JULIANO JULIO CERCI
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conferenceObject Incidence of post-treatment PET-positivity and relapse in Hodgkin lymphoma patients with a negative interim FDG-PET(2012) ZANONI, L.; CERCI, J.; LOPCI, E.; BIANCHI, A.; HUTCHINGS, M.; LEE, S. Ting; DELBEKE, D.; CELLI, M.; CHITI, A.; FANTI, S.Background: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), used for assessment of early response in Hodgkin’s lymphoma (HL) patients, is an accurate predictor of progression-free survival. Is has been suggested that end-treatment PET (PETe) is unnecessary if interim PET (PETi) results are negative. The purpose of this study was to evaluate the incidence and clinical characteristics of HL patients with PETi-negative and PETe-positive scans. Material and Methods: For this purpose we retrospectively analyzed data from HL patients enrolled in seven different nuclear medicine centers worldwide. Scans were read by at least one board certified nuclear physician. PETi-negative was defined as no pathologic FDG uptake at any site, including all sites of previously increased pathologic uptake. PETi minimal residual uptake (MRU) was defined as low-grade FDG uptake, although PETi-MRU scans were considered as PETi-negative scan for the purpose of the analysis. A study was considered PETi-positive in case of focal FDG uptake that could not be attributed to physiological distribution. There was no modification in treatment based on PETi results. The incidence of a PETi-negative scan in combination with a PETe-positive scan was calculated. Results: A total of 868 patients were analysed and after two or three cycles of chemotherapy, 643/868 (74.1%) patients were PETi-negative, and 225/868 (25.9%) were PETi-positive. Of the 643 PETi-negative patients, 7.2% (46/643) showed PETe-positive scans. HL was confirmed in 5.1% (33/643) patients, while 2.2% (14/643) were false positive results. Four of those patients died during follow-up, due to HL complications, with a median follow up of 47 (±24.1) months. Clinical characteristics of the 33 early relapsed patients were investigated (sex; age; pathological subtype; B symptoms; Bulky diseae; Clinical stage; International Prognostic Score). Of those patients, 81.8% (27/33) were treated with ABVD. Radiotherapy was administrated in 12 (33.6%) patients. Of the 13 patients with early stage disease, six (46.1%) were submitted to combined therapy. Of the 14 patients with advanced disease, six (42.8%) were submitted to combined therapy. Conclusion: We conclude that, although a rare occurrence, a small number of HL patients will show recurrent signs of disease at the end of treatment, despite a negative PETi. Thus, there is at present not evidence for the omission of PETe. PETe should still be performed as part of the patient's management plan , in order to identify these patients who need additional therapy.- Consistency of FDG-PET Accuracy and Cost-Effectiveness in Initial Staging of Patients With Hodgkin Lymphoma Across Jurisdictions(2011) CERCI, Juliano J.; TRINDADE, Evelinda; BUCCHERI, Valeria; FANTI, Stefano; COUTINHO, Artur M. N.; ZANONI, Lucia; LINARDI, Camila C. G.; CELLI, Monica; DELBEKE, Dominique; PRACCHIA, Luis F.; PITELA, Felipe A.; SOARES JR., Jose; ZINZANI, Pier Luigi; MENEGHETTI, Jose C.Introduction: Two hundred ten patients with newly diagnosed Hodgkin's lymphoma (HL) were consecutively enrolled in this prospective trial to evaluate the cost-effectiveness of fluorine-18 ((18)F)-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) scan in initial staging of patients with HL. Methods: All 210 patients were staged with conventional clinical staging (CCS) methods, including computed tomography (CT), bone marrow biopsy (BMB), and laboratory tests. Patients were also submitted to metabolic staging (MS) with whole-body FDG-PET scan before the beginning of treatment. A standard of reference for staging was determined with all staging procedures, histologic examination, and follow-up examinations. The accuracy of the CCS was compared with the MS. Local unit costs of procedures and tests were evaluated. Incremental cost-effectiveness ratio (ICER) was calculated for both strategies. Results: In the 210 patients with HL, the sensitivity for initial staging of FDG-PET was higher than that of CT and BMB in initial staging (97.9% vs. 87.3%; P < .001 and 94.2% vs. 71.4%, P < 0.003, respectively). The incorporation of FDG-PET in the staging procedure upstaged disease in 50 (24%) patients and downstaged disease in 17 (8%) patients. Changes in treatment would be seen in 32 (15%) patients. Cumulative cost for staging procedures was $3751/patient for CCS compared to $5081 for CCS + PET and $4588 for PET/CT. The ICER of PET/CT strategy was $16,215 per patient with modified treatment. PET/CT costs at the beginning and end of treatment would increase total costs of HL staging and first-line treatment by only 2%. Conclusion: FDG-PET is more accurate than CT and BMB in HL staging. Given observed probabilities, FDG-PET is highly cost-effective in the public health care program in Brazil.
conferenceObject FDG-PET initial staging in Hodgkin lymphoma patients has impact on 5-year overall and event free survival(2012) CERCI, Juliano; LINARDI, Camila; PRACCHIA, Luis; SOARES, Jose; TRINDADE, Evelinda; CERCI, Rodrigo; DELBEKE, Dominique; MENEGHETTI, Jose