title: Hodgkin lymphoma: a negative interim-PET cannot circumvent the need for end-of-treatment-PET evaluation.
abstract: We examined the outcome of a cohort of patients with Hodgkin lymphoma (HL) in order to assess if fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) at the end of treatment (end-PET) can be omitted when the interim PET (int-PET) is negative. Seventy-six ABVD(adriamycin, bleomycin, vinblastine, dacarbazine)-treated patients were retrospectively included. No change in treatment was made on the basis of int-PET results. Suspicious foci on end-PET received biopsy confirmation whenever possible. Median follow-up was 58·9 months. Uptake on int-PET higher than liver (scores 4-5) was rated positive according to the Lugano classification, while a positive end-PET corresponded to scores 3, 4 and 5. Fifteen patients had treatment failure. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and accuracy of int-PET were 46·7%, 85·2%, 43·8%, 86·7% and 77·6%, respectively. For end-PET the figures were: 80%, 93·4%, 75%, 95% and 90·8%. Eight patients with negative int-PET had treatment failure; six of them were identified as non-responders with end-PET. The 5-year progression-free survival (PFS) was 87% for patients with negative int-PET versus 56% with positive int-PET. The 5-year PFS was 96% with negative end-PET versus 23% with positive end-PET. The prognostic information from int-PET as regards PFS (log-rank test P = 0·0048) was lower than that provided by end-PET (P < 0·0001). Int-PET predicted only half of the failures. When used in clinical routine, a negative int-PET study cannot obviate the need for end-PET examination.
authors.affiliation: Department of Nuclear Medicine, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
authors.forename: Charles
authors.identifier: http://orcid.org/0000-0002-3889-755X
authors.initials: C
authors.lastname: Mesguich
authors.affiliation: Department of Nuclear Medicine, Institut Bergonié Cancer Centre, Bordeaux, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Cazeau
authors.affiliation: Department of Haematology, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
authors.forename: Krimo
authors.initials: K
authors.lastname: Bouabdallah
authors.affiliation: Department of Haematology, Institut Bergonié Cancer Centre, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Soubeyran
authors.affiliation: Department of Nuclear Medicine, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Guyot
authors.affiliation: Department of Haematology, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
authors.forename: Noël
authors.initials: N
authors.lastname: Milpied
authors.affiliation: Department of Nuclear Medicine, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Bordenave
authors.affiliation: Department of Nuclear Medicine, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France.
authors.forename: Elif
authors.initials: E
authors.lastname: Hindié
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000627:therapeutic use; D019468:Disease Management; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D017211:Treatment Failure; D016896:Treatment Outcome; D014747:Vinblastine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18; D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin
keywords: 18-Fluorodeoxyglucose; Hodgkin's lymphoma; end-of-treatment positron emission tomography; interim-positron emission tomography; positron emission tomography-computed tomography; prognosis