Chemotherapy Response Assessment by FDG-PET-CT in Early-stage Classical Hodgkin Lymphoma: Moving Beyond the Five-Point Deauville Score

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• 作者：Sarah A. Milgrom ; MD^&lowast ; ; ^{samilgrom@mdanderson.org} ; Wenli Dong ; MD ; MS^&dagger ; ; Mani Akhtari ; MD^&lowast ; ; Grace L. Smith ; MD ; PhD ; MPH^&lowast ; ; Chelsea C. Pinnix ; MD ; PhD^&lowast ; ; Osama Mawlawi ; PhD^&Dagger ; ; Eric Rohren ; MD^§ ; ; Naveen Garg ; MD^‖ ; Hubert Chuang ; MD ; PhD^¶ ; ; Zeinab Abou Yehia ; MD^&lowast ; ; Jay P. Reddy ; MD ; PhD^&lowast ; ; Jillian R. Gunther ; MD ; PhD^&lowast ; ; Joseph D. Khoury ; MD^# ; Tina Suki^&lowast ; ; Eleanor M. Osborne ; MD^&lowast ; ; Yasuhiro Oki ; MD^&lowast ; &lowast ; ; Michelle Fanale ; MD^&lowast ; &lowast ; ; Bouthaina S. Dabaja ; MD^&lowast ;
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：97
• 期：2
• 页码：333-338
• 全文大小：212 K
• 卷排序：97

文摘

In early-stage classical Hodgkin lymphoma, fluorodeoxyglucose positron emission tomography (PET)-computed tomography (CT) scans are performed routinely after chemotherapy, and the 5-point Deauville score is used to report the disease response. We hypothesized that other PET-CT parameters, considered in combination with Deauville score, would improve risk stratification.Methods and MaterialsPatients treated for stage I to II Hodgkin lymphoma from 2003 to 2013, who were aged ≥18 years and had analyzable PET-CT scans performed before and after chemotherapy, were eligible. The soft tissue volume (STV), maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis were recorded from the PET-CT scans before and after chemotherapy. Reductions were defined as 1 − (final PET-CT value)/(corresponding initial PET-CT value). The primary endpoint was freedom from progression (FFP).ResultsFor 202 patients treated with chemotherapy with or without radiation therapy, the 5-year FFP was 89% (95% confidence interval 85%-93%). All PET-CT parameters were strongly associated with the Deauville score (P<.001) and FFP (P<.0001) on univariate analysis. The Deauville score was highly predictive of FFP (C-index 0.89) but was less discriminating in the Deauville 1 to 4 subset (C-index 0.67). Therefore, we aimed to identify PET-CT parameters that would improve risk stratification for this subgroup (n=187). STV reduction was predictive of outcome (C-index 0.71) and was dichotomized with an optimal cutoff of 0.65 (65% reduction in STV). A model incorporating the Deauville score and STV reduction predicted FFP more accurately than either measurement alone in the Deauville 1 to 4 subset (C-index 0.83). The improvement in predictive accuracy of this composite measure compared with the Deauville score alone met statistical significance (P=.045).ConclusionsThe relative reduction in tumor size is an independent predictor of outcome. Combined with the Deauville score, it might improve risk stratification and contribute to response-adapted individualization of therapy.