This disease is rare, accounting for only 3% of primary brain tumors and
* Domenico Albano [email protected] 1
Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy
Health Physics Department, Spedali Civili, Brescia, Italy
2
5% of extranodal NHL [1, 2]. Diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype of PCNSL; its prognosis is relatively poor compared
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