Staging and response assessment in XXXX : the new Lugano classification.

@entity1 @entity706 @entity5 @entity1893 @entity978
Staging and response criteria were initially developed for @entity978 ( @entity978 ) over 60 years ago, but not until 1999 were response criteria published for @entity1893 ( @entity1893 ). Revisions to these criteria for both @entity1893 and @entity978 were published in 2007 by an international working group, incorporating PET for response assessment, and were widely adopted. After years of experience with these criteria, a workshop including representatives of most major international @entity706 cooperative groups and @entity5 centers was held at the 11th International Conference on @entity706 (ICML) in June, 2011 to determine what changes were needed. An Imaging Task Force was created to update the relevance of existing imaging for staging, reassess the role of interim PET-CT, standardize PET-CT reporting, and to evaluate the potential prognostic value of quantitative analyses using PET and CT. A clinical task force was charged with assessing the potential of PET-CT to modify initial staging. A subsequent workshop was help at ICML-12, June 2013. Conclusions included: PET-CT should now be used to stage FDG-avid @entity706 ; for others, CT will define stage. Whereas Ann Arbor classification will still be used for disease localization, @entity1 should be treated as limited disease [I (E), II (E)], or extensive disease [III-IV (E)], directed by prognostic and risk factors. Since symptom designation A and B are frequently neither recorded nor accurate, and are not prognostic in most widely used prognostic indices for @entity978 or the various types of @entity1893 , these designations need only be applied to the limited clinical situations where they impact treatment decisions (e.g., stage II @entity978 ). PET-CT can replace the bone marrow biopsy (BMBx) for @entity978 . A positive PET of bone or bone marrow is adequate to designate advanced stage in DLBCL. However, BMBx can be considered in DLBCL with no PET evidence of BM involvement, if identification of discordant histology is relevant for @entity1 management, or if the results would alter treatment. BMBx remains recommended for staging of other histologies, primarily if it will impact therapy. PET-CT will be used to assess response in FDG-avid histologies using the 5-point scale, and included in new PET-based response criteria, but CT should be used in non-avid histologies. The definition of PD can be based on a single node, but must consider the potential for flare reactions seen early in treatment with newer targeted agents which can mimic disease progression. Routine surveillance scans are strongly discouraged, and the number of scans should be minimized in practice and in clinical trials, when not a direct study question. Hopefully, these recommendations will improve the conduct of clinical trials and @entity1 management.
