End-Therapy Positron Emission Tomography for Treatment ResponseAssessmentinFollicularLymphoma:ASystematic

Purpose: Use of 2[ 18 F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in postchemotherapyresponseassessmentinfollicularlymphomaisstillacontroversialissue.Here,weconducted the first systematic review and meta-analysis to determine the predictive value of FDG-PET in predicting outcome after chemotherapy of follicular lymphoma. Experimental Design: Comprehensive literature search in Ovid-MEDLINE and EMBASE databases was performed to identify studies which evaluate predictive value of end-therapy PET and/or computed tomography (CT) in patients with follicular lymphoma. To quantitatively compare the predictive value ofPETandCT,pooledhazardratios(HRs)comparingprogression-freesurvival(PFS)betweenpatientswith positive and negative results were adopted as the primary indicators for meta-analysis. To explore the efficiency in determining complete remission (CR), pooled CR rates of PET- and CT-based response criteria were calculated. Pooling of these parameters was based on the random-effects model. Results: Review of 285 candidate articles identified eight eligible articles with a total of 577 patients for qualitativereviewandmeta-analysis. ThepooledHRsof end-therapyPETandCTwere5.1[95%confidence interval (CI), 3.7‐7.2] and 2.6 (95% CI, 1.2‐5.8), respectively, which implies that PET is more predictive of PFS after chemotherapy than CT. The pooled CR rates of PET- and CT-based response criteria were 75% (95% CI, 70‐79%) and 63% (95% CI, 53‐73%), respectively, which implies that PET is more efficient in distinguishingCR(withoutresidualdisease)fromotherstateswithresidualdisease.Inaddition,qualitative systematic review indicates the same findings. Conclusions:ConsistentevidencefavoringPET-basedtreatmentassessmentshouldbeconsideredinthe management of patients with follicular lymphoma. Clin Cancer Res; 19(23); 6566–77. � 2013 AACR.