Image-Aided Estimate of Tumor Burden in Hodgkin’s Disease: Evidence of Its Primary Prognostic Importance

Gobbi, Paolo G.; Ghirardelli, Maria Laura; Solcia, Marco; Giulio, Giuseppe Di; Merli, Francesco; Tavecchia, Luisa; Bertè, Raffaella; Davini, Ottavio; Levis, Alessandro; Broglia, Chiara; Maffè, Gabriella Carnevale; Ilariucci, Fiorella; Dore, Roberto; Ascari, E

doi:10.1200/jco.2001.19.5.1388

Cited by 62 publications

(49 citation statements)

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“…16 The current series included 121 patients in whom the feasibility of TB measurement through CT scans was evaluated and reported first. 8 The follow-up of these patients was prolonged by an average of 2.5 years; 3 additional recurrences and 1 cardiac sudden death occurred among the patients in this period. The median followup of the whole study population was 62 months (range, 9 -198 months).…”

Section: Study Population and Managementmentioning

confidence: 99%

“…The bone marrow TB was then calculated as 1 ⁄3 of the calculated volume when involvement was diffuse, 1 ⁄10 when it was focal, and 1 ⁄20 when it was defined as nodular. 8 The few patients who had involved superficial lymph nodes outside the CT scans were considered in this study only if they had ultrasonographic measurements of at least two greatest dimensions of each involved lymph node. The volumes of these superficial lesions were calculated geometrically and then summed with those from the CT evaluation to reach the total TB.…”

Section: Tb Assessmentmentioning

confidence: 99%

“…8 In brief, scans had to be no more than 10 mm thick and contiguous. They could be generated either by a spiral unit or by a conventional unit; for nonspiral CT units, the scanning time had to be no longer than 5 seconds.…”

Section: Tb Assessmentmentioning

confidence: 99%

“…However, the original technique of evaluation (based on physical examination, chest X-ray, and bipedal lymphangiography) was semiquantitative, rather complex, and difficult to reproduce, and it never was applied subsequently by other investigators. Recently, some of us 8,9 demonstrated the feasibility of a more accurate measurement of TB through the evaluation of standard computed tomography (CT) images, confirmed the pivotal prognostic role of TB compared with all of the other clinical parameters currently used, and opened new prospects regarding early treatment choices.…”

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The clinical value of tumor burden at diagnosis in Hodgkin lymphoma

Gobbi

Broglia

Giulio

et al. 2004

Cancer

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BACKGROUNDThe authors investigated the clinical role of tumor burden (TB) in patients with Hodgkin lymphoma, relating this parameter to most of the current clinical and prognostic factors and to the best predictive multifactorial models.METHODSThe volume of TB at diagnosis was measured directly from the initial staging computed tomography scans in 351 patients who were treated on standard protocols. The mean patient age was 34.0 years ± 16.4 years. Forty‐six patients had clinical Stage I disease, 201 patients had Stage II disease, 64 patients had Stage III disease, and 40 patients had Stage IV disease. There were 146 symptomatic patients. Overall survival (OS), disease‐free survival (DFS), and time to treatment failure (TTF) were the time parameters evaluated in the multivariate analysis. Logistic regression was applied according to those who achieved or failed complete remission.RESULTSThe mean TB normalized to body surface area (rTB) was 137.8 cm3/m2 ± 124.7 cm3/m2 (range, 1.9–694.5 cm3/m2). In multivariate analysis, rTB was the best predictor of TTF, DFS, and complete remission; the second best predictor of OS after patient age; and largely superior to all prognostic models analyzed. For the same stage and treatment, patients who were destined to clinical failure had an initial rTB 60–108% higher compared with the initial rTB in patients who achieved a cure, whereas differences in drug dose intensity were not significant.CONCLUSIONSIn the current study, it was found that the rTB, as a prognostic factor, was more effective than and was independent of hitherto used factors and scores. The rTB may be a tool for evaluating the curative potential of treatment combinations, allowing physicians and patients to make better therapeutic choices earlier. Cancer 2004. © 2004 American Cancer Society.

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Section: Study Population and Managementmentioning

confidence: 99%

Section: Tb Assessmentmentioning

confidence: 99%

Section: Tb Assessmentmentioning

confidence: 99%

mentioning

confidence: 99%

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The clinical value of tumor burden at diagnosis in Hodgkin lymphoma

Gobbi

Broglia

Giulio

et al. 2004

Cancer

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“…O número de AAE pode ser um indicador secundário de carga tumoral, um forte fator prognóstico adverso para LH apesar de ser uma variável difícil de ser quantificada ou mesmo estimada [27][28][29][30][31] . O estadiamento não é capaz de prever a carga tumoral com mais precisão, porque não considera o número de sítios anatômicos afetados.…”

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Number of involved anatomic areas as a risk predictor in pediatric Hodgkin’s lymphoma: a retrospective study

Morais¹,

Barros²,

Hassan³

et al. 2009

J Pediatr (Rio J)

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Objective: To determine if the number of involved anatomic areas can modify the standard risk groups in pediatric Hodgkin's lymphoma, identifying children who would benefit from a reduction in treatment intensity. Methods:Retrospective study evaluating age, sex, histology, AnnArbor stage, presence of B symptoms, number of involved anatomic areas, risk grouping (favorable vs. unfavorable), and laboratory exams. All patients received doxorubicin-containing chemotherapy. Patients in complete remission for 5 years or longer were evaluated as for late effects.Results: Sixty-nine patients (2-18 years) were included, 68% belonged to the unfavorable risk group. Overall survival and event-free survival were 94 and 87%, respectively. Late effects were screened in 46 cases. Advanced stage and ≥ four involved anatomic areas had negative impact on event-free survival, while only the number of involved anatomic areas retained statistical significance when using Cox analysis (hazard ratio = 6.4, 95%CI = 1.08-38.33; p = 0.04). Risk groups were adjusted by number of involved anatomic areas (< four/≥ four involved anatomic areas), with a significant reallocation of patients (p = 0.008). Of the 30 patients with late effects, 21 were in the original unfavorable risk group and 14 (66.6%) could have been reallocated to the favorable risk group based on the number of involved anatomic areas. Conclusion:If re-stratification had been applied, a considerable number of children would have received less intensive treatment and, consequently, could have had lower chances of late effects. A prospective study could define if adjustment of risk group by number of involved anatomic areas would have any impact on survival rates. J Pediatr (Rio J). 2009;85(3):236-242:Hodgkin's lymphoma, childhood, risk groups, involved anatomic areas, late effects. ResumoObjetivo: Determinar se o número de áreas anatômicas envolvidas pode modificar os grupos de risco padrão no linfoma de Hodgkin pediátrico, identificando as crianças que poderiam se beneficiar de uma redução da intensidade do tratamento.Métodos: Estudo retrospectivo com avaliação de idade, sexo, histologia, classificação de Ann-Arbor, presença de sintomas B, número de áreas anatômicas envolvidas, grupos de risco (favorável versus desfavorável) e exames laboratoriais. Todos os pacientes receberam quimioterapia com doxorrubicina. Os pacientes em remissão completa por 5 anos ou mais foram avaliados para a detecção de efeitos tardios.Resultados: Sessenta e nove pacientes (2-18 anos) foram incluídos, sendo que 68% pertenciam ao grupo de risco desfavorável. A sobrevida global e a sobrevida livre de eventos foram de 94 e 87%, respectivamente. Os efeitos tardios foram detectados em 46 casos. Estágio avançado e ≥ quatro áreas anatômicas envolvidas tiveram impacto negativo sobre a sobrevida livre de eventos, enquanto que o número de áreas anatô-micas envolvidas apresentou significância estatística de acordo com a análise de Cox (razão de risco = 6,4; IC95% = 1,08-38,33; p = 0,04). Os grupos de risco...

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Tumour burden predicts treatment resistance in patients with early unfavourable or advanced stage Hodgkin lymphoma treated with ABVD and radiotherapy

Gobbi

Bassi

Bergonzi

et al. 2012

Hematological Oncology

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The purpose of the work was to investigate the factors predicting early resistance to treatment in Hodgkin lymphoma. Many staging parameters, including relative tumour burden (rTB), were analysed in 246 patients with Hodgkin lymphoma in relation to early failure, that is, less than complete remission (i.e. partial response, null response or progression) or occurrence of early relapse, as clinical expressions of resistance to treatment. Patients with early unfavourable disease were 129 and were treated with four to six cycles of ABVD + involved field radiotherapy; 117 patients with advanced stage disease received six cycles of ABVD + optional irradiation to no more than two sites. The rTB was volumetrically measured through the evaluation of staging computed tomography for all the lesions except bone marrow involvement, which was quantified by calculation. The relationship with early resistance was analysed with logistic regressions. The rTB demonstrated to be the best predictor of early failure in both patient subsets, being superior to the multiparameter International Prognostic Score. The rTB showed a significant exponential relationship with the relative risk of early failure, and with inclusion of the extranodal involvement into the model, a single equation became adequate to predict resistance in both early unfavourable and advanced stage patients. The conclusions are that the rTB is the best pretreatment factor related to the risk of resistance to combined ABVD + radiotherapy and that this relationship can be mathematically expressed in an easy way. A simplified assessment of rTB is highly desirable.

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Image-Aided Estimate of Tumor Burden in Hodgkin’s Disease: Evidence of Its Primary Prognostic Importance

Abstract: Relative TB is emerging as a strong prognostic factor in HD, more powerful than and largely independent of those hitherto known and used. Further studies are needed to confirm these results and exploit their clinical value, particularly the relationship among rTB, drug doses, and response.

Cited by 62 publications

References 25 publications

The clinical value of tumor burden at diagnosis in Hodgkin lymphoma

The clinical value of tumor burden at diagnosis in Hodgkin lymphoma

Number of involved anatomic areas as a risk predictor in pediatric Hodgkin’s lymphoma: a retrospective study

Tumour burden predicts treatment resistance in patients with early unfavourable or advanced stage Hodgkin lymphoma treated with ABVD and radiotherapy

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