Prognostic significance of interim PET/CT based on visual, SUV-based, and MTV-based assessment in the treatment of peripheral T-cell lymphoma.

Sung-Hoon Jung,Joon Ho Moon,Je-Jung Lee,Byung Hyun Byun,Jung-Joon Min,Sang Woo Lee,Young Rok Do,Sang Kyun Sohn,Yeo-Kyeoung Kim,Jae-Sook Ahn,Hee-Seung Bom,Deok-Hwan Yang,Hyeoung-Joon Kim,Yee Soo Chae,Sun-Seog Kweon

doi:10.1186/s12885-015-1193-1

Abstract

BackgroundsThe role of interim PET/CT in peripheral T-cell lymphoma (PTCL) is less identified compared to other subtype of lymphoma. This study prospectively investigated the prognostic accuracy of sequential interim PET/CT using visual and quantitative assessment to determine whether it provided prognostic information for the treatment of PTCL.MethodsSixty-three patients with newly diagnosed PTCL were enrolled, and 59 patients underwent interim PET/CT after three or four courses of induction treatment. The response of interim PET/CT was assessed by three parameters: the Deauville five-point scale (5-PS), ΔSUVmax, and ΔMTV2.5.ResultsOver a median follow up of 40.3 months, each assessment of interim PET/CT using the 5-PS, ΔSUVmax, and ΔMTV2.5 had predictive value for progression-free survival. To increase the predictive accuracy of interim PET/CT, we divided patients into three groups according to the sum of scores for three adverse responses based on the visual, SUV-based and MTV-based assessment: favorable, intermediate, and poor responder. The clinical outcome of patients in the favorable group was significantly superior to patients in the poor or intermediate group.ConclusionVisual, quantitative SUV-based, and MTV-based assessment in interim PET/CT are valuable for early treatment response assessment in patients with PTCL, and the combined approach using the three parameters was more efficient in discriminating between patients with different survival outcomes compared with single-parameter assessment.Trial registrationNCT01470066.

Highlights

Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of aggressive lymphomas, in which the T-cell phenotype itself is associated with unfavorable prognostic factors compared with B-cell-phenotype lymphomas [1]
The lack of agreed-upon standardized response criteria, difference in the percent risk according to the international prognostic index (IPI) or prognostic index of peripheral T-cell lymphoma (PIT), and different treatment modalities used have contributed to the variability of outcomes and poor reproducibility [9,10,11]
We prospectively investigated the prognostic accuracy of sequential interim positron emission tomography (PET)/CT using visual and quantitative assessment to determine whether it provided prognostic information for the treatment of PTCL

Summary

Introduction

Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of aggressive lymphomas, in which the T-cell phenotype itself is associated with unfavorable prognostic factors compared with B-cell-phenotype lymphomas [1]. Jung et al BMC Cancer (2015) 15:198 to avoid poor outcomes Such treatment modification using the interim metabolic response remains controversial, and its clinical use is not permitted, except in clinical trials. The lack of agreed-upon standardized response criteria, difference in the percent risk according to the international prognostic index (IPI) or prognostic index of peripheral T-cell lymphoma (PIT), and different treatment modalities used have contributed to the variability of outcomes and poor reproducibility [9,10,11]. Methods to improve the predictive value of interim PET/CT include quantitative approaches, such as measuring the rate of reduction in maximum SUV (ΔSUVmax) or metabolic tumor volume (ΔMTV), defined as the volume of tumor tissue with increased FDG uptake. A quantitative approach might be more appropriate in the early response of PET to reduce the false-positive rate or decrease the inter-observer variability in interpretation [14,15,16]

Methods

Results

Conclusion