The Role of FDG-PET Scanning and PET-adapted Therapy in the Primary Treatment of Hodgkin Lymphoma: A Primer for Clinicians
The evolving treatment paradigm for classical Hodgkin lymphoma (cHL) remains focused on maintaining high rates of progression-free survival (PFS) and overall survival (OS), while seeking to reduce both short-term and late toxicities from chemotherapy and radiation. Functional imaging with fluoro-deoxyglucose (FDG)‑positron emission tomography (PET) combined with computed tomography (CT) is recognized as standard for staging and response evaluation of Hodgkin lymphoma (HL). Recent randomized controlled trials evaluating FDG-PET-guided therapy for patients with limited stage and advanced stage Hodgkin lymphoma provide clinicians and patients with meaningful data upon which to base individualized treatment approaches. FDG‑PET scanning after two cycles of therapy (interim PET or PET2) represents the most important determinant of further appropriate treatment and subsequent outcomes, and is now the cornerstone of risk-adapted therapy for all patients receiving curative-intent initial therapy for Hodgkin lymphoma. For patients with limited stage cHL, post-chemotherapy assessment (after two or four cycles of treatment depending on the regimen used) is also a key determinant of the need for the addition of involved site or nodal radiation as part of combined modality therapy. This review summarizes the important role of interim and end of chemotherapy FDG-PET scanning to guide individualized initial therapy for patients to achieve optimal treatment outcomes.
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