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June 18, 2008 （路易斯安那州纽奥良讯）－根据一项发表于核子医学学会2008年年会的研究结果显示，罹患非何杰金氏淋巴瘤（NHL）病患，氟去氧葡萄糖（FDG）正子摄影断层扫描（PET）可作为在选择病患是否适合在标准化疗后癌症再发接受钇90 ibritumomab tituxetan（Zevalin）的有效工具。
Paolo Castellucci医师，他来自义大利Bologna的Policinico S. Orsola-Malpighi，在本次年会上发表收纳38位CD20阳性滤泡型NHL病患的研究结果，他的团队目前正对55位病患研究这项措施的可行性。
Castellucci医师向Medscape放射学表示，对这个疾病，PET是唯一可以在治疗后看出疾病是否再发的工具，这些病患可以接受钇90的治疗，所以这对于病患的预后是很重要的。
FDG-PET被用来找出38位CD20阳性NHL且接受标准化疗后再发的病患，这些病患在开始使用ibritumomab后4与10个月再次接受扫描。
在发现疾病再发后，PET确认其中20位病患的疾病局限于横膈膜的一侧（其中7例在横膈膜上，13例在横膈膜下），其中11个案例侵犯到两边的淋巴结，另外7例侵犯到肺实质；在最后评估时，21位病患（55%）因为放射免疫疗法而完全消退，13位病患（34%）有部分反应，4位病患（11%）疾病持续恶化。
研究者观察到，相较于淋巴结外疾病病患，局限性疾病病患达到完全反应的机率较高。对所有病患而言，FDG-PET在4个月时的检验结果与后续追踪的临床发现是相符的。Castellucci医师指出，再发的程度与放射免疫疗法完全反应的可能性相关。
他指出，我们相信FDG-PET在评估CD20阳性NHL，不论是侦测再发或是确认对放射免疫疗法的反应上是已经被确效的工具；他表示，我们目前正在临床应用中。
洛杉矶南加州大学医学院的Peter Conti医师，同时也是放射学、临床药学与生物工程教授，以及放射医学会的前理事，他在分子生物技术与治疗新兴伙伴记者会上评论这项研究。
他表示，这项研究为放射免疫治疗与标的治疗及显像科技，根据疾病程度实践个人化医学的全新用途举了一个例子。
他表示，高达90%到PET中心接受检查的病患是癌症病患，这是放射造影一个很重要的领域；虽然这是项小型研究，但收纳了许多不同病患，且清楚地显示治疗后疾病消退仍然再发的例子。
Conti医师表示与Fluoropharma有限公司、Molecular Imaging Corp、NuView Radiopharmaceuticals、Molecular Insights有限公司与Siemens有资金上的往来。
PET Plays a Role in Radioimmunotherapy for NHL
By Caroline Helwick
Medscape Medical News
June 18, 2008 (New Orleans, Louisiana) — In subsets of patients with non-Hodgkin's lymphoma (NHL), fluorodeoxyglucose (FDG) positron-emission tomography (PET) can be a valuable tool for selecting candidates for treatment with yttrium?90 ibritumomab tiuxetan (Zevalin) after relapse on standard chemotherapy, according to a study presented here at the Society of Nuclear Medicine 2008 Annual Meeting.
Paolo Castellucci, MD, from Policlinico S. Orsola-Malpighi, in Bologna, Italy, presented the findings from 38 patients with CD20-positive follicular NHL. His group has now evaluated the approach in 55 patients.
"In this disease, PET is really the only way to show the presence of relapse soon after treatment. These patients can then be treated with yttrium?90, so it is important for patient outcomes," Dr. Castellucci told Medscape Radiology.
FDG-PET was used to identify 38 patients with CD20-positive NHL as having relapsed on standard therapy. Patients were rescanned at 4 and 10 months after starting on ibritumomab.
In the documentation of relapse, PET identified the extent of disease as being limited to 1 side of the diaphragm in 20 cases (7 above and 13 below), involving nodal sites at both sides of the diaphragm in 11 cases, and involving the nodes and parenchyma in 7 cases. At the final assessment, radioimmunotherapy treatment resulted in complete remission in 21 patients (55%), partial remission in 13 (34%), and progressive disease in 4 (11%).
The investigators observed a higher rate of complete responses in patients with limited disease than in those with extranodal disease. In all cases, FDG-PET at 4 months was consistent with the clinical findings at follow-up. The extent of relapse correlated with the likelihood of complete response to radioimmunotherapy, Dr. Castellucci reported.
"We believe that FDG-PET is a valid tool for evaluating CD20-positive NHL, for both detecting relapse and documenting the response to radioimmunotherapy," he said. "We are beginning clinical applications now."
Peter Conti, MD, MD, PhD, professor of radiology, clinical pharmacy, and biomedical engineering at the University of Southern California School of Medicine, in Los Angeles, and past president of the Society of Nuclear Medicine, commented at a press conference that this study speaks to the emerging partnership between molecular-imaging technology and therapeutics.
"This study exemplifies the use of novel radioimmunotherapeutics with molecularly targeted agents combined with imaging technology to deliver personalized medicine based on extent of disease," he said.
He noted that as many as 90% of patients seen at PET-imaging centers are cancer patients. "This is a big field for nuclear imaging," he added, "and although the study is small, it contains a spectrum of cases and clearly shows relapse followed by a nice resolution of disease with treatment."
Dr. Conti disclosed relationships with Fluoropharma, Inc, Molecular Imaging Corp, NuView Radiopharmaceuticals, Molecular Insights, Inc, and Siemens.
Society of Nuclear Medicine (SNM) 2008 Annual Meeting: Abstract 584. Presented June 18, 2008.