Authors: MD Egesta Lopci, MD Arnoldo Piccardo
Publisher: Springer International Publishing
In pediatric population, approximately 12 % of all malignancies are represented by lymphoma, and of these, the majority are composed of non-Hodgkin lymphoma, whereas 40 % are represented by Hodgkin disease (HD). NHL is more common in younger children and preteen age, whereas HD shows a bimodal age distribution with an initial peak incidence around 14 years of age. A different prognosis is also reported in the two lymphoma types, with over 90–95 % of patients with HD having a 5-year event-free survival upon 70–85 % of NHL patients.
Treatment options comprise different combination of chemotherapy regimens and/or consolidation radiotherapy, which can be safely omitted in limited stages and good responders after few cycles of chemotherapy. In this context, instrumental imaging becomes crucial either for disease staging or for a proper treatment response assessment. This fact is confirmed by the introduction of early response to chemotherapy as a predictor to disease outcome in recent trials.
As for other malignancies, a significant role in the evaluation of HD and NHL is played by 18F-fluorodeoxyglucose PET (18F-FDG PET). As a noninvasive imaging technique, it allows for a whole-body detection of all lymphatic and extralymphatic sites of disease, resulting superior to other conventional imaging modalities. Moreover, this imaging modality allows a reliable identification of residual tumor after treatment, thus significantly improving treatment planning and overall survival. Therefore, the method is recommended for initial staging and for response assessment of pediatric lymphoma.