Early interim PET/CT predicts post-treatment response in diffuse large B-cell lymphoma

Wu, Xingchen; Pertovaara, Hannu; Korkola, Pasi; Vornanen, Martine; Järvenpää, Ritva; Dastidar, Prasun; Eskola, Hannu; Kellokumpu-Lehtinen, Pirkko-Liisa

doi:10.3109/0284186x.2014.927074

Cited by 11 publications

(9 citation statements)

References 27 publications

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“…Previous studies suggested that a low MTV on I-PET or a major decrease of MTV vs. baseline PET in DLBCL, predicts response at end-of-treatment PET and progression-free-survival (7-9,15-17). However, MTV cut-offs were different, and it is unclear whether and/or to which extent this relates to the use of different semi-automated delineation algorithms; Oñate-Ocaña used a 40%SUVmax threshold, Zhang a 41%, Wu a 42% and Malek a 37%SUVmax threshold and a gradient-based segmentation method (Gradient), while Islam applied a SUV4.0 threshold and Yang and Mikhaeel a SUV2.5 threshold (7)(8)(9)(15)(16)(17)34). This precludes any meaningful meta-analysis to build the case of evidence for MTV as a predictor for clinical outcome additional to (delta)SUVmax and the five-point DS (10,11).…”

Section: Discussionmentioning

confidence: 99%

Interobserver Agreement on Automated Metabolic Tumor Volume Measurements of Deauville Score 4 and 5 Lesions at Interim ¹⁸F-FDG PET in Diffuse Large B-Cell Lymphoma

et al. 2021

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Metabolic tumor volume (MTV) on interim-PET (I-PET) is a potential prognostic biomarker for diffuse large B-cell lymphoma (DLBCL). Implementation of MTV on I-PET requires consensus which semiautomated segmentation method delineates lesions most successfully with least user interaction.Methods used for baseline PET are not necessarily optimal for I-PET due to lower lesional standardized uptake values (SUV) at I-PET. Therefore, we aimed to evaluate which method provides the best delineation quality of Deauville-score (DS) 4-5 DLBCL lesions on I-PET at best interobserver agreement on delineation quality and, secondly, to assess the effect of lesional SUVmax on delineation quality and performance agreements. Methods: DS4-5 lesions from 45 I-PET scans were delineated using six semiautomated methods i) SUV 2.5, ii) SUV 4.0, iii) adaptive threshold [A50%peak], iv) 41% of maximum SUV [41%max], v) majority vote including voxels detected by ≥2 methods [MV2] and vi) detected by ≥3 methods [MV3]. Delineation quality per MTV was rated by three independent observers as acceptable or non-acceptable. For each method, observer scores on delineation quality, specific agreements and MTV were assessed for all lesions, and per category of lesional SUVmax (<5, 5-10, >10). Results: In 60 DS4-5 lesions on I-PET, MV3 performed best, with acceptable delineation in 90% of lesions, with a positive agreement (PA) of 93%. Delineation quality scores and agreements per method strongly depended on lesional SUV: the best delineation quality scores were obtained using MV3 in lesions with SUVmax<10 and SUV4.0 in more FDG-avid lesions. Consequently, overall delineation quality and PA improved by applying the most preferred method per SUV category instead of using MV3 as single best method. MV3-and SUV4.0-derived MTVs of lesions with SUVmax>10, were comparable after excluding visually failed MV3 contouring. For lesions with SUVmax<10, MTVs using different methods correlated poorly. Conclusion: On I-PET, MV3 performed best and provided the highest interobserver agreement regarding acceptable delineations of DS4-5 DLBCL lesions. However, delineation method preference strongly depended on lesional SUV. Therefore, we suggest to explore an approach that identifies the optimal delineation method per lesion as function of tumor FDG uptake characteristics, i.e. SUVmax.

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Section: Discussionmentioning

confidence: 99%

Interobserver Agreement on Automated Metabolic Tumor Volume Measurements of Deauville Score 4 and 5 Lesions at Interim ¹⁸F-FDG PET in Diffuse Large B-Cell Lymphoma

et al. 2021

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“…Previous literature has reported that interim treatment response to first-line chemotherapy acts as an important prognostic factor in DLBCL patients. Patients with poor interim treatment response and positive interim PET are more likely to have recurrence and progression, and the prognosis generally remains worsened (26)(27)(28)(29). Poor interim treatment response is an indication for early clinical intervention, including salvage treatment, intensive treatment or autologous stem cell transplantation (30).…”

Section: Discussionmentioning

confidence: 99%

Predictive value of baseline ¹⁸F‑FDG PET/CT and interim treatment response for the prognosis of patients with diffuse large B‑cell lymphoma receiving R‑CHOP chemotherapy

et al. 2020

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The present study aimed to investigate the prognostic value of baseline 18 F-FDG PET/CT quantitative parameters and interim treatment response, and to assess whether the combination of these could improve the predictive efficacy in patients with diffuse large B-cell lymphoma (DLBCL) receiving R-CHOP chemotherapy. PET/CT images and clinical data of 64 patients with DLBCL who had undergone 18 F-FDG PET/CT scan before and after 3 or 4 cycles of R-CHOP chemotherapy were retrospectively reviewed. The quantitative parameters including standardized uptake value (SUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum diameter of the maximum lesion (Dmax) were measured on baseline PET/CT images. Cox proportional hazards model was used to evaluate the influence of baseline PET/CT parameters, clinical indicators and interim treatment response on prognosis. Survival analysis was performed using Kaplan-Meier method. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive efficacy of the combination of baseline PET/CT parameters and interim treatment response. Ann Arbor stage, International Prognostic Index (IPI), lactate dehydrogenase (LDH), necrosis, MTVmax, TLGmax, Dmax and interim treatment response showed association with 2-year progression-free survival (PFS, P<0.05). LDH, necrosis, MTVmax, MTVsum, TLGmax, TLGsum, Dmax and interim treatment response showed association with 2-year overall survival (OS, P<0.05). Ann Arbor stage, Dmax and interim treatment response were found to be independent predictors of 2-year PFS (P<0.05), while Dmax and interim treatment response were found to be independent predictors of 2-year OS (P<0.05). The PFS and OS curves of Dmax <5.7 cm group and Dmax ≥5.7 cm group, complete response (CR) group and non-CR group were significantly different, respectively (P<0.05). The baseline 18 F-FDG PET/CT parameters and interim treatment response have important prognostic values in DLBCL patients who received R-CHOP chemotherapy. Combined application of Dmax and interim treatment response improved the predictive efficacy of 2-year PFS. It may be helpful to identify patients who are at high-risk of relapse and to guide early clinical intervention of these patients.

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“…PET allows target adjustment due to volume changes in response to chemotherapy (adaptive planning) during treatment. More importantly, PET-CT provides excellent post-treatment evaluation, especially in patients with HL and DLBCL [36,37]. Although the clinical benefits may be less apparent for other lymphomas, PET-CT is considered the state-of-the-art imaging technique and the most sensitive and specific functional imaging currently available for the assessment of lymphoma and many other malignancies [26].…”

Section: Lymphoma Imagingmentioning

confidence: 99%

Image-Guided Radiation Therapy in Lymphoma Management

2016

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Image-guided radiation therapy (IGRT) is a process of incorporating imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), Positron emission tomography (PET), and ultrasound (US) during radiation therapy (RT) to improve treatment accuracy. It allows real-time or near real-time visualization of anatomical information to ensure that the target is in its position as planned. In addition, changes in tumor volume and location due to organ motion during treatment can be also compensated. IGRT has been gaining popularity and acceptance rapidly in RT over the past 10 years, and many published data have been reported on prostate, bladder, head and neck, and gastrointestinal cancers. However, the role of IGRT in lymphoma management is not well defined as there are only very limited published data currently available. The scope of this paper is to review the current use of IGRT in the management of lymphoma. The technical and clinical aspects of IGRT, lymphoma imaging studies, the current role of IGRT in lymphoma management and future directions will be discussed.

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Early interim PET/CT predicts post-treatment response in diffuse large B-cell lymphoma

Cited by 11 publications

References 27 publications

Interobserver Agreement on Automated Metabolic Tumor Volume Measurements of Deauville Score 4 and 5 Lesions at Interim ¹⁸F-FDG PET in Diffuse Large B-Cell Lymphoma

Interobserver Agreement on Automated Metabolic Tumor Volume Measurements of Deauville Score 4 and 5 Lesions at Interim ¹⁸F-FDG PET in Diffuse Large B-Cell Lymphoma

Predictive value of baseline ¹⁸F‑FDG PET/CT and interim treatment response for the prognosis of patients with diffuse large B‑cell lymphoma receiving R‑CHOP chemotherapy

Image-Guided Radiation Therapy in Lymphoma Management

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Early interim PET/CT predicts post-treatment response in diffuse large B-cell lymphoma

Cited by 11 publications

References 27 publications

Interobserver Agreement on Automated Metabolic Tumor Volume Measurements of Deauville Score 4 and 5 Lesions at Interim 18F-FDG PET in Diffuse Large B-Cell Lymphoma

Interobserver Agreement on Automated Metabolic Tumor Volume Measurements of Deauville Score 4 and 5 Lesions at Interim 18F-FDG PET in Diffuse Large B-Cell Lymphoma

Predictive value of baseline 18F‑FDG PET/CT and interim treatment response for the prognosis of patients with diffuse large B‑cell lymphoma receiving R‑CHOP chemotherapy

Image-Guided Radiation Therapy in Lymphoma Management

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Interobserver Agreement on Automated Metabolic Tumor Volume Measurements of Deauville Score 4 and 5 Lesions at Interim ¹⁸F-FDG PET in Diffuse Large B-Cell Lymphoma

Interobserver Agreement on Automated Metabolic Tumor Volume Measurements of Deauville Score 4 and 5 Lesions at Interim ¹⁸F-FDG PET in Diffuse Large B-Cell Lymphoma

Predictive value of baseline ¹⁸F‑FDG PET/CT and interim treatment response for the prognosis of patients with diffuse large B‑cell lymphoma receiving R‑CHOP chemotherapy