title: Metabolic tumor volume by positron emission tomography/computed tomography as a clinical parameter to determine therapeutic modality for early stage Hodgkin's lymphoma.
abstract: Recent studies have shown that metabolic tumor volume (MTV) by positron emission tomography/computed tomography (PET/CT) is an important prognostic parameter in patients with non-Hodgkin's lymphoma. However, it is unknown whether doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) alone in early stage Hodgkin's lymphoma would lead to similar disease control as combined modality therapy (CMT) using MTV by PET/CT. One hundred and twenty-seven patients with early stage Hodgkin's lymphoma who underwent PET/CT at diagnosis were enrolled. The MTV was delineated on PET/CT by the area ≥SUV(max), 2.5 (standardized uptake value [SUV]). Sixty-six patients received six cycles of ABVD only. The other 61 patients received CMT (involved-field radiotherapy after 4-6 cycles of ABVD). The calculated MTV cut-off value was 198 cm(3) . Clinical outcomes were compared according to several prognostic factors (i.e. age ≥50 years, male, performance status ≥2, stage II, B symptoms, ≥4 involved sites, extranodal site, large mediastinal mass, CMT, elevated erythrocyte sedimentation rate and high MTV). Older age (progression-free survival [PFS], P = 0.003; overall survival [OS], P = 0.007), B symptoms (PFS, P = 0.006; OS, P = 0.036) and high MTV (PFS, P = 0.008; OS, P = 0.007) were significant independent prognostic factors. Survival of two high MTV groups treated with ABVD only and CMT were lower than the low MTV groups (PFS, P < 0.012; OS, P < 0.045). ABVD alone was sufficient to control disease in those with low MTV status. However, survival was poor, even if the CMT was assigned a high MTV status. The MTV would be helpful for deciding the therapeutic modality in patients with early stage Hodgkin's lymphoma.
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Korea.
authors.forename: Moo-Kon
authors.initials: MK
authors.lastname: Song
authors.forename: Joo-Seop
authors.initials: JS
authors.lastname: Chung
authors.forename: Je-Jung
authors.initials: JJ
authors.lastname: Lee
authors.forename: Shin Young
authors.initials: SY
authors.lastname: Jeong
authors.forename: Sang-Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Jun-Shik
authors.initials: JS
authors.lastname: Hong
authors.forename: Ari
authors.initials: A
authors.lastname: Chong
authors.forename: Joon-Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Seok-Mo
authors.initials: SM
authors.lastname: Lee
authors.forename: Seong Jang
authors.initials: SJ
authors.lastname: Kim
authors.forename: Ho-Jin
authors.initials: HJ
authors.lastname: Shin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D003606:Dacarbazine / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D047368:Tumor Burden; D014747:Vinblastine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18; D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin
references.citation: J Clin Oncol. 2000 Feb;18(3):487-97
references.pmid: 10653864
references.citation: Ann Oncol. 2006 Dec;17(12):1749-60
references.pmid: 16984979
references.citation: Cancer Sci. 2013 Dec;104(12):1656-61
references.pmid: 24033666
references.citation: Ann Oncol. 2004 Nov;15(11):1699-704
references.pmid: 15520074
references.citation: J Clin Oncol. 2005 Jul 20;23(21):4574-6
references.pmid: 15837972
references.citation: N Engl J Med. 2003 Jun 12;348(24):2375-6
references.pmid: 12802021
references.citation: Eur J Haematol Suppl. 2005 Jul;(66):135-40
references.pmid: 16007882
references.citation: J Natl Compr Canc Netw. 2012 May;10(5):589-97
references.pmid: 22570290
references.citation: Hematol Oncol Clin North Am. 2007 Oct;21(5):841-54
references.pmid: 17908623
references.citation: Cancer. 2004 Oct 15;101(8):1824-34
references.pmid: 15372482
references.citation: Am J Med. 2002 Mar;112(4):262-8
references.pmid: 11893364
references.citation: Ann Oncol. 2004 Dec;15(12):1798-804
references.pmid: 15550585
references.citation: J Clin Oncol. 1989 Nov;7(11):1630-6
references.pmid: 2809679
references.citation: J Natl Cancer Inst. 2005 Oct 5;97(19):1394-5
references.pmid: 16204683
references.citation: Ann Hematol. 2012 May;91(5):697-703
references.pmid: 22071570
references.citation: J Clin Oncol. 2007 Aug 20;25(24):3746-52
references.pmid: 17646666
references.citation: J Clin Oncol. 2003 Oct 1;21(19):3601-8
references.pmid: 12913100
references.citation: Nucl Med Commun. 1999 Jan;20(1):13-20
references.pmid: 9949408
references.citation: Ann Hematol. 2002 Jan;81(1):20-5
references.pmid: 11807631
references.citation: J Clin Oncol. 2001 Mar 1;19(5):1388-94
references.pmid: 11230483
references.citation: Int J Hematol. 2013 Mar;97(3):397-402
references.pmid: 23400410
references.citation: J Clin Oncol. 2002 Apr 15;20(8):2101-8
references.pmid: 11956271
references.citation: Haematologica. 2006 Apr;91(4):475-81
references.pmid: 16585014
references.citation: Blood. 2006 Jan 1;107(1):52-9
references.pmid: 16150944
references.citation: Ann Oncol. 2005 Jul;16(7):1160-8
references.pmid: 15939713
references.citation: J Clin Oncol. 2007 Aug 10;25(23):3495-502
references.pmid: 17606976
references.citation: Eur J Nucl Med Mol Imaging. 2004 Mar;31(3):325-9
references.pmid: 14647988
references.citation: Leuk Res. 2013 Jan;37(1):58-63
references.pmid: 23040533
references.citation: J Natl Cancer Inst. 1995 May 17;87(10):732-41
references.pmid: 7563150
references.citation: J Natl Cancer Inst. 2003 Jul 2;95(13):928-9
references.pmid: 12837820
references.citation: Eur J Nucl Med. 1998 Jul;25(7):721-8
references.pmid: 9662594
references.citation: Blood. 1999 Jul 15;94(2):429-33
references.pmid: 10397709
references.citation: Cancer Sci. 2012 Mar;103(3):477-82
references.pmid: 22126515
references.citation: Eur J Nucl Med Mol Imaging. 2010 Jan;37(1):181-200
references.pmid: 19915839
references.citation: J Clin Oncol. 2006 Jul 1;24(19):3128-35
references.pmid: 16754934
references.citation: Blood. 2004 Dec 1;104(12):3483-9
references.pmid: 15315964