Can PET/CT scanning during chemotherapy help predict lung side effects in patients with Hodgkin lymphoma?

This study evaluated whether FDG-PET/CT scanning could help predict side effects from bleomycin (Blenoxane) in patients with Hodgkin lymphoma (HL) treated with ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine). This study concluded that this type of scanning could help predict lung side effects earlier than other clinical tools.

The most commonly used frontline chemotherapy regimen for HL is ABVD. However, bleomycin is associated with a serious lung side effect called interstitial lung fibrosis. Due to treatment, the tissues between the tiny air sacs in the lungs develop scars or thicken. Common symptoms include shortness of breath and coughing, which usually begin 1 to 6 months after treatment. Lung fibrosis can lead to heart failure, which is life-threatening.

Patients receiving bleomycin may be recommended to stop treatment if symptoms of lung fibrosis appear. However, some patients may not have symptoms right away. Recognizing lung fibrosis early on during treatment is crucial. FDG-PET/CT scanning is one tool that may help detect this condition. Whether it is effective for patients with HL who are being treated with ABVD is unclear.

This study had 30 patients with HL. All patients received ABVD chemotherapy. FDG-PET/CT scanning was done during treatment to evaluate lung side effects.

Overall, 16.7% (5 patients) developed side effects from bleomycin. FDG-PET/CT scanning was done for all five of these patients after 4 cycles of chemotherapy. In patients with lung tissue damage, the scans showed significantly more FDG uptake compared to patients without tissue damage (3.24 vs. 1.84). FDG is a radioactive form of glucose (sugar) that can be detected on a scan. A high FDG uptake means that the cells are absorbing more FDG. In healthy cells, this can indicate tissue damage.

Certain factors can increase the risk of side effects of bleomycin. These include kidney failure, having radiation therapy at the same time as bleomycin, and having a history of smoking. In this study, slightly more patients who smoked cigarettes developed lung fibrosis compared to patients who did not smoke (40% vs. 36%).

This study concluded that FDG-PET/CT scanning could help predict lung side effects early in patients with HL during ABVD treatment. The authors suggest that this scanning may especially benefit patients who do not show immediate symptoms of lung fibrosis.

This study had a very small number of patients. Larger studies are needed to confirm these results.

Talk to your care team about the benefits of PET/CT scanning during chemotherapy treatment.