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Letter from the Editors
Volume 35, Number 3
July 2005
Letter from the Editors
N
uclear medicine techniques have always had a significant impact on the diagnosis and management of lymphoma. Since its initial introduction 4 decades ago by Dr. Raymond Hayes and his associates at the Oak Ridge National Laboratories, gallium-67 citrate had emerged as the agent of choice for the diagnosis of lymphoma. The early work of Dov Front and the group from Haifa has had a profound impact on our understanding and use of gallium in both the initial staging and subsequent monitoring of patients with both Hodgkin’s disease and non-Hodgkin’s lymphoma. However, the increasing availability of positron emission tomography (PET) imaging and the understanding that 18F-fluorodeoxyglucose uptake is significantly increased in most lymphomas has led to a decrease in the use of gallium and a rapid increase in the use of PET. PET images have the advantage of being easier to interpret and of being able to provide a greater sensitivity and specificity than gallium. Wherever PET imaging is available, it is now the preferred nuclear medicine examination for studying patients with lymphoma. It is also interesting to note that, as many of the authors in this issue of Seminars in Nuclear Medicine point out, PET imaging even is beginning to eclipse the use of computed tomography (CT) in this disease. The ideal approach appears to be initial evaluation with PET/CT followed by either follow-up PET/CTs or, in many situations, PET alone. It is important that both nuclear medicine physicians and oncologists who currently treat patients with lymphoma become familiar with the material in this issue of Seminars. The staging and classification of lymphoma have changed throughout the years and now take into account many of the things we have learned about the genetics of the disease. Dr. Lu’s very clear and concise description of the staging and classification of lymphoma is a prerequisite for any further
0001-2998/05/$-see front matter © 2005 Elsevier Inc. All rights reserved. doi:10.1053/j.semnuclmed.2005.02.001
perusal of this issue. After having become familiar with the staging and classification, Dr. Hicks and colleagues very clearly show us how PET and CT play a critical role in bringing that staging into the clinical arena. Lest we forget that there are still other potential approaches, Dr. Ferone has outlined for us the role of octreoscan and other receptor imaging agents. It remains to be seen where the boundary lines will be drawn between patients requiring PET imaging and those in whom the peptides are more helpful. Having made the diagnosis and staged the patient, we are then left with the need for therapy. The article by Dr. Jerusalem and colleagues puts into perspective how the patient should be evaluated to make appropriate therapeutic decisions. Any of these therapies have associated risks. As an important example, Dr. Lu outlines the risk to cardiac function that treatment with doxorubicin poses and points out how patients on this therapy can be monitored to avoid severe complications. Finally, the eternal promise of radiolabeled antibody treatment cannot be overlooked. In the case of lymphoma, the use of radioimmunotherapy has progressed farther than in any other disease. Dr. DeNardo, who has pioneered this approach, provides a comprehensive review of the radionuclide labels that are practical, as well as the antibodies under development. Their use in this disease entity, which very often is exquisitely radiosensitive, offers hope to many patients who have exhausted traditional chemotherapy approaches. A full review and understanding of this issue is essential to the nuclear medicine practitioner to be up-to-date on the most current and growing application of nuclear medicine’s role in managing patients with lymphoma. Leonard M. Freeman, MD M. Donald Blaufox, MD, PhD
159
July 2005
Letter from the Editors
N
uclear medicine techniques have always had a significant impact on the diagnosis and management of lymphoma. Since its initial introduction 4 decades ago by Dr. Raymond Hayes and his associates at the Oak Ridge National Laboratories, gallium-67 citrate had emerged as the agent of choice for the diagnosis of lymphoma. The early work of Dov Front and the group from Haifa has had a profound impact on our understanding and use of gallium in both the initial staging and subsequent monitoring of patients with both Hodgkin’s disease and non-Hodgkin’s lymphoma. However, the increasing availability of positron emission tomography (PET) imaging and the understanding that 18F-fluorodeoxyglucose uptake is significantly increased in most lymphomas has led to a decrease in the use of gallium and a rapid increase in the use of PET. PET images have the advantage of being easier to interpret and of being able to provide a greater sensitivity and specificity than gallium. Wherever PET imaging is available, it is now the preferred nuclear medicine examination for studying patients with lymphoma. It is also interesting to note that, as many of the authors in this issue of Seminars in Nuclear Medicine point out, PET imaging even is beginning to eclipse the use of computed tomography (CT) in this disease. The ideal approach appears to be initial evaluation with PET/CT followed by either follow-up PET/CTs or, in many situations, PET alone. It is important that both nuclear medicine physicians and oncologists who currently treat patients with lymphoma become familiar with the material in this issue of Seminars. The staging and classification of lymphoma have changed throughout the years and now take into account many of the things we have learned about the genetics of the disease. Dr. Lu’s very clear and concise description of the staging and classification of lymphoma is a prerequisite for any further
0001-2998/05/$-see front matter © 2005 Elsevier Inc. All rights reserved. doi:10.1053/j.semnuclmed.2005.02.001
perusal of this issue. After having become familiar with the staging and classification, Dr. Hicks and colleagues very clearly show us how PET and CT play a critical role in bringing that staging into the clinical arena. Lest we forget that there are still other potential approaches, Dr. Ferone has outlined for us the role of octreoscan and other receptor imaging agents. It remains to be seen where the boundary lines will be drawn between patients requiring PET imaging and those in whom the peptides are more helpful. Having made the diagnosis and staged the patient, we are then left with the need for therapy. The article by Dr. Jerusalem and colleagues puts into perspective how the patient should be evaluated to make appropriate therapeutic decisions. Any of these therapies have associated risks. As an important example, Dr. Lu outlines the risk to cardiac function that treatment with doxorubicin poses and points out how patients on this therapy can be monitored to avoid severe complications. Finally, the eternal promise of radiolabeled antibody treatment cannot be overlooked. In the case of lymphoma, the use of radioimmunotherapy has progressed farther than in any other disease. Dr. DeNardo, who has pioneered this approach, provides a comprehensive review of the radionuclide labels that are practical, as well as the antibodies under development. Their use in this disease entity, which very often is exquisitely radiosensitive, offers hope to many patients who have exhausted traditional chemotherapy approaches. A full review and understanding of this issue is essential to the nuclear medicine practitioner to be up-to-date on the most current and growing application of nuclear medicine’s role in managing patients with lymphoma. Leonard M. Freeman, MD M. Donald Blaufox, MD, PhD
159