The clinical value of tumor burden at diagnosis in Hodgkin lymphoma

Abstract

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.

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

“…Previous studies have demonstrated that total tumor burden measured using a CT scan can be a predictive tool for evaluating the curative potential of a treatment combination. (30,31) According to those studies, the treatment strategy might be decided dependent on the total tumor burden as well as the presence of bulky disease.…”

Tumor Burden Analysis on Computed Tomography by Automated Liver and Tumor Segmentation

“…Tumor burden also provides meaningful comparison between different treatment regimens, and has been shown to be accurate as an assessment of prognosis. An accurate assessment allows both physicians and patients to make better therapeutic choices earlier [17]. …”

PET Scan in Hodgkin Lymphoma

“…In a prior study of HL patients treated on standard protocols, the mean tumor burden normalized to body surface area based on CT measurements was found to be largely superior to all prognostic models as a predictor of complete remission and survival [124,125]. Given the coverage of the entire body, metabolic volume determination may be a better surrogate for response and survival by representing overall tumor functionality.…”

“…Hodgkin lymphoma Tumor bulk is a significant negative prognostic factor in early-stage HL [113,[123][124][125]. However, not only the exact definition of tumor bulk remains a controversial topic but also an objective method to measure whole body tumor burden is yet to be established for a patient-tailored management.…”