Baseline metabolic tumour volume is an independent prognostic factor in Hodgkin lymphoma

Kanoun, Salim; Rossi, Cédric; Berriolo‐Riedinger, Alina; Dygai‐Cochet, Inna; Cochet, Alexandre; Humbert, Olivier; Toubeau, Michel; Ferrant, Emmanuelle; Brunotte, François; Casasnovas, Olivier

doi:10.1007/s00259-014-2783-x

Cited by 152 publications

(132 citation statements)

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“…This method used the 41% SUV max threshold method, as recommended by European Association of Nuclear Medicine (EANM), and because of its high interobserver reproducibility already described in lymphoma (23). A volume of interest was set around each lesion (node or organ involvement) as described previously (10,13,23). Bone marrow involvement was included in volume measurement only if there was focal uptake.…”

Section: Pet/ct Parametersmentioning

confidence: 99%

“…New promising PET metrics derived from baseline PET, allowing an estimate of tumor burden and metabolism, are proposed as biomarkers: the total metabolic tumor volume (TMTV) which is the sum of the regions of the local tumors with FDG uptake; the total lesion glycolysis (TLG) which is the sum of these regions weighted by the intensity of their FDG uptake. Retrospective studies have at least shown that a high TMTV was significantly associated with a worse PFS and/or overall survival (OS) in DLBCL (10,11) but also in other type of lymphoma, in primary mediastinal large B-cell lymphoma (12), in Hodgkin lymphoma (13), and in peripheral T-cell lymphoma (14).…”

Section: Introductionmentioning

confidence: 99%

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Molecular Profile and FDG-PET/CT Total Metabolic Tumor Volume Improve Risk Classification at Diagnosis for Patients with Diffuse Large B-Cell Lymphoma

Cottereau

Lanic

Mareschal

et al. 2016

Clinical Cancer Research

158

136

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Purpose: The prognostic impact of total metabolic tumor volume (TMTV) measured on pretreatment 18 F-FDG PET/CT and its added value to molecular characteristics was investigated in patients with diffuse large B-cell lymphoma (DLBCL).Experimental Design: For 81 newly diagnosed patients with DLBCL treated with rituximab and CHOP/CHOP-like regimen, TMTV was computed using the 41% SUV max thresholding method. According to the gene expression profile, determined using DASL (cDNA-mediated Annealing, Selection, Ligation and extension) technology, a subset of 57 patients was classified in germinal center B (GCB) or activated B-cell (ABC) subtypes and MYC or BCL2 overexpressed.Results: Median follow-up was 64 months. Five-year progression-free survival (PFS) and overall survival (OS) were 60% and 63% in the whole population. Median pretherapy TMTV was 320 cm 3 (25th-75th percentiles 106-668 cm 3 ). With a 300 cm 3 cutoff, patients with high TMTV (n ¼ 43) had a 5-year PFS and OS of 43% and 46% compared with 76% and 78% for patients with a low TMTV (P ¼ 0.0023, P ¼ 0.0047). ABC status, MYC, or BCL2 overexpression and both overexpression ("dual expressor," DE) were significantly associated with a worse PFS and OS. TMTV combined with molecular data allowed a significant better risk substratification of ABC/GCB patients, on PFS and OS. High TMTV individualized in molecular-low-risk patients a group with a poor outcome (MYC, PFS¼51%, OS¼55% BCL2, PFS¼49%, OS¼49% or DE PFS¼50%, OS¼50%) and a group with a good outcome (MYC, PFS¼93%, OS¼93% BCL2, PFS¼86%, OS¼86%, or DE PFS¼81%, OS¼81%). Conclusions:The combination of molecular and imaging characteristics at diagnosis could lead to a more accurate selection of patients, to increase tailor therapy.

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Section: Pet/ct Parametersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Molecular Profile and FDG-PET/CT Total Metabolic Tumor Volume Improve Risk Classification at Diagnosis for Patients with Diffuse Large B-Cell Lymphoma

Cottereau

Lanic

Mareschal

et al. 2016

Clinical Cancer Research

158

136

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“…It can be relative, using a percentage of the maximum uptake. A threshold of 41% of the SUV max within the lesion, recommended by the European Association of Nuclear Medicine for solid tumors (7), has been used in patients with Hodgkin lymphoma (4), diffuse large B cell lymphoma (3), and PTCL (5), with a good interobserver reproducibility. However, because lymphomas are heterogeneous disease with several tumor sites with a wide range of volumes, SUVs, and tumor background ratios, the adaptive segmentation methods might be of interest for TMTV measurement and could be proposed as an alternative to fixed thresholding methods.…”

mentioning

confidence: 99%

Baseline Total Metabolic Tumor Volume Measured with Fixed or Different Adaptive Thresholding Methods Equally Predicts Outcome in Peripheral T Cell Lymphoma

et al. 2016

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The purpose of this study was to compare in a large series of peripheral T cell lymphoma, as a model of diffuse disease, the prognostic value of baseline total metabolic tumor volume (TMTV) measured on 18 F-FDG PET/CT with adaptive thresholding methods with TMTV measured with a fixed 41% SUV max threshold method. Methods: One hundred six patients with peripheral T cell lymphoma, staged with PET/CT, were enrolled from 5 Lymphoma Study Association centers. In this series, TMTV computed with the 41% SUV max threshold is a strong predictor of outcome. On a dedicated workstation, we measured the TMTV with 4 adaptive thresholding methods based on characteristic image parameters: Daisne (Da) modified, based on signal-to-background ratio; Nestle (Ns), based on tumor and background intensities; Fit, including a 3-dimensional geometric model based on spatial resolution (Fit); and Black (Bl), based on mean SUV max . The TMTV values obtained with each adaptive method were compared with those obtained with the 41% SUV max method. Their respective prognostic impacts on outcome prediction were compared using receiver-operatingcharacteristic (ROC) curve analysis and Kaplan-Meier survival curves. Results: The median value of TMTV 41% , TMTV Da , TMTV Ns , TMTV Fit , and TMTV Bl were, respectively, 231 cm 3 (range, 5-3,824), 175 cm 3 (range, 8-3,510), 198 cm 3 (range, 3-3,934), 175 cm 3 (range, 8-3,512), and 333 cm 3 (range, 3-5,113). The intraclass correlation coefficients were excellent, from 0.972 to 0.988, for TMTV Da , TMTV Fit , and TMTV Ns , and less good for TMTV Bl (0.856). The mean differences obtained from the Bland-Altman plots were 48.5, 47.2, 19.5, and 2253.3 cm 3 , respectively. Except for Black, there was no significant difference within the methods between the ROC curves (P . 0.4) for progression-free survival and overall survival. Survival curves with the ROC optimal cutoff for each method separated the same groups of low-risk (volume # cutoff) from high-risk patients (volume . cutoff), with similar 2-y progression-free survival (range, 66%-72% vs. 26%-29%; hazard ratio, 3.7-4.1) and 2-y overall survival (79%-83% vs. 50%-53%; hazard ratio, 3.0-3.5). Conclusion: The prognostic value of TMTV remained quite similar whatever the methods, adaptive or 41% SUV max , supporting its use as a strong prognosticator in lymphoma. However, for implementation of TMTV in clinical trials 1 single method easily applicable in a multicentric PET review must be selected and kept all along the trial. PET/ CT with 18 F-FDG has been recognized as the best imaging tool for staging and response assessment in FDG-avid lymphoma. The last International Conference on Malignant Lymphoma recommendations (1) encourage investigating the quantitative analysis of 18 F-FDG PET/CT at staging. In this regard, the measurement of the total metabolic tumor volume (TMTV), which gives an estimation of the total tumor burden, has gained special interest. Indeed, several series have shown that TMTV was predictive of outcome in different lymphoma subtypes: d...

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“…46 In addition, a recent analysis examined the prognostic importance of baseline (pretreatment) total MTV in untreated HL patients. 47 Baseline total MTV more accurately predicted outcome than tumor bulk and was prognostic in multivariate analysis for PFS.…”

Section: New Techniquesmentioning

confidence: 92%

The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

Evens

Kostakoğlu

2014

Blood

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Given the excellent survival rates for early-stage Hodgkin lymphoma (HL), the young age of many patients, and concerns regarding acute and late treatment-related toxicities, there is a desire to have a predictive tool that enables therapy to be tailored toward the individual patient. Early (or interim) 18F-fluorodeoxyglucose positron emission tomography with computerized tomography (FDG-PET/CT), as a test of tumor sensitivity to ongoing/planned therapy, has been shown to be prognostic for survival in HL. Based on results of interim FDG-PET/CT, therapy may be subsequently modified through minimization or via intensification for low- and high-risk patient populations, respectively (ie, response-adapted therapy). Important data have been generated to standardize the interpretability and reproducibility of interim FDG-PET/CT (eg, the Deauville 5-point system), and observational and noncontrolled prospective studies have produced evidence supporting the hypothesis that response-adapted therapy may potentially serve as a predictive tool. Furthermore, results from noninferiority phase 3 clinical trials randomizing early-stage HL patients with negative interim FDG-PET/CT to combined modality therapy versus chemotherapy alone have been reported. The current collective findings from these randomized early-stage HL studies have shown that acute relapse rates are lower with combined modality therapy, even in patients with negative interim FDG-PET/CT. Additional randomized response-adapted studies are ongoing and novel FDG-PET/CT applications involving quantitative techniques and innovative imaging modalities are being investigated to identify more robust imaging biomarkers. Treatment of early-stage HL remains a clinical management choice for physicians and patients to make with consideration of acute and long-term outcomes.

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Baseline metabolic tumour volume is an independent prognostic factor in Hodgkin lymphoma

Cited by 152 publications

References 35 publications

Molecular Profile and FDG-PET/CT Total Metabolic Tumor Volume Improve Risk Classification at Diagnosis for Patients with Diffuse Large B-Cell Lymphoma

Molecular Profile and FDG-PET/CT Total Metabolic Tumor Volume Improve Risk Classification at Diagnosis for Patients with Diffuse Large B-Cell Lymphoma

Baseline Total Metabolic Tumor Volume Measured with Fixed or Different Adaptive Thresholding Methods Equally Predicts Outcome in Peripheral T Cell Lymphoma

The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

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