PET Beim Hodgkin Lymphom

Transkript

1 PET Beim Hodgkin Lymphom Freitag, Düsseldorf 34. Jahrestagung der RWGN Carsten Kobe für die Deutsche Hodgkin Studiengruppe (GHSG)

2 Suggested changes due to FDG PET Stage or treatment 22/88 Pat.(25%) 30/186 (16%) Treatment strategy 16/88 Pat. (18%) Therapy intensification 9/88 Pat. (10%) Therapy intensification 9/44 Pat. (20%) 14/123 (11%) early stages (Ia-IIB) % Therapy intensification in early stages - Substantial impact of FDG PET in Staging HL Naumann et al., 2004, Rigacci et al., 2007

3 Staging Hodgkin Lymphoma Involvement: left Axilla and bone marrow *a) large mediastinal mass; b) extranodal disease; c) high ERS; d) 3 or more areas

4 Staging Hodgkin Lymphoma Involvement: Cervical, lung hilum, mediastinum, paraaortal

5 Pitfalls Thymic uptake Brown fat Castellucci et al., Nucl. Med. Comm., 2005

6 Prognostic significance of FDG-PET after completed therapy Author Study Pat. Observation 1 1 Overall [n] [months] PET+ [%] PET- [%] PPV/NPV [%] De Witt 2001 Weihrauch 2001 Spaepen 2001 Prospective /100 Prospective /84 Retrospective /91

7 HD15 (advanced stages) A 8x BEACOPP esk. B 6x BEACOPP esk. Restaging (CT) C 8x BEACOPP 14 CR, CRr, PR < 2.5 cm PR 2.5 cm PET Panel (GHSG Cologne) NPV PET? PET - follow up PET + 30 Gy Radiotherapy

8 > 2.5 cm PET negative

9 > 2.5 cm PET positive

10 Additional Radiotherapy?

11 PET after 2 Cycles ABVD Hodgkin Lymphoma Hutchings et al., Blood.2006 ;107(1):52-9.

12 PET after 2 Cycles ABVD Hodgkin Lymphoma Gallamini et al., J Clin Oncol

13 PET after 2 Cycles BEACOPP Hodgkin Lymphoma Patients in unfavourable and advanced stages 2x BEACOPP esc. 54 Pat. PET PET - 4x BEACOPP std. n=43 PET + 4x BEACOPP esc. n=11 12 months follow-up 42/43 EVS 8/11 EVS Dann EJ et al., Blood 2007, 109:905-9

14 PET after 2 Cycles BEACOPP Hodgkin Lymphoma HD18 (advanced stages) 2 x BEACOPP esc PET-Panel (GHSG Cologne) PET positiv R PET negativ R 6 x BEACOPP esc. 6 x BEACOPP esc. + Rituximab 6 x BEACOPP esc. 2 x BEACOPP esc. Radiotherapy PET positive PR > 2.5 cm

15 PET after 2 Cycles ABVD Hodgkin Lymphoma HD16 (early stages) 2 x ABVD PET-Panel (GHSG Cologne) PET positiv R PET negativ R 2 x ABVD 2 x ABVD IF Radiotherapy 30 Gy 2 x ABVD 2 x ABVD

16 PET Vergütung I ICD10: C81.- OPS 301: DRG: R 65B Kostengewicht 0,237 (Grouper), 1-Tages DRG 640 (Annahme: Baserate 2.700) Rechtsgrundlage BSG : stationär zulässig, wenn keine vertragsärztliche Behandlung und medizinisch notwendig in HD16 und HD18 wird nach VdAK die GKV entsprechende stationäre Aufenthalte nicht als Fehlbelegung einordnen

17 PET Vergütung II Fazit für Onkologen/Nuklearmediziner: Verwaltung informieren Verhandlungen mit den Krankenkassen zu Beginn 2008!

18 Acknowledgement GHSG: M Dietlein (1) J Franklin (2) A Pluetschow (2) HT Eich (3) M Fuchs (4) A Gossmann (5) B Pfistner (2) V Diehl (2) A Engert (4) PET centers: J Markova (6) O Belohlavek (7) H Schicha (1) H Amthauer (8) W Brenner (9) M de Wit (10) WH Knapp (11) A Bockisch (12) M Weckesser (13) R Lorenz (14) M Schreckenberger (15) R Bares (16) J Sciuk (17) F Grunwald (18) U Haberkorn (19) O Sabri (20) J Marienhagen (21) CM Kirsch (22) K Scheidhauer (23) R Tiling (24) (1) Department of Nuclear Medicine, University of Cologne, (2) German Hodgkin Study Group, University of Cologne (3) Department of Radiation Oncology, University of Cologne (4) Department I of Internal Medicine, University of Cologne (5) Department of Radiology, University of Cologne (6) Oddeleni klinicke hematologie FN KV, Prague, Czech Republic (7) PET Center, Na Homolce Hospital, Prague, Czech Republic (8) Klinik fur Strahlenheilkunde, Charite Universitatsmedizin Berlin (9) Department of Nuclear Medicine, University Medical Center Hamburg- Eppendorf (10) Department of Medicine, University Hospital Hamburg-Eppendorf (11) Department of Nuclear Medicine, Hannover University Medical School (12) Department of Nuclear Medicine, University of Duisburg-Essen (13) Department of Nuclear Medicine, University Hospital Muenster (14) Department of Nuclear Medicine, University of Wuerzburg (15) Department of Nuclear Medicine, Gutenberg University Hospital (16) Department of Nuclear Medicine,University of Tuebingen (17) Department of Nuclear Medicine, Klinikum Augsburg (18) Department of Nuclear Medicine, Hospital of the J.W.G.-University, Frankfurt (19) Department of Nuclear Medicine, University Hospital Heidelberg (20) Department of Nuclear Medicine, University of Leipzig (21) Department of Nuclear Medicine, University of Regensburg (22) Department of Nuclear Medicine, Saarland University Medical Center, Homburg (23) Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich (24) Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich

19 Thank you for your attention!