Reclassifying patients with early-stage Hodgkin lymphoma based on functional radiographic markers at presentation

Abstract

The presence of bulky disease in Hodgkin lymphoma (HL), traditionally defined with a 1-dimensional measurement, can change a patient's risk grouping and thus the treatment approach. We hypothesized that 3-dimensional measurements of disease burden obtained from baseline F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), would more accurately risk-stratify patients. To test this hypothesis, we reviewed pretreatment PET-CT scans of patients with stage I-II HL treated at our institution between 2003 and 2013. Disease was delineated on prechemotherapy PET-CT scans by 2 methods: (1) manual contouring and (2) subthresholding of these contours to give the tumor volume with standardized uptake value ≥2.5. MTV and TLG were extracted from the threshold volumes (MTV, TLG) and from the manually contoured soft-tissue volumes. At a median follow-up of 4.96 years for the 267 patients evaluated, 27 patients were diagnosed with relapsed or refractory disease and 12 died. Both MTV and TLG were highly correlated with freedom from progression and were dichotomized with 80th percentile cutoff values of 268 and 1703, respectively. Consideration of MTV and TLG enabled restratification of early unfavorable HL patients as having low- and high-risk disease. We conclude that MTV and TLG provide a potential measure of tumor burden to aid in risk stratification of early unfavorable HL patients.

FDG‐PET/CT in the management of lymphomas: current status and future directions

“…Although TLG in one study was predictive of PFS , MTV performs better in multivariate analyses indicating that degree of FDG avidity per se is less important in HL. MTV remained prognostic after adjustment for clinical risk factors . The role of quantitative FDG‐PET/CT for outcome prediction in DLBCL is less clear with some investigators reporting that MTV (both VOI 2.5 and VOI 41 ) is prognostic of outcome and others not finding an association .…”

“…Nevertheless, a growing body of literature shows that quantitative FDG‐PET/CT can be used to risk stratify patients with lymphoma. In primary and relapsed HL, baseline MTV predicts progression free survival (PFS) both when applying the VOI 2.5 and the VOI 41 methods. Although TLG in one study was predictive of PFS , MTV performs better in multivariate analyses indicating that degree of FDG avidity per se is less important in HL.…”

“…In primary and relapsed HL, baseline MTV predicts progression free survival (PFS) both when applying the VOI 2.5 and the VOI 41 methods. Although TLG in one study was predictive of PFS , MTV performs better in multivariate analyses indicating that degree of FDG avidity per se is less important in HL. MTV remained prognostic after adjustment for clinical risk factors .…”

Hybridbildgebung bei Lymphom

“…Eine zunehmende Anzahl von Studien berichtet von der prognostischen Aussagekraft prätherapeutischer oder (seltener) Interim-Response (semi)quantitativer [18F]FDG-PET-Parameter, welche neben SUV-Werten auch metabolisches Tumorvolumen (MTV) und totale Glykolyse im Lymphomgewebe (TLG, Produkt aus MTV und mittlerem SUV) umfassen. Die bisherigen Ergebnisse lassen auf eine Anwendbarkeit über ein breites Spektrum verschiedener Lymphomsubtypen schließen, welches u. a. Hodgkin-Lymphome, DLBCL, follikuläre Lymphome, MALT-Lymphome und T-Zell-Lymphome umfasst [32][33][34][35][36][37]. Diese prognostische Aussagekraft, welche in den meisten Fällen auf die Vorhersage des progressionsfreien Überlebens (PFS, "progression-free survival") oder Gesamtüberlebens (OS, "overall survival") abzielt, ließ sich für Patienten unter verschiedenen Therapien nachweisen.…”

MRI and PET/MRI in hematologic malignancies

“…Notably, many previous studies have also shown that pretherapeutic SUVs, metabolic tumor volumes (MTV), and total lesion glycolysis (TLG) extracted from [ 18 F]FDG‐PET enable outcome prognostication in a variety of histological subtypes, including HL, DLBCL, FL, and also T‐cell lymphomas . In addition, [ 18 F]FDG‐PET has also been evaluated as a tool for risk stratification in clinical trials, and several studies to investigate this topic are still ongoing.…”