The use of PET scanning to inform treatment decisions

• Limitations in CT-based assessments of response to therapy prompted the investigation of ¹⁸F-FDG PET to assess response to treatment³¹
• ¹⁸F-FDG PET is now widely used for staging, restaging, and detection of recurrence in many patients with NHL and also is increasingly used to monitor the response to chemotherapy in these patients⁴⁸
• The optimum timing of PET scans (whether during interim staging or in final staging) is unknown. If a PET scan indicates that the patient is positive for treatment after receiving therapy, a biopsy is recommended to confirm that the disease is still present and that the mass detected by the PET is not due to fibrosis⁴⁸
• While ¹⁸F-FDG PET has become an important component of posttherapy response assessments in DLBCL, questions remain regarding how this technique should be used during the treatment of patients and whether
  ¹⁸F-FDG PET results taken in the midst of treatment cycles should impact course of treatment or future treatment decisions^48,89
• Open questions remain regarding the use of ¹⁸F-FDGPET in lymphoma response assessment⁴⁸
  • What is the earliest time point to predict treatment outcome with reasonable certainty? Can one avoid overtreatment of patients with apparently good prognosis, based on a negative interim PET scan?
  • What alternate treatment strategy exists for patients who are likely to fail standard treatment as indicated by a persistent positive interim PET?

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