Abstract
Abstract 81
The management of follicular lymphoma (FL) can vary according to stage at presentation. The use of 18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for initial staging of FL may result in upstaging and/or changes in treatment strategy. In this study, we describe the patterns of use of FDG-PET for the initial staging of patients with newly diagnosed FL and its potential impact on treatment.
Data were obtained from the NCCN Non-Hodgkin's Lymphoma Outcomes Database, a prospective cohort study collecting comprehensive clinical, treatment, and outcome data for patients treated at 7 participating NCCN centers. Patients who presented between January 1, 2001 and September 30, 2009 with newly diagnosed low grade FL (grade 1, 2), received staging imaging within 6 weeks of diagnosis, and with at least 6 months of follow-up were included. We compared baseline and clinical characteristics as well as treatment among patients by receipt of FDG-PET for initial staging.
We identified 953 eligible FL patients with a mean age of 56 years; 532 (56%) underwent FDG-PET as part of initial staging. Use of FDG-PET varied significantly across NCCN centers (p<0.0001). Among patients who underwent FDG-PET for initial staging, 438 (82%) received early treatment (defined as treatment within 180 days of diagnosis) compared to 259 (61.5%) who were staged with conventional CT scanning only (p<0.0001).
Among 189 patients with early stage FL (ESFL), 120 (63.5%) underwent FDG-PET for initial staging. Significant differences in use were observed across NCCN centers (p<0.0001). Of all ESFL, 55 (29.1%) were treated with radiotherapy (RT) alone, 68 (36%) with chemotherapy/immunotherapy (CIT) alone, 28 (14.8%) with combined RT and CIT and 38 (20.1%) were observed. Initial treatment strategy for ESFL varied significantly according to NCCN centers (p<0.001). Choice of initial treatment strategy for ESFL did not vary significantly by use of FDG-PET (p=0.09).
The use of FDG-PET for staging of FL varies by center and is widespread despite a paucity of evidence supporting its use in this disease. Patients who undergo FDG-PET scan for initial staging appear more likely to receive early therapy although this may not be directly attributed to FDG-PET results. The management of ESFL is surprisingly heterogeneous and varies across NCCN centers but is not influenced by the use of FDG-PET scan at staging. Given the widespread use and high cost of FDG-PET, its clinical utility in ESFL should be further evaluated.
No relevant conflicts of interest to declare.
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