The presence of a bulky mediastinal mass of 7 cm or greater in diameter confers an adverse prognosis to patients with advanced Hodgkin lymphoma in case of negative interim PET/CT

Lopez-Alonso, Rebeca; Qi, Shunan; Mashiach, Tanya; Weiler-Sagie, Michal; Yahalom, Joachim; Dann, Eldad J.

doi:10.1080/10428194.2021.1872069

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…The CECT arm of our study did pick more bulky disease patients as compared with PET‐CT. Nonetheless, we do not anticipate this denotes superiority of one modality over the other as both CECT and PET‐CT have the accurate ability to obtain two dimensional measurements 7 . This difference though significant could be due to the late presentation of patients in government hospitals where CECT was more often used as compared with the trust hospitals or private sector where PET‐CT was the preferred modality.…”

Section: Discussionmentioning

confidence: 92%

Response assessment by positron emission tomography‐computed tomography as compared with contrast‐enhanced computed tomography in childhood Hodgkin lymphoma can reduce the need for radiotherapy in low‐ and middle‐income countries

Kalra

Bakhshi

Singh

et al. 2022

Pediatric Blood & Cancer

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Introduction The InPOG‐HL‐15‐01, a multicentric prospective study, used a risk‐stratified and response‐based approach with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) backbone to treat children and adolescents with newly diagnosed Hodgkin lymphoma (HL) and reduce the use of radiation therapy (RT). Children/adolescents with bulky disease or inadequate response at early response assessment (ERA) after two cycles of chemotherapy were assigned to receive RT. For ERA, positron emission tomography computed tomography (PET‐CT) was recommended but not mandatory in view of limited access. This study aimed to compare the impact of using contrast‐enhanced computed tomography (CECT) and PET‐CT on treatment decisions and outcomes. Methodology 396 patients were enrolled and 382 had an ERA at the assigned time point. Satisfactory response was defined as Deauville score 3 or less for patients undergoing PET‐CT and complete response (CR)/very good partial response (VGPR) for patients undergoing CECT. Outcomes of interest incorporate 5 year event‐free survival (EFS), EFS including abandonment (EFSa), and overall survival (OS). Results At ERA, satisfactory response was documented in 277 out of 382 (72.5%) participants and this was significantly higher in PET‐CT (151 out of 186, 81.2%) as compared with CECT‐based assessments (126 out of 196, 64.3%) respectively (p value < .001). Amongst the 203 patients with nonbulky disease (wherein the indication for RT was entirely dependent on ERA), 96 out of 114 (84.2%) and 61 out of 89 (68.5%) patients achieved a satisfactory response according to the PET‐CT and CECT (p value = .008) respectively and hence a lesser proportion of patients in the PET‐CT arm received RT. Despite a lower usage of RT the 5 year OS of both groups, ERA based on CECT (91.8%) versus PET‐CT (94.1%) was comparable (p value = .391) and so was the 5 year EFS (86.7 vs. 85.5%, p value = .724). Conclusion Use of PET‐CT as the modality for ERA is more likely to indicate a satisfactory response as compared with CECT and thereby decreases the need for RT in response‐based treatment algorithm for HL‐afflicted children. The reduction in the application of RT did not impact the overall outcome and plausibly would lower the risk of delayed toxic effects.

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Section: Discussionmentioning

confidence: 92%

Response assessment by positron emission tomography‐computed tomography as compared with contrast‐enhanced computed tomography in childhood Hodgkin lymphoma can reduce the need for radiotherapy in low‐ and middle‐income countries

Kalra

Bakhshi

Singh

et al. 2022

Pediatric Blood & Cancer

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“…To our knowledge, this is the first study in the literature proposing a reasonable trade-off between previously suggested numbers of target lesions and methodological approaches, and we believe it could draw a feasible path towards application in clinical practice. Previous reports have described correlation between tumoral bulks and DS [ 19 , 44 ], high SUV max and tumor aggressiveness [ 45 , 46 , 47 ], radiomics from one/several/all lymphoma lesions, and prognosis in univariate/multivariate analyses, though mostly in small cohorts and with no model validation [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Baseline 18F-FDG PET/CT Radiomics in Classical Hodgkin’s Lymphoma: The Predictive Role of the Largest and the Hottest Lesions

et al. 2023

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This study investigated the predictive role of baseline 18F-FDG PET/CT (bPET/CT) radiomics from two distinct target lesions in patients with classical Hodgkin’s lymphoma (cHL). cHL patients examined with bPET/CT and interim PET/CT between 2010 and 2019 were retrospectively included. Two bPET/CT target lesions were selected for radiomic feature extraction: Lesion_A, with the largest axial diameter, and Lesion_B, with the highest SUVmax. Deauville score at interim PET/CT (DS) and 24-month progression-free-survival (PFS) were recorded. Mann–Whitney test identified the most promising image features (p < 0.05) from both lesions with regards to DS and PFS; all possible radiomic bivariate models were then built through a logistic regression analysis and trained/tested with a cross-fold validation test. The best bivariate models were selected based on their mean area under curve (mAUC). A total of 227 cHL patients were included. The best models for DS prediction had 0.78 ± 0.05 maximum mAUC, with a predominant contribution of Lesion_A features to the combinations. The best models for 24-month PFS prediction reached 0.74 ± 0.12 mAUC and mainly depended on Lesion_B features. bFDG-PET/CT radiomic features from the largest and hottest lesions in patients with cHL may provide relevant information in terms of early response-to-treatment and prognosis, thus representing an earlier and stronger decision-making support for therapeutic strategies. External validations of the proposed model are planned.

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“…16 Bulky disease was characterized as $7.0 cm (maximal diameter), per previous reports highlighting the prognostic benefit of this cutoff. 12,17…”

Section: Pet Scan Data and Treatment Responsementioning

confidence: 99%

“…The median radiation dose delivered was 30 Gy (range, 20-40 Gy), with a median of 15 fractions (range, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. In those receiving bleomycin (n 5 119), 25 (21%) patients had bleomycin discontinued due to good clinical response; 22 of these had bleomycin discontinued after cycle 2.…”

Section: Study Population and Outcomesmentioning

confidence: 99%

A real-world study of combined modality therapy for early-stage Hodgkin lymphoma: too little treatment impacts outcome

et al. 2022

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Multiple clinical trials have assessed de-escalation strategies from combined modality therapy (CMT) to chemotherapy-alone for treatment of early-stage classical Hodgkin lymphoma (cHL) confirming similar outcomes, but the application of these data to the real-world is limited. We conducted a retrospective, multi-center cohort study comparing CMT to chemotherapy-alone in patients with early-stage cHL (stage IA-IIB) treated between January 2010 to December 2020. Positron emission tomography (PET) scans after chemotherapy cycle 2 (PET2) were independently reviewed by a nuclear radiologist (Deauville score ≥4: positive, ≤3: negative). Patient outcomes were compared using intention-to-treat analysis. Among 125 patients (CMT: n=63, chemotherapy-alone: n=62) with a median follow-up of 59.8 months (95% CI, 48.6 to 71.0), no overall survival (OS) differences were observed (5-year OS: CMT 98.0% vs chemotherapy-alone 95.1%, log-rank p=0.38). However, there was reduced progression-free survival (PFS) with chemotherapy-alone among all patients (2-year PFS: CMT 95.1% vs chemotherapy-alone 75.3%, log-rank p=0.005), and in those with bulky (n=43, log-rank p<0.001), unfavorable (n=81, log-rank p=0.002), or PET2-positive disease (n=15, log-rank p=0.02). No significant PFS differences were seen for patients with non-bulky (log-rank p=0.35), favorable (log-rank p=0.62), or PET2-negative (log-rank p=0.19) disease. Based on our real-world experience, CMT appears beneficial for patients with early-stage cHL, especially those with PET2-positive, and unfavorable disease. Chemotherapy-alone regimens can lead to comparable outcomes for patients with favorable, non-bulky, or PET2-negative disease. We conclude that while results seen in clinical trials are replicated in certain patient subgroups, other subgroups not fitting trial criteria do poorly when radiotherapy is excluded.

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The presence of a bulky mediastinal mass of 7 cm or greater in diameter confers an adverse prognosis to patients with advanced Hodgkin lymphoma in case of negative interim PET/CT

Cited by 5 publications

References 23 publications

Response assessment by positron emission tomography‐computed tomography as compared with contrast‐enhanced computed tomography in childhood Hodgkin lymphoma can reduce the need for radiotherapy in low‐ and middle‐income countries

Response assessment by positron emission tomography‐computed tomography as compared with contrast‐enhanced computed tomography in childhood Hodgkin lymphoma can reduce the need for radiotherapy in low‐ and middle‐income countries

Baseline 18F-FDG PET/CT Radiomics in Classical Hodgkin’s Lymphoma: The Predictive Role of the Largest and the Hottest Lesions

A real-world study of combined modality therapy for early-stage Hodgkin lymphoma: too little treatment impacts outcome

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