title: The evolving role of response-adapted PET imaging in Hodgkin lymphoma.
abstract: (18)F-fluorodeoxyglucose positron emission tomography with (FDG-PET) has a well-established role in the pre- and post-treatment staging of Hodgkin lymphoma (HL), however its use as a predictive therapeutic tool via responded-adapted therapy continues to evolve. There have been a multitude of retrospective and noncontrolled clinical studies showing that early (or interim) FDG-PET is highly prognostic in HL, particularly in the advanced-stage setting. Response-adapted treatment approaches in HL are attempting to diminish toxicity for low-risk patients by minimizing therapy, and conversely, intensify treatment for high-risk patients. Results from phase III noninferiority studies in early-stage HL with negative interim FDG-PET that randomized patients to chemotherapy alone versus combined modality therapy showed a continued small improvement in progression-free survival for patients who did not receive radiation. Preliminary reports of data escalating therapy for positive interim FDG-PET in early-stage HL and for de-escalation of therapy [i.e. bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone (BEACOPP)] for negative interim FDG-PET in advanced stage HL (i.e. deletion of bleomycin) have demonstrated improved outcomes. Maturation of these studies and continued follow up of all response-adapted studies are needed. Altogether, the treatment of HL remains an individualized clinical management choice for physicians and patients. Continued refinement and optimization of FDG-PET is needed, including within the context of targeted therapeutic agents. In addition, a number of new and novel techniques of functional imaging, including metabolic tumor volume and tumor proliferation, are being explored in order to enhance staging, characterization, prognostication and ultimately patient outcome.
authors.affiliation: Tufts Medical Center in Boston, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Coyle
authors.affiliation: Icahn School of Medicine at Mount Sinai in New York, New York, USA.
authors.forename: Lale
authors.initials: L
authors.lastname: Kostakoglu
authors.affiliation: Division of Hematology-Oncology, Director, Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, Box #245, Boston, MA 02111, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Evens
keywords: 18F-fluorodeoxyglucose positron emission tomography; Hodgkin lymphoma; contrast-enhanced computerized tomography; interim positron emission tomography; positron emission tomography; prognosis