Can positron emission tomography with [F-18]-fluorodeoxyglucose after first-line treatment distinguish Hodgkin's disease patients who need additionaltherapy from others in whom additional therapy would mean avoidable toxicity?

To assess the ability of restaging positron emission tomography (PET) scann ing to predict clinical outcome after first-line treatment in patients with Hodgkin's disease, we included 60 patients with histologically proven HD. who underwent whole-body [F-18]-fluorodeoxygenase ([F-18]-FDG)-PET studies after first-line treatment and with a follow-up of at least 1 year. Persist ence or absence of residual disease on PET was related to progression-free survival (PFS) using Kaplan-Meier survival analysis. After treatment, 55 pa tients showed a normal [F-18]-FDG-PET scan; 50 of 55 remained in complete r emission (CR), with a median follow-up of 955 d. Only five patients relapse d (median PFS, 296 d). During follow-up in all five patients, [F-18]-FDG-PE T was the first tool that became positive for relapse. Persistent abnormal [F-18]-FDG uptake was seen in only five patients: all of them relapsed (med ian PFS, 296 d). In four of five patients, only PET predicted persistent di sease. All relapses were proven histologically. Two-year actuarial PFS rate for negative patients was 91% compared with 0% for positive patients. We c oncluded that [F-18]-FDG-PET has an important prognostic role in the post-t reatment evaluation of HD patients.