Metabolic tumor volume by positron emission tomography/computed tomography as a clinical parameter to determine therapeutic modality for early stage Hodgkin's lymphoma

Abstract

Recent studies have shown that metabolic tumor volume (MTV) by positron emission tomography ⁄ computed tomography (PET ⁄ CT) is an important prognostic parameter in patients with non-Hodgkin's lymphoma. However, it is unknown whether doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) alone in early stage Hodgkin's lymphoma would lead to similar disease control as combined modality therapy (CMT) using MTV by PET ⁄ CT. One hundred and twentyseven patients with early stage Hodgkin's lymphoma who underwent PET ⁄ CT at diagnosis were enrolled. The MTV was delineated on PET ⁄ CT by the area ≥SUV max , 2.5 (standardized uptake value [SUV]). Sixty-six patients received six cycles of ABVD only. The other 61 patients received CMT (involved-field radiotherapy after 4-6 cycles of ABVD). The calculated MTV cut-off value was 198 cm 3 . Clinical outcomes were compared according to several prognostic factors (i.e. age ≥50 years, male, performance status ≥2, stage II, B symptoms, ≥4 involved sites, extranodal site, large mediastinal mass, CMT, elevated erythrocyte sedimentation rate and high MTV). Older age (progression-free survival [PFS], P = 0.003; overall survival [OS], P = 0.007), B symptoms (PFS, P = 0.006; OS, P = 0.036) and high MTV (PFS, P = 0.008; OS, P = 0.007) were significant independent prognostic factors. Survival of two high MTV groups treated with ABVD only and CMT were lower than the low MTV groups (PFS, P < 0.012; OS, P < 0.045). ABVD alone was sufficient to control disease in those with low MTV status. However, survival was poor, even if the CMT was assigned a high MTV status. The MTV would be helpful for deciding the therapeutic modality in patients with early stage Hodgkin's lymphoma. (Cancer Sci 2013; 104: 1656-1661

FDG-PET is prognostic and predictive for progression-free survival in relapsed follicular lymphoma: exploratory analysis of the GAUSS study

“…[33] Nonetheless, our results corroborate those of several studies that reported a significant association between baseline PET-derived volumetrics and PFS in other lymphoma subtypes. [34][35][36][37][38][39][40][41] There was, however, no association between baseline SUV max and either PFS or response, in agreement with the results of another recent study in FL. [31] SUV is derived from a single measurement in Table 3.…”

“…[44] Consequently, the current literature does not yet provide evidence that the volume-derived indices MTV and TLG are superior to SUV max for predicting outcome in lymphoma. [35][36][37][38][39][40][41][42]45,46] In our analysis, the optimal cutoff for change in SUV was 60%, although dichotomization with a broad range of SUV cutoffs between 45% and 80% were also discriminative, with significant probability values. Notably, the degree of tumor response is a continuous variable, and thus response evaluation would be better with a continuous measurement method than a dichotomous one.…”

Role of FDG-PET/CT in staging and first-line treatment of Hodgkin and aggressive B-cell lymphomas

“…Preliminary results in small-or medium-sized series suggest that higher MTV may be independently associated with the outcome in HL [23,24] and DLBCL [25,26]. Similarly, high TLG has been independently associated with inferior outcomes in DLBCL [27].…”

Baseline metabolic tumour volume in Hodgkin lymphoma: the prognostic value of accessory cells

“…In the other study an absolute SUV >2.5 was used for volume delineation. This led to overestimation of the metabolic volume by including voxels from the background which in patients with stage I/II HL resulted in finding a median TMTV higher than the median reported by Kanoun et al in patients with more advanced disease [14].…”