Interim-treatment quantitative PET parameters predict progression and death among patients with hodgkin's disease

Diane Tseng,Billy W Loo,Leelanand P Rachakonda,Phuoc T Tran,Richard T Hoppe,Sandra Horning,Zheng Su,Edward E Graves,Andrew Quon,Ranjana Advani

doi:10.1186/1748-717x-7-5

Diane Tseng, Billy W Loo + Show 8 more

Open Access

https://doi.org/10.1186/1748-717x-7-5

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Abstract

PurposeWe hypothesized that quantitative PET parameters may have predictive value beyond that of traditional clinical factors such as the International Prognostic Score (IPS) among Hodgkin's disease (HD) patients.MethodsThirty HD patients treated at presentation or relapse had staging and interim-treatment PET-CT scans. The majority of patients (53%) had stage III-IV disease and 67% had IPS ≥ 2. Interim-treatment scans were performed at a median of 55 days from the staging PET-CT. Chemotherapy regimens used: Stanford V (67%), ABVD (17%), VAMP (10%), or BEACOPP (7%). Hypermetabolic tumor regions were segmented semiautomatically and the metabolic tumor volume (MTV), mean standardized uptake value (SUVmean), maximum SUV (SUVmax) and integrated SUV (iSUV) were recorded. We analyzed whether IPS, absolute value PET parameters or the calculated ratio of interim- to pre-treatment PET parameters were associated with progression free survival (PFS) or overall survival (OS).ResultsMedian follow-up of the study group was 50 months. Six of the 30 patients progressed clinically. Absolute value PET parameters from pre-treatment scans were not significant. Absolute value SUVmax from interim-treatment scans was associated with OS as determined by univariate analysis (p < 0.01). All four calculated PET parameters (interim/pre-treatment values) were associated with OS: MTVint/pre (p < 0.01), SUVmeanint/pre (p < 0.05), SUVmaxint/pre (p = 0.01), and iSUVint/pre (p < 0.01). Absolute value SUVmax from interim-treatment scans was associated with PFS (p = 0.01). Three calculated PET parameters (int/pre-treatment values) were associated with PFS: MTVint/pre (p = 0.01), SUVmaxint/pre (p = 0.02) and iSUVint/pre (p = 0.01). IPS was associated with PFS (p < 0.05) and OS (p < 0.01).ConclusionsCalculated PET metrics may provide predictive information beyond that of traditional clinical factors and may identify patients at high risk of treatment failure early for treatment intensification.

Highlights

Positron emission tomography [1] imaging using [18F] fluorodeoxyglucose serves as a valuable functional imaging modality in patients with lymphoma [2,3,4]
Advani et al showed that a positive [18F]FDG-PET scan following completion of Stanford V chemotherapy was predictive of freedom from progression, even after controlling for bulky disease and International Prognostic Score (IPS) greater than 2 [14]
IPS was associated with progression free survival (PFS) (p < 0.05) and overall survival (OS) (p < 0.01)

Summary

Introduction

Positron emission tomography [1] imaging using [18F] fluorodeoxyglucose serves as a valuable functional imaging modality in patients with lymphoma [2,3,4]. The ability of PET to distinguish between viable tumor and potentially curable lymphomas such as Hodgkin’s disease and diffuse large B-cell lymphoma [13]. Several recent studies have demonstrated the role of [18F]FDG-PET in predicting clinical outcome for patients with Hodgkin’s disease. Advani et al showed that a positive [18F]FDG-PET scan following completion of Stanford V chemotherapy was predictive of freedom from progression, even after controlling for bulky disease and International Prognostic Score (IPS) greater than 2 [14]. The potential clinical utility of [18F]FDG-PET scan may be extended even further. The optimal timing for evaluating early response to treatment is yet to be defined, a recent joint Italian-Danish study has prospectively shown that [18F] FDG-PET scan following two cycles of AVBD chemotherapy is superior than IPS in predicting progression-free survival in patients with Hodgkin’s disease [4]

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