title: Chemotherapy Response Assessment by FDG-PET-CT in Early-stage Classical Hodgkin Lymphoma: Moving Beyond the Five-Point Deauville Score.
abstract: In early-stage classical Hodgkin lymphoma, fluorodeoxyglucose positron emission tomography (PET)-computed tomography (CT) scans are performed routinely after chemotherapy, and the 5-point Deauville score is used to report the disease response. We hypothesized that other PET-CT parameters, considered in combination with Deauville score, would improve risk stratification.
  
  
  
  Patients treated for stage I to II Hodgkin lymphoma from 2003 to 2013, who were aged ≥18 years and had analyzable PET-CT scans performed before and after chemotherapy, were eligible. The soft tissue volume (STV), maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis were recorded from the PET-CT scans before and after chemotherapy. Reductions were defined as 1 - (final PET-CT value)/(corresponding initial PET-CT value). The primary endpoint was freedom from progression (FFP).
  
  
  
  For 202 patients treated with chemotherapy with or without radiation therapy, the 5-year FFP was 89% (95% confidence interval 85%-93%). All PET-CT parameters were strongly associated with the Deauville score (P<.001) and FFP (P<.0001) on univariate analysis. The Deauville score was highly predictive of FFP (C-index 0.89) but was less discriminating in the Deauville 1 to 4 subset (C-index 0.67). Therefore, we aimed to identify PET-CT parameters that would improve risk stratification for this subgroup (n=187). STV reduction was predictive of outcome (C-index 0.71) and was dichotomized with an optimal cutoff of 0.65 (65% reduction in STV). A model incorporating the Deauville score and STV reduction predicted FFP more accurately than either measurement alone in the Deauville 1 to 4 subset (C-index 0.83). The improvement in predictive accuracy of this composite measure compared with the Deauville score alone met statistical significance (P=.045).
  
  
  
  The relative reduction in tumor size is an independent predictor of outcome. Combined with the Deauville score, it might improve risk stratification and contribute to response-adapted individualization of therapy.
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. Electronic address: samilgrom@mdanderson.org.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Milgrom
authors.affiliation: Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Wenli
authors.initials: W
authors.lastname: Dong
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Mani
authors.initials: M
authors.lastname: Akhtari
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Grace L
authors.initials: GL
authors.lastname: Smith
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Chelsea C
authors.initials: CC
authors.lastname: Pinnix
authors.affiliation: Department of Imaging Physics, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Osama
authors.initials: O
authors.lastname: Mawlawi
authors.affiliation: Department of Radiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Eric
authors.initials: E
authors.lastname: Rohren
authors.affiliation: Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Naveen
authors.initials: N
authors.lastname: Garg
authors.affiliation: Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Hubert
authors.initials: H
authors.lastname: Chuang
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Zeinab Abou
authors.initials: ZA
authors.lastname: Yehia
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jay P
authors.initials: JP
authors.lastname: Reddy
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jillian R
authors.initials: JR
authors.lastname: Gunther
authors.affiliation: Department of Hematopathology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Khoury
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Tina
authors.initials: T
authors.lastname: Suki
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Osborne
authors.affiliation: Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oki
authors.affiliation: Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Michelle
authors.initials: M
authors.lastname: Fanale
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Bouthaina S
authors.initials: BS
authors.lastname: Dabaja
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D016001:Confidence Intervals; D003606:Dacarbazine / Q000008:administration & dosage; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D006019:Glycolysis; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D012008:Recurrence; D012306:Risk; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects*; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin