title: Assessment of tumor size reduction improves outcome prediction of positron emission tomography/computed tomography after chemotherapy in advanced-stage Hodgkin lymphoma.
abstract: OBJECTIVE
  Positron emission tomography (PET) after chemotherapy can guide consolidating radiotherapy in advanced-stage Hodgkin lymphoma (HL). This analysis aims to improve outcome prediction by integrating additional criteria derived by computed tomography (CT).
  
  
  METHODS
  The analysis set consisted of 739 patients with residues≥2.5 cm after chemotherapy from a total of 2,126 patients treated in the HD15 trial (HD15 for advanced stage Hodgkin's disease: Quality assurance protocol for reduction of toxicity and the prognostic relevance of fluorodeoxyglucose-positron-emission tomography [FDG-PET] in the first-line treatment of advanced-stage Hodgkin's disease) performed by the German Hodgkin Study Group. A central panel performed image analysis and interpretation of CT scans before and after chemotherapy as well as PET scans after chemotherapy. Prognosis was evaluated by using progression-free survival (PFS); groups were compared with the log-rank test. Potential prognostic factors were investigated by using receiver operating characteristic analysis and logistic regression.
  
  
  RESULTS
  In all, 548 (74%) of 739 patients had PET-negative residues after chemotherapy; these patients did not receive additional radiotherapy and showed a 4-year PFS of 91.5%. The 191 PET-positive patients (26%) receiving additional radiotherapy had a 4-year PFS of 86.1% (P=.022). CT alone did not allow further separation of patients in partial remission by risk of recurrence (P=.9). In the subgroup of the 54 PET-positive patients with a relative reduction of less than 40%, the risk of progression or relapse within the first year was 23.1% compared with 5.3% for patients with a larger reduction (difference, 17.9%; 95% CI, 5.8% to 30%).
  
  
  CONCLUSIONS
  Patients with HL who have PET-positive residual disease after chemotherapy and poor tumor shrinkage are at high risk of progression or relapse.
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany. carsten.kobe@uk-koeln.de.
authors.forename: Carsten
authors.initials: C
authors.lastname: Kobe
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Kuhnert
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Deniz
authors.initials: D
authors.lastname: Kahraman
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Haverkamp
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Hans-Theodor
authors.initials: HT
authors.lastname: Eich
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Franke
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Persigehl
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Klutmann
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Amthauer
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bockisch
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Regine
authors.initials: R
authors.lastname: Kluge
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Hans-Heinrich
authors.initials: HH
authors.lastname: Wolf
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Maintz
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Fuchs
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Borchmann
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Diehl
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Drzezga
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.affiliation: Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Dietlein
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D047368:Tumor Burden; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone