Only strongly enhanced residual FDG uptake in early response PET (Deauville 5 or qPET ≥ 2) is prognostic in pediatric Hodgkin lymphoma: Results of the GPOH‐HD2002 trial

Abstract

Purpose In 2014, we published the qPET method to quantify fluorodeoxyglucose positron emission tomography (FDG‐PET) responses. Analysis of the distribution of the quantified signals suggested that a clearly abnormal FDG‐PET response corresponds to a visual Deauville score (vDS) of 5 and high qPET values ≥ 2. Evaluation in long‐term outcome data is still pending. Therefore, we analyzed progression‐free survival (PFS) by early FDG‐PET response in a subset of the GPOH‐HD2002 trial for pediatric Hodgkin lymphoma (PHL). Patients/Methods Pairwise FDG‐PET scans for initial staging and early response assessment after two cycles of chemotherapy were available in 93 PHL patients. vDS and qPET measurement were performed and related to PFS. Results Patients with a qPET value ≥ 2.0 or vDS of 5 had 5‐year PFS rates of 44%, respectively 50%. Those with qPET values < 2.0 or vDS 1 to 4 had 5‐year PFS rates of 90%, respectively 80%. The positive predictive value of FDG‐PET response assessment increased from 18% (9%; 33%) using a qPET threshold of 0.95 (vDS ≤ 3) to 30% (13%; 54%) for a qPET threshold of 1.3 (vDS ≤ 4) and to 56% (23%; 85%) when the qPET threshold was ≥ 2.0 (vDS 5). The negative predictive values remained stable at ≥92% (CI: 82%; 98%). Conclusion Only strongly enhanced residual FDG uptake in early response PET (vDS 5 or qPET ≥ 2, respectively) seems to be markedly prognostic in PHL when treatment according to the GPOH‐HD‐2002 protocol is given.

Interim PET in Diffuse Large B-Cell Lymphoma

“…To restrict interim analysis to a single scan, while maintaining the advantage of a continuous scale, we developed the qPET method (q, quotient) where the mean SUV of the four most intense connected voxels of residual lymphoma-related uptake are put into relation with the mean SUV of a large volume in the liver. Pioneered in Hodgkin's lymphoma, this approach converted the ordinal Deauville scale into a well-defined quantitative scale (12)(13)(14).…”

A rapid review of evidence and recommendations from the SIOPE radiation oncology working group to help mitigate for reduced paediatric radiotherapy capacity during the COVID-19 pandemic or other crises

“…o Hypofractionation (!3 Gy/f) has been used to treat metastatic STS and ES, achieving high levels of local control[24] (level 3). o SBRT has demonstrated good local control in small single centre series[25]; it is being evaluated in the French SBRT study (see above), and the COG AEWS1221 Ewing study where 30-40 Gy in 5 fractions is being used for bone metastases (level 3).Evidence o Most protocols for the treatment of paediatric Hodgkin lymphoma have used 1.5-1.8 Gy fractions[26][27][28]. However, in adult Hodgkin lymphoma, 2 Gy fractions are standard[29].In addition, the boost dose per fraction is also 2 Gy in the EuroNet protocol (level 2).…”

Early Radiation-Induced Sarcoma in an Adolescent Treated for Relapsed Hodgkin Lymphoma with Nivolumab

“…As per protocol, 30 Gy were delivered to the mediastinum based on the insufficient early response after two OEPA courses. A recent study confirmed an adverse prognostic value of a strongly enhanced residual 18 FDG uptake in early PET-response for treatment outcome [13]. Adversely, the disease was overstaged to Lugano stage IV instead of II based on the positive 18 FDG uptake in the benign enchondroma of the femur that caused initial overtreatment.…”