Predictive value of baseline metabolic tumor volume in early-stage favorable Hodgkin Lymphoma – Data from the prospective, multicenter phase III HD16 trial

Abstract

Background 18F -fluorodeoxyglucose (FDG) positron emission tomography (PET) plays an important role in the staging and response assessment of lymphoma patients. Our aim was to explore the predictive relevance of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with early stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD16 trial. Methods 18F-FDG PET/CT images were available for MTV and TLG analysis in 107 cases from the HD16 trial. We calculated MTV and TLG using three different threshold methods (SUV4.0, SUV41% and SUV140%L), and then performed receiver-operating-characteristic analysis to assess the predictive impact of these parameters in predicting an adequate therapy response with PET negativity after 2 cycles of chemotherapy. Results All three threshold methods analyzed for MTV and TLG calculation showed a positive correlation with the PET response after 2 cycles chemotherapy. The largest area under the curve (AUC) was observed using the fixed threshold of SUV4.0 for MTV- calculation (AUC 0.69 [95% CI 0.55–0.83]) and for TLG-calculation (AUC 0.69 [0.55–0.82]). The calculations for MTV and TLG with a relative threshold showed a lower AUC: using SUV140%L AUCs of 0.66 [0.53–0.80] for MTV and 0.67 for TLG [0.54–0.81]) were observed, while with SUV41% an AUC of 0.61 [0.45–0.76] for MTV, and an AUC 0.64 [0.49–0.80]) for TLG were seen. Conclusions MTV and TLG do have a predictive value after two cycles ABVD in early stage Hodgkin lymphoma, particularly when using the fixed threshold of SUV4.0 for MTV and TLG calculation. Trial registration ClinicalTrials.gov NCT00736320.

An illuminating piece in the jigsaw of Hodgkin lymphoma risk stratification

“…Baseline MTV has been shown as a reliable predictive factor for early treatment response in both children and adults with cHL. 4,5,6 Of the four baseline volumetric PET parameters reported by Milgrom et al, TLG2.5 was reported to best correlate with event-free survival [EFS]. The superiority of TLG is unsurprising, as TLG combines information of the overall tumour burden and its metabolic activity.…”

“…Predictably, SERs had higher baseline MTV 2.5 , TLG 2.5 and MTV 40% TLG 40% values as these values reflect the higher lymphoma burden in these children. Baseline MTV has been shown as a reliable predictive factor for early treatment response in both children and adults with cHL 4,5,6 …”

Advances in positron emission tomography and radiomics

“…The “MTV4” method which automatically segments areas with SUV ≥4.0 required the least manual editing when tested against other commonly applied methods in diffuse large B‐cell lymphoma (DLBCL) 32 and Hodgkin lymphoma (HL) 33 and was the least sensitive to the influence of different imaging reconstructions from different PET systems 34 . This method is gaining acceptance amongst researchers 35–37 . A minimum volume of lesions to be included in an automated approximation of tMTV can be specified within software programmes (e.g., 3mls) 32 which simplifies measurement of tMTV further with little impact on the overall volume estimation.…”

Prognostic value of baseline metabolic tumor volume (MTV) for forecasting chemotherapy outcome in early‐stage unfavorable Hodgkin lymphoma: Data from the phase III HD17 trial

“…The benefits of using metabolic tumor volume (MTV) are now emerging. First, the predictive value of MTV was recently demonstrated in patients with early‐stage favorable and advanced‐stage Hodgkin lymphoma 16,17 and lung cancer 18 . Furthermore, in early‐stage unfavourable disease, it could be shown that MTV measured for response assessment better reflects treatment response under immunotherapy 19 .…”