Subscribe to RSS
DOI: 10.1055/a-2385-3647
FDG-PET/CT zur Bewertung der Therapieantwort in der Onkologie: Aktuelle Standards und Herausforderungen
FDG-PET/CT for Therapy Response Assessment in Oncology: Current Standards and Challenges
Zusammenfassung
Die FDG-PET/CT ist eine wichtige Methode zur Bewertung des Therapieansprechens in der Onkologie. Mithilfe des Tracers [18F] Fluordesoxyglukose (FDG) lassen sich metabolische Veränderungen in Tumorzellen frühzeitig detektieren, häufig noch bevor morphologische Veränderungen sichtbar werden. Um eine präzise und reproduzierbare Bewertung des Ansprechens zu gewährleisten, wurden standardisierte, tumorübergreifende Kriterien wie die EORTC- und PERCIST-Kriterien entwickelt. Neuere Erweiterungen berücksichtigen zudem spezifische Muster bei Immuntherapien. Für bestimmte Tumorarten, wie beispielsweise Lymphome, sind spezialisierte Klassifikationssysteme wie die Lugano-Kriterien etabliert. Herausforderungen bestehen weiterhin in der komplexen Integration dieser Verfahren in die klinische Routine sowie in der limitierten Anwendung außerhalb von Studien. Dennoch bieten diese Ansätze das Potenzial, Therapieentscheidungen zu optimieren und die Patientenversorgung nachhaltig zu verbessern.
Abstract
The FDG-PET/CT is an important method for assessing therapy response in oncology. Using the tracer [18F] fluorodeoxyglucose (FDG), metabolic changes in tumor cells can be detected early, often before morphological alterations become apparent. Standardized, cross-tumor criteria such as the EORTC and PERCIST guidelines have been developed to enable precise and reproducible response evaluation. Recent advancements also account for immunotherapy-specific response patterns. For certain tumor types, such as lymphomas, specialized classification systems like the Lugano criteria have been established. Challenges remain in the complex implementation of these methods in clinical practice and their limited use outside of research settings. Nevertheless, these approaches hold significant potential to optimize therapy decisions and improve patient care in the long term.
Publication History
Article published online:
02 September 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
Referenzen
- 1 Litiere S, Collette S, de Vries EG. et al. RECIST - learning from the past to build the future. Nat Rev Clin Oncol 2017; 14: 187-192
- 2 Therasse P, Arbuck SG, Eisenhauer EA. et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000; 92: 205-216
- 3 Eisenhauer EA, Therasse P, Bogaerts J. et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-247
- 4 Young H, Baum R, Cremerius U. et al. Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group. Eur J Cancer 1999; 35: 1773-1782
- 5 Pinker K, Riedl C, Weber WA. Evaluating tumor response with FDG PET: updates on PERCIST, comparison with EORTC criteria and clues to future developments. Eur J Nucl Med Mol Imaging 2017; 44: 55-66
- 6 Wahl RL, Jacene H, Kasamon Y. et al. From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med 2009; 50: 122S-150S
- 7 Adams MC, Turkington TG, Wilson JM. et al. A systematic review of the factors affecting accuracy of SUV measurements. AJR Am J Roentgenol 2010; 195: 310-320
- 8 Pinker K, Riedl CC, Ong L. et al. The Impact That Number of Analyzed Metastatic Breast Cancer Lesions Has on Response Assessment by <sup>18</sup>F-FDG PET/CT Using PERCIST. Journal of Nuclear Medicine 2016; 57: 1102-1104
- 9 Oo JH, Jacene H, Stearns V. et al. How many lesions to measure for response assessment? Comparing SULpeak changes in a single lesion and the sum of the 5 hottest lesions in 3 types of cancer and 3 types of therapy. Journal of Nuclear Medicine 2013; 54: 229-229
- 10 Kim JH. Comparison of the EORTC criteria and PERCIST in solid tumors: a pooled analysis and review. Oncotarget 2016; 7: 58105-58110
- 11 Shang J, Ling X, Zhang L. et al. Comparison of RECIST, EORTC criteria and PERCIST for evaluation of early response to chemotherapy in patients with non-small-cell lung cancer. Eur J Nucl Med Mol Imaging 2016; 43: 1945-1953
- 12 Skougaard K, Nielsen D, Jensen BV. et al. Comparison of EORTC criteria and PERCIST for PET/CT response evaluation of patients with metastatic colorectal cancer treated with irinotecan and cetuximab. J Nucl Med 2013; 54: 1026-1031
- 13 Lodge MA, Wahl RL. O JH. Practical PERCIST: A Simplified Guide to PET Response Criteria in Solid Tumors 1.0. Radiology 2016; 280: 576-584
- 14 Vogsen M, Harbo F, Jakobsen NM. et al. Response Monitoring in Metastatic Breast Cancer: A Prospective Study Comparing 18F-FDG PET/CT with Conventional CT. Journal of Nuclear Medicine 2023; 64: 355-361
- 15 Hein S, Uhrbrand Moellerjakobsen NM, Naghavi-Behzad M. et al. The PREMIO criteria: A further development of the PERCIST criteria for patient-centric response monitoring of solid tumors in PET/CT scans. Nuklearmedizin 2025; 64: V63
- 16 Hein S, Uhrbrand Moellerjakobsen NM, Naghavi-Behzad M. et al. Assessment of new lesions in [18F]FDG-PET/CT scans of metastatic breast cancer patients: A proposal for metastatic breast cancer imaging reporting and data systems (mBI-RADS). Nuklearmedizin 2025; 64: V03
- 17 Wolchok JD, Hoos A, O'Day S. et al. Guidelines for the evaluation of immune therapy activity in solid tumors: immune-related response criteria. Clin Cancer Res 2009; 15: 7412-7420
- 18 Cheson BD, Ansell S, Schwartz L. et al. Refinement of the Lugano Classification lymphoma response criteria in the era of immunomodulatory therapy. Blood 2016; 128: 2489-2496
- 19 Seymour L, Bogaerts J, Perrone A. et al. iRECIST: guidelines for response criteria for use in trials testing immunotherapeutics. Lancet Oncol 2017; 18: e143-e152
- 20 Cho SY, Lipson EJ, Im HJ. et al. Prediction of Response to Immune Checkpoint Inhibitor Therapy Using Early-Time-Point (18)F-FDG PET/CT Imaging in Patients with Advanced Melanoma. J Nucl Med 2017; 58: 1421-1428
- 21 Sachpekidis C, Anwar H, Winkler J. et al. The role of interim (18)F-FDG PET/CT in prediction of response to ipilimumab treatment in metastatic melanoma. Eur J Nucl Med Mol Imaging 2018; 45: 1289-1296
- 22 Anwar H, Sachpekidis C, Winkler J. et al. Absolute number of new lesions on (18)F-FDG PET/CT is more predictive of clinical response than SUV changes in metastatic melanoma patients receiving ipilimumab. Eur J Nucl Med Mol Imaging 2018; 45: 376-383
- 23 Goldfarb L, Duchemann B, Chouahnia K. et al. Monitoring anti-PD-1-based immunotherapy in non-small cell lung cancer with FDG PET: introduction of iPERCIST. EJNMMI Res 2019; 9: 8
- 24 Ito K, Teng R, Schoder H. et al. (18)F-FDG PET/CT for Monitoring of Ipilimumab Therapy in Patients with Metastatic Melanoma. J Nucl Med 2019; 60: 335-341
- 25 Cheson BD, Fisher RI, Barrington SF. et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014; 32: 3059-3068
- 26 Deutsche Gesellschaft für Hämatologie und Onkologie (DGHO) e.V. S3-Leitlinie Diagnostik, Therapie und Nachsorge für erwachsene Patient*innen mit einem diffusen großzelligen B-Zell-Lymphom und verwandten Entitäten, Version 1.0 (2022). https://www.leitlinienprogramm-onkologie.de/leitlinien/diffuses-grosszelligen-b-zell-lymphom-dlbcl
- 27 Deutsche Gesellschaft für Hämatologie und Onkologie (DGHO) e.V. S3-Leitlinie Hodgkin-Lymphom, Version 3.2 (2022). https://www.leitlinienprogramm-onkologie.de/leitlinien/hodgkin-lymphom
- 28 Meignan M, Gallamini A, Meignan M. et al. Report on the First International Workshop on Interim-PET-Scan in Lymphoma. Leuk Lymphoma 2009; 50: 1257-1260
- 29 Lee AJ, Kim KW, Cho YC. et al. Incidence of Immune-Mediated Pseudoprogression of Lymphoma Treated with Immune Checkpoint Inhibitors: Systematic Review and Meta-Analysis. J Clin Med 2021; 10
- 30 Barrington SF, Cottereau A-S, Zijlstra JM. Is 18F-FDG Metabolic Tumor Volume in Lymphoma Really Happening?. Journal of Nuclear Medicine 2024; 65: 510-511
- 31 Ferdinandus J, Kaul H, Schneider G. et al. Metabolic Tumor Volume after Two Cycles of Chemotherapy in Patients Treated for Advanced-Stage Hodgkin Lymphoma: Analysis of the German Hodgkin Study Group Phase III HD18 and HD21 Trials. Blood 2024; 144: 566-566
- 32 Marcus C, Ciarallo A, Tahari AK. et al. Head and neck PET/CT: therapy response interpretation criteria (Hopkins Criteria)-interreader reliability, accuracy, and survival outcomes. J Nucl Med 2014; 55: 1411-1416
- 33 Sheikhbahaei S, Mena E, Marcus C. et al. 18F-FDG PET/CT: Therapy Response Assessment Interpretation (Hopkins Criteria) and Survival Outcomes in Lung Cancer Patients. J Nucl Med 2016; 57: 855-860