End-therapy positron emission tomography for treatment response assessment in follicular lymphoma: A systematic review and meta-analysis
A partir d'une revue systématique de la littérature (8 articles, 577 patients), cette méta-analyse évalue la valeur d'une tomographie numérique par émission de positrons à base de fluorodésoxyglucose (18F) pour prédire la réponse à une chimiothérapie chez les patients atteints d'un lymphome folliculaire
Purpose : Use of FDG-PET in post-chemotherapy response assessment in follicular lymphoma (FL) is still a controversial issue. Here, we conducted the first systematic review and meta-analysis to determine the predictive value of FDG-PET in predicting outcome after chemotherapy of FL.
Experimental Design : Comprehensive literature search in Ovid-MEDLINE and EMBASE databases was performed to identify studies which evaluate predictive value of end-therapy PET and/or CT in patients with FL. To quantitatively compare the predictive value of PET and CT, pooled hazard ratios (HRs) comparing progression-free survival (PFS) between patients with positive and negative results were adopted as the primary indicators for meta-analysis. To explore efficiency in determining complete remission (CR), pooled CR rates of PET- and CT-based response criteria were calculated. Pooling of these parameters was based on random-effects model.
Results : Review of 285 candidate articles identified 8 eligible articles with a total of 577 patients for qualitative review and meta-analysis. The pooled HRs of end-therapy PET and CT were 5.1 (95% CI, 3.7-7.2) and 2.6 (95% CI, 1.2-5.8), respectively, which implies that PET is more predictive of PFS after chemotherapy than CT. The pooled CR rates of PET- and CT-based response criteria were 75% (95% CI, 70−79%) and 63% (95% CI, 53-73%), respectively, which implies that PET is more efficient in distinguishing CR (without residual disease) from other states with residual disease. Qualitative systematic review also indicates the same findings.
Conclusions : Consistent evidence favoring PET-based treatment assessment should be considered in the management of patients with FL.
Clinical Cancer Research , résumé, 2013