Postchemotherapy PET evaluation correlates with patient outcome in paediatric Hodgkin’s disease (original) (raw)
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FDG-PET/CT in Early Assessment of Response to Therapy in Pediatric Hodgkin Lymphoma
The Egyptian Journal Nuclear Medicine, 2013
Purpose of the study: was to estimate the value of early assessment of response in pediatric Hodgkin lymphoma (PHL) patients using FDG-PET/CT. Methods: prospective analysis of 195 patients presented in Children's Cancer Hospital, Egypt (CCHE) with pathologically proven untreated PHL, they underwent 18 F-fluorodeoxyglucose positron emission tomography (F-18 FDG PET/CT) early after 2 cycles of chemotherapy (PET 2).This chemotherapy regimen consists of concurrent treatment with Adriamycin, Bleomycin ,Vinblastine & Dacarbazine (ABVD). Analysis of PET 2 was done according to the Deauville score (5-point score) with cutoff 3-4 between Minimal Residual Uptake (MRU) and positive result. Results: Follow-up was done for mean period of 2.9 years (range, 0.6 to 5.2 years).Visual assessment of PET 2 was found to be significantly correlated with Overall Survival (OS) and Progression Free Survival (PFS) in advanced stages PHL (intermediate and high risk patients); the estimate for OS and PFS was 83.3% and 68.8 respectively in the PET-positive (PET +ve) group compared with 97.3% and 92.6|% respectively in the PET-negative (PETve) group (p-value <0.0001 and 0.0001). Conclusion: Early assessment of FDG-PET/CT after 2 cycles of ABVD in PHL shows potential value in prediction of OS and PFS in advanced stages (intermediate and high risk patients).
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2016
Data about significance of (18)F-FDG positron emission tomography (PET) at interim assessment and end of treatment in pediatric Hodgkin lymphoma (HL) are limited. Patients (≤18 years) with HL were prospectively evaluated with contrast-enhanced computed tomography (CECT) and PET combined with low-dose CT(PET-CT) at baseline, post 2 cycles of chemotherapy and post completion of treatment. Revised international working group criteria (RIW) and Deauville (DA) five point-scale for response assessment by PET-CT were used. All patients received ABVD chemotherapy along with involved field radiotherapy (25 Gy) for early stage (IA, IB and IIA) and advanced stage (IIB-IV) with bulky disease. Of the 57 enrolled patients, median follow-up was 81.6 months (range: 11-97.5 months). Treatment decisions were based on CECT. At baseline, PET-CT vs CECT identified 67 more disease sites; 23 patients (40.3%) were upstaged and of them in 9 patients (39%) upstaging would have affected treatment decision; no...
Contribution of PET imaging to the initial staging and prognosis of patients with Hodgkin's disease
Annals of Oncology, 2004
Background: Positron emission tomographic (PET) scanning utilizing [ 18 F]fluorodeoxyglucose (FDG) is a new method of tumor imaging based on the increased glucose metabolic activity of malignant tumors. In Hodgkin's disease (HD), PET has proven value for the evaluation of residual masses following treatment and for the early diagnosis of relapse. In the initial staging of HD, PET frequently shows a higher stage than conventional methods (upstaging by PET). In the present study, we evaluated the frequency of stage changes by PET in a multicenter setting and determined its prognostic relevance. Patients and methods: A total of 73 patients with newly diagnosed HD were staged with both conventional methods and whole-body PET scanning. All histological types and stages were represented. The median time of follow-up after the initial diagnosis was 25 months (range 1 month to 5 years). The response to treatment was determined by standard clinical and diagnostic criteria. For the purpose of this analysis, data from a PET center associated with a university medical center and a PET center associated with a group oncology practice were combined. Results: A total of 21 patients (28.8%) were upstaged by PET compared with conventional methods. In two cases (2.7%), a lower stage was suggested by PET scanning. With one possible exception, the upstaging had no obvious clinical or biological correlate. Among 12 patients in stage I (A + B) by conventional methods, seven were upstaged by PET (58.3%), four to stage II, one to stage III and two to stage IV. Among 42 patients in stage II, eight were upstaged by PET (19.0%), six to stage III and two to stage IV. Among 12 patients in stage III, six (50%) were upstaged to stage IV by PET. If only early-stage patients and major changes are considered (stages IA-IIB to III or IV), among 49, 10 were upstaged to III or IV, whereas in 39 staging was unchanged following PET. In the former group, three relapsed or were refractory compared with none in the latter group (P < 0.006). In advanced stage patients (IIIA or IIIB) a trend toward treatment failure was apparent in patients who were upstaged by PET. Conclusions: PET scanning is an interesting new modality for the accurate staging of patients with HD and frequently shows a higher stage than conventional methods. PET should be performed at initial diagnosis and should be included in prospective studies of patients with HD. Upstaging by PET may represent a risk factor for a more advanced stage or a biologically more aggressive tumor. Patients with early-stage disease as identified by conventional methods have a significant risk of treatment failure if a more advanced stage is indicated by PET. At present, major stage changes suggested by PET imaging should be confirmed by an independent diagnostic method.
Medicine, 2017
We investigated the prognostic value of interim F-FDG PET/CT (PET-2) in pediatric Hodgkin lymphoma (pHL), evaluating both visual and semiquantitative analysis.Thirty pHL patients (age ≤16) underwent serial F-FDG PET/CT: at baseline (PET-0), after 2 cycles of chemotherapy (PET-2) and at the end of first-line chemotherapy (PET-T). PET response assessment was carried out visually according to the Deauville Score (DS), as well as semiquantitatively by using the semiquantitative parameters reduction from PET-0 to PET-2 (ΔΣSUVmax0-2, ΔΣSUVmean0-2). Final clinical response assessment (outcome) at the end of first-line chemotherapy was the criterion standard, considering patients as responders (R) or nonresponders (NR). Disease status was followed identifying patients with absence or relapsed/progression disease (mean follow-up: 24 months, range 3-78).Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of visual and semiquantitative asses...
Pediatric Blood & Cancer, 2021
Background:Positron emission tomography (PET)-based measures of baseline total-body tumor burden may improve risk stratification in intermediate-risk Hodgkin lymphoma (HL).Materials and Methods:Evaluable patients were identified from a cohort treated homogeneously with the same combined modality regimen on the Children’s Oncology Group AHOD0031 study. Eligible patients had high-quality baseline PET scans. Metabolic tumor volume (MTV) and total lesion glycosis (TLG) were each measured based on 15 thresholds for every patient. Univariate and multivariable Cox regression and Kaplan-Meier survival analyses assessed for an association of MTV and TLG with event-free survival (EFS).Results:From the AHOD0031 cohort (n=1,712), 86 patients were identified who i) were treated with 4 cycles of ABVE-PC chemotherapy followed by involved field radiotherapy and ii) had a baseline PET scan that was amenable to quantitative analysis. Based on univariate Cox regression analysis, 6 PET-derived parameters were significantly associated with EFS. For each of these, Kaplan-Meier analyses and the log-rank test were used to compare patients with highest tumor burden (i.e. highest 15%) to the remainder of the cohort. EFS was significantly associated with all 6 PET parameters (all P<0.029). In a multivariable model controlling for important coviariates including disease bulk and response to chemotherapy, MTV2BP was significantly associated with EFS (P=0.012).Conclusion:Multiple baseline PET-derived volumetric parameters were associated with EFS. MTV2BP was highly associated with EFS when controlling for disease bulk and response to chemotherapy. Incorporation of baseline MTV into risk-based treatment algorithms may improve outcomes in intermediate-risk HL.
Annals of nuclear medicine, 2017
Minimizing side effects by using response-adopted therapy strategies plays an important role in the management of pediatric Hodgkin lymphoma (HL); however, the criteria for the definition of adequate or inadequate response are controversial. The aim of this study is to compare different methods of interpretation of (18)F-FDG-PET/CT (PET) in the prediction of disease outcome in order to determine the optimum method in this regard. Baseline, interim and post-treatment PET scans of 72 children were interpreted according to revised International Harmonization Project criteria (IHP) and Deauville criteria. Cut-off values for changes in interim and post-treatment FDG uptake (ΔSUVmax) in the prediction of progression-free survival (PFS) were measured using ROC analysis. Quantitative and visual data were compared with each other in the prediction of PFS. Mean interim and post-treatment ΔSUVmax of the primary lesions were 77.4 ± 19.5 and 68.8 ± 30.4% and respective cut-off values were 82 and...
Acta chirurgica iugoslavica, 2011
The aim of this study was to present preliminary experience with FDG PET/CT in pediatric oncology patients in National PET Center, Clinical Center of Serbia and to asses its impact on management of malignancies in children. 33 FDG PET /CT scans were performed on 30 pediatric patients. PET/CT imaging was performed for staging the disease, assessing therapy efficacy and diagnosing recurrent or metastatic disease. FDG PET/CT changed the stage of the disease in 60.6 % (20/33) of the cases. 14 patients were down-staged after PET/CT, mostly patients with Hodgkin?s disease, were in 7/10 cases PET/CT showed no activity in residual masses. Six scans led to upstage of the disease. In three cases PET/CT did not change the stage of disease, but has showed new distant metastases. In conclusion, FDG PET/CT showed important role in managing pediatric patients with different malignancies and was useful complementary diagnostic tool to conventional imaging methods.
Klinische Pädiatrie, 2004
Today it is possible to cure more than 90 % of children and adolescents with Hodgkin's disease with a combination of radiotherapy and chemotherapy. Since the DAL-HD 82 study, the main scientific focus has been on avoiding late effects such as the OPSI syndrome, late complications involving the heart, lungs, thyroid and/or gonads particularly sterility in men and premature onset of menopause in women, and the prevention of secondary malignancies. The GPOH-HD 2003 study will introduce FDG-PET to the initial diagnostic program and the assessment of response to therapy in order to evaluate further possibilities for reducing therapy. In this context, the central review of all clinical and radiological findings, systematically done since the DAL-HD 90 study, will be increasingly relevant in maintaining standardised stage classification and therapy group assignment which was established by the preceding studies. Continuing in the direction of
Molecular imaging and radionuclide therapy, 2017
To compare standardized uptake values (SUV) derived from pre-treatment (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging and clinical prognostic factors in pediatric patients with Hodgkin lymphoma (HL). Pre-treatment FDG PET/CT findings of 28 children with HL were evaluated in this retrospective study. Metabolic tumor volume (MTV), SUVmax normalized by weight (SUVweight), lean body mass (SUVlbm), body surface area (SUVbsa) and plasma glucose levels of tumors (SUVglucose) were calculated using pre-treatment FDG PET/CT scan images. These metabolic parameters were correlated with clinical factors [age, sex, number of lymph node groups, presence of splenic involvement, bulky mediastinal disease, Ann Arbor stage, serum white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), serum albumin and hemoglobin levels]. SUVbsa, SUVlbm, SUVweight, SUVglucose and MTV were higher in patients with stage III-IV disease, bulky tumor and ≥3 lymp...