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Pretherapeutic FDG-PET total metabolic tumor volume predicts response to induction therapy in pediatric Hodgkin’s lymphoma
Rogasch, J. M.; Hundsdoerfer, P.; Hofheinz, F.; Wedel, F.; Schatka, I.; Brenner, W.; Amthauer, H.; Furth, C.;
Standardized treatment in pediatric patients with Hodgkin’s lymphoma (HL) follows risk stratification by tumor stage, erythrocyte sedimentation rate and tumor bulk. We aimed to identify quantitative parameters from pretherapeutic FDG-PET to assist prediction of response to induction chemotherapy.

Retrospective analysis in 50 children with HL (f:18; m:32; median age, 14.8 [4-18] a) consecutively treated according to EuroNet-PHL-C1 (n=42) or -C2 treatment protocol (n=8). Total metabolic tumor volume (MTV) in pretherapeutic FDG-PET was defined using a semi-automated, background adapted threshold. Metabolic (SUVmax/mean/peak, total lesion glycolysis [MTV*SUVmean]) and heterogeneity parameters (asphericity [ASP], entropy, contrast, local homogeneity, energy, and cumulative SUV-volume histograms) were derived. Early response assessment (ERA) was performed after 2 cycles of induction chemotherapy according to treatment protocol and verified by reference rating. Prediction of inadequate response (IR) in ERA was based on ROC analysis separated by stage 1/2 (1 and 26 patients) and stage 3/4 disease (7 and 16 patients) or treatment group/level (TG/TL) 1 to 3.

IR was seen in 28/50 patients (TG/TL1, 6/12 patients; TG/TL2, 10/17; TG/TL3, 12/21). Among all PET parameters, MTV best predicted IR; ASP was the best heterogeneity parameter. AUC of MTV was 0.84 (95%-confidence interval, 0.69-0.99) in stage 1/2 and 0.86 (0.7-1.0) in stage 3/4. In patients of TG/TL1, AUC of MTV was 0.92 (0.74-1.0); in TG/TL2 0.71 (0.44-0.99), and in TG/TL3 0.85 (0.69-1.0). Patients with high vs. low MTV had IR in 86 vs. 0% in TG/TL1, 80 vs. 29% in TG/TL2, and 90 vs. 27% in TG/TL3 (cut-off, >80 ml, >160 ml, >410 ml).

In this explorative study, high total MTV best predicted inadequate response to induction therapy in pediatric HL of all pretherapeutic FDG-PET parameters – in both low and high tumor stages as well as the 3 different TG/TL.
  • Lecture (Conference)
    Jahrestagung der DGN, 19.-21.04.2018, Bremen, Deutschland

Publ.-Id: 27395 - Permalink