JCO Early Release, published online ahead of print Jan 22 2007
Journal of Clinical Oncology, 10.1200/JCO.2006.08.2305
Received July 13, 2006
Accepted November 22, 2006
Use of Positron Emission Tomography for Response Assessment of Lymphoma: Consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma
Malik E. Juweid,* Sigrid Stroobants, Otto S. Hoekstra, Felix M. Mottaghy, Markus Dietlein, Ali Guermazi, Gregory A. Wiseman, Lale Kostakoglu, Klemens Scheidhauer, Andreas Buck, Ralph Naumann, Karoline Spaepen, Rodney J. Hicks, Wolfgang A. Weber, Sven N. Reske, Markus Schwaiger, Lawrence H. Schwartz, Josee M. Zijlstra, Barry A. Siegel, and Bruce D. Cheson
From the Department of Radiology, University of Iowa, Iowa City, IA; Department of Nuclear Medicine, University Hospital Gasthuisberg, Leuven, Belgium; Departments of Hematology and Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands; Department of Nuclear Medicine, University of Ulm, Ulm; Department of Nuclear Medicine, University of Cologne, Cologne; Department of Nuclear Medicine, Technische Universitat Munchen, Munich; Department of Medicine, Dresden University of Technology, Dresden, Germany; Department of Oncology Services, Synarc Inc, San Francisco, CA; Department of Radiology, Mayo Clinic, Rochester, MN; Department of Radiology, Mount Sinai School of Medicine; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; Centre for Molecular Imaging, University of Melbourne, East Melbourne, Australia; Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; and the Department of Medicine, Georgetown University Hospital, Washington, DC.
* To whom correspondence should be addressed. E-mail: malik-juweid{at}uiowa.edu
Purpose: To develop guidelines for performing and interpreting positron emission tomography (PET) imaging for treatment assessment in patients with lymphoma both in clinical practice and in clinical trials.
Methods: An International Harmonization Project (IHP) was convened to discuss standardization of clinical trial parameters in lymphoma. An imaging subcommittee developed consensus recommendations based on published PET literature and the collective expertise of its members in the use of PET in lymphoma. Only recommendations subsequently endorsed by all IHP subcommittees were adopted.
Recommendations: PET after completion of therapy should be performed at least 3 weeks, and preferably at 6 to 8 weeks, after chemotherapy or chemoimmunotherapy, and 8 to 12 weeks after radiation or chemoradiotherapy. Visual assessment alone is adequate for interpreting PET findings as positive or negative when assessing response after completion of therapy. Mediastinal blood pool activity is recommended as the reference background activity to define PET positivity for a residual mass  2 cm in greatest transverse diameter, regardless of its location. A smaller residual mass or a normal sized lymph node (ie,  1 x 1 cm in diameter) should be considered positive if its activity is above that of the surrounding background. Specific criteria for defining PET positivity in the liver, spleen, lung, and bone marrow are also proposed. Use of attenuation-corrected PET is strongly encouraged. Use of PET for treatment monitoring during a course of therapy should only be done in a clinical trial or as part of a prospective registry.
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