# PET/CT-based target volume definition in involved-site radiotherapy for treatment of early-stage nodal follicular lymphoma

## TL;DR

This study shows that FDG-PET/CT improves radiation target volume definition in early-stage follicular lymphoma compared to CT alone.

## Contribution

The study demonstrates that FDG-PET/CT detects more lymph nodes than CT, significantly altering radiation treatment fields in 30% of patients.

## Key findings

- FDG-PET/CT identified additional lymph nodes in 61% of patients not detected by CT.
- 30% of patients had significant changes in radiation treatment fields due to FDG-PET/CT findings.
- Only 58% of involved lymph nodes showed abnormal CT morphology.

## Abstract

Recent advancements in imaging, particularly 18F-fluorodeoxyglucose positron-emission tomography–computed tomography (FDG-PET/CT), have improved the detection of involved lymph nodes, thus influencing staging accuracy and potentially treatment outcomes. This study is a post hoc analysis of the GAZAI trial data to evaluate the impact of FDG-PET/CT versus computed tomography (CT) alone on radiation target volumes for involved-site radiotherapy (IS-RT) in early-stage follicular lymphoma (FL).

All patients in the GAZAI trial underwent pretherapeutic FDG-PET/CT examinations, which were subject to central quality control. Lymph nodes with pathological metabolism were assessed for CT morphology. Differential regional involvement and the impact on radiation target volume for IS-RT were compared between PET/CT-based to solely CT-based staging.

In 54 patients with PET-positive lymph nodes after initial surgery, 170 involved lymph nodes were identified in total. FDG-PET/CT identified additionally involved lymph nodes not detected by CT in 61% of the patients, leading to a significant change in radiation treatment fields for 30% of the cohort. Only 58% of all involved lymph nodes exhibited pathological CT morphology. The findings were robust across different Deauville score thresholds and CT morphological metrics.

The findings confirm the essential role of FDG-PET/CT in accurately defining the radiation volume for treatment of early-stage follicular lymphomas with radiotherapy. These results support the integration of FDG-PET/CT into the standard diagnostic pathway and its inclusion in the service catalogue of statutory health insurance, emphasizing its importance for optimal treatment planning and the potential impact on patient outcomes.