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Angewandte Nuklearmedizin 2022; 45(01): 47-55
DOI: 10.1055/a-1666-2572
Update Lymphome
Übersicht

18F-FDG PET-CT zur Strahlentherapie der lokalisierten follikulären Lymphome

18F-FDG PET-CT in Radiotherapy of localized Follicular Lymphoma
Stephan Rehn
1   Klinik für Strahlentherapie, Universitätsklinikum Münster
,
Michaela Pixberg
2   Klinik für Nuklearmedizin, Universitätsklinikum Münster
,
Gabriele Reinartz
1   Klinik für Strahlentherapie, Universitätsklinikum Münster
,
Hans Theodor Eich
1   Klinik für Strahlentherapie, Universitätsklinikum Münster
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Zusammenfassung

Das follikuläre Lymphom ist das zweithäufigste Lymphom der westlichen Welt und beinhaltet im Regelfall insbesondere in den lokalisierten Stadien auch eine (18F-FDG) PET-CT im Rahmen des Stagings. Die Einteilung nach Ann-Arbor bzw. der modifizierten Lugano-Klassifikation ermöglicht eine Einschätzung über das weitere Therapievorgehen als auch über die Prognose. Der PET-CT kommt hier eine bedeutende Rolle zu, indem sie die bildgebende Sensitivität im Vergleich zur konventionellen CT weiter stark erhöhen kann. Verschiedene Parameter dienen bei der PET-CT zur Interpretation der Befunde, wobei insbesondere der SUVmax hier eine wichtige Rolle spielt. Weitere Parameter wie metabolisches Tumorvolumen (MTV) oder Total Lesion Glycolysis (TLG) sind Gegenstand der aktuellen Forschung. Für die Strahlentherapie spielt die PET-CT eine bedeutende Rolle, da sie eine noch präzisere Erfassung des metabolisch aktiven Lymphoms ermöglichen kann. Hierdurch können Zielvolumina weiter verkleinert und so umliegende Gewebe geschont werden. Zudem wird durch die PET-CT auch die initiale Stadieneinteilung präziser und damit einhergehend auch die Prognose bzw. das Therapie-Outcome besser abschätzbar. Im Bereich der Diagnostik und Therapiesteuerung der Hodgkin-Lymphomerkrankung ist die PET-CT schon länger unverzichtbar geworden. Mit der in den letzten Jahren steigenden Verfügbarkeit ist die PET-CT heute ein immer wichtiger werdender Bestandteil sowohl in der Primärdiagnostik als auch in der Rezidivsituation bei Patienten mit follikulärem Lymphom und findet zunehmend Eingang in die aktuellen Leitlinienempfehlungen für die Non-Hodgkin Lymphome (NHL).

Abstract

Follicular lymphoma is the second most common lymphoma in the western world and usually includes (18F-FDG) PET-CT as part of staging, especially in the localized stages. The classification according to Ann-Arbor or to the modified Lugano classification enables an assessment of the further therapeutic procedure and the prognosis. PET-CT plays an important role here, as it further can greatly increase the imaging sensitivity compared to conventional CT. Various parameters are used in PET-CT to interpret the findings, with SUVmax in particular playing an important role. Further parameters such as metabolic tumor volume (MTV) or Total Lesion Glycolysis (TLG) are the subject of current research. For radiation therapy, PET-CT plays a major role, as it can enable an even more precise recording of the metabolically active lymphoma. As a result, target volumes can be further reduced and surrounding tissue can be spared. In addition, PET-CT also makes the initial staging more precise and, as a result, the prognosis and therapy outcome can be better assessed. In the field of diagnostics and therapy management of Hodgkin's lymphoma disease, PET-CT has long been indispensable. With the growing availability in recent years, PET-CT is now an increasingly important component both in primary diagnostics and in the relapse situation in patients with follicular lymphoma and is progressively being included in the current guideline recommendations for NHL.

Schlüsselwörter

PET-CT - Follikuläres Lymphom - Strahlentherapie - Zielvolumendefinition

Keywords

PET-CT - Follicular lymphoma - Radiotherapy - Target volume definition


Publication History

Article published online:
07 March 2022

© 2022. Thieme. All rights reserved.

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