Non-Hodgkin's Lymphoma Clinical Trial
Official title:
Imaging Cell Proliferation With FLT PET: A Pilot Study in Paediatric Lymphoma Patients With Equivocal FDG PET Findings
Background: Residual masses on follow-up surveillance imaging are frequently detected in paediatric patients with Hodgkin's lymphoma and non-Hodgkin's lymphoma. The residual mass may consist of inflammatory, fibrous or necrotic tissue, or it could represent residual tumor. In most cases, positron emission tomography (PET) with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) is useful for distinguishing tumor from fibrosis. However, FDG is not tumor-specific, and increased accumulation of the tracer may be seen in a variety of benign entities which can give rise to false-positive or equivocal FDG PET findings. Alternatively, the uptake of 3'-deoxy-3'-[fluorine-18]-fluorothymidine (FLT) reflects cellular proliferation, and may prove to be a reliable method in resolving equivocal FDG PET findings. Indeed, several studies have demonstrated that FLT can be safely administered to children, and in some cases be more useful than FDG PET in differentiating between infection or inflammation and malignancy. This study hypothesizes that FLT PET can be used as an adjunct imaging modality in paediatric lymphoma patients with equivocal interim or post-therapy FDG PET findings, and that this technique can provide additional diagnostic information which will be useful in distinguishing fibrotic or necrotic residual mass lesions from those that may be harbouring malignancy.
This is a prospective pilot study evaluating the clinical use of FLT PET in paediatric
patients with Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL). The overall objective
of this trial is to assess the feasibility of using FLT PET as an adjunct imaging modality to
follow-up paediatric lymphoma patients whose interim or post-therapy FDG PET scan is
interpreted as being equivocal. The primary outcome measure is to obtain a preliminary
estimate of the diagnostic performance (including the sensitivity, specificity and accuracy)
of adjunct FLT PET. This pilot study will yield sufficient preliminary data to help justify
and design a subsequent larger study of FLT PET in paediatric lymphoma patients.
This study is open only to HL and NHL patients whose interim or post-therapy FDG PET scan is
interpreted as being equivocal and in whom it is not possible resolve the exam results using
other conventional imaging techniques such as CT or MRI. All FLT PET image findings will be
presented to the treating physician(s) responsible for managing the care of any patient
enrolled in this trial. Treating physicians will continue to use routine practices to resolve
equivocal FDG PET findings.
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