Egesta Lopci1, Maurizio Mascarin2, Arnoldo Piccardo3, Angelo Castello4, Caterina Elia2, Luca Guerra5, Eugenio Borsatti6, Alessandra Sala7, Alessandra Todesco8, Pietro Zucchetta9, Piero Farruggia10, Angelina Cistaro11, Salvatore Buffardi12, Patrizia Bertolini13, Maurizio Bianchi14, Maria Luisa Moleti15, Feisal Bunkheila16, Paolo Indolfi17, Franca Fagioli14, Alberto Garaventa18, Roberta Burnelli19. 1. Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy. egesta.lopci@gmail.com. 2. AYA and Pediatric Radiotherapy, IRCCS Centro di Riferimento Oncologico, Aviano, PN, Italy. 3. Nuclear Medicine, Galliera Hospital, Genoa, Italy. 4. Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy. 5. Nuclear Medicine, Hospital San Gerardo, Monza, Italy. 6. Nuclear Medicine, Centro di Riferimento Oncologico, Aviano, Pordenone, Italy. 7. Pediatric Division, Hospital San Gerardo, Monza, Italy. 8. Pediatric Division, University Hospital, Padova, Italy. 9. Nuclear Medicine Department, University Hospital, Padova, Italy. 10. Pediatric Division, Ospedale dei Bambini, Palermo, Italy. 11. Positron Emission Tomography Centre IRMET S.p.A. Affidea, Turin, Italy. 12. Department of Oncology, Hospital Santobono-Pausilipon, Naples, Italy. 13. Hematology and Pediatric Oncology, Azienda Ospedaliera, Parma, Italy. 14. Oncohematology, Regina Margherita Hospital, Torino, Italy. 15. Pediatric Oncohematology, Hospital Umberto I, University La Sapienza, Rome, Italy. 16. Radiotherapy, Hospital San Salvatore, Pesaro, Italy. 17. Department of Pediatrics, II University Hospital, Naples, Italy. 18. Hematology and Pediatric Oncology, Gaslini Hospital, Genoa, Italy. 19. Pediatric Onco-hematologic Unit, University Hospital S. Anna, Ferrara, Italy.
Abstract
PURPOSE: We present the results of an investigation of the role of FDG PET in response evaluation of bulky masses in paediatric patients with Hodgkin's lymphoma (HL) enrolled in the Italian AIEOP-LH2004 trial. METHODS: We analysed data derived from 703 patients (388 male, 315 female; mean age 13 years) with HL and enrolled in 41 different Italian centres from March 2004 to September 2012, all treated with the AIEOP-LH2004 protocol. The cohort comprised 309 patients with a bulky mass, of whom 263 were evaluated with FDG PET at baseline and after four cycles of chemotherapy. Responses were determined according to combined functional and morphological criteria. Patients were followed up for a mean period of 43 months and for each child we calculated time-to-progression (TTP) and relapse rates considering clinical monitoring, and instrumental and histological data as the reference standard. Statistical analyses were performed for FDG PET and morphological responses with respect to TTP. Multivariate analysis was used to define independent predictive factors. RESULTS: Overall, response evaluation revealed 238 PET-negative patients (90.5%) and 25 PET-positive patients (9.5%), with a significant difference in TTP between these groups (mean TTP: 32.67 months for negative scans, 23.8 months for positive scans; p < 0.0001, log-rank test). In the same cohort, computed tomography showed a complete response (CR) in 85 patients (32.3%), progressive disease (PD) in 6 patients (2.3%), and a partial response (PR) in 165 patients (62.7%), with a significant difference in TTP between patients with CR and patients with PD (31.1 months and 7.9 months, respectively; p < 0.001, log-rank test). Similarly, there was a significant difference in relapse rates between PET-positive and PET-negative patients (p = 0000). In patients with PR, there was also a significant difference in TTP between PET-positive and PET-negative patients (24.6 months and 34.9 months, respectively; p < 0.0001). In the multivariate analysis with correction for multiple testing, only the PET result was an independent predictive factor in both the entire cohort of patients and the subgroup showing PR on CT (p < 0.01). CONCLUSION: After four cycles of chemotherapy, FDG PET response assessment in paediatric HL patients with a bulky mass is a good predictor of TTP and disease outcome. Moreover, in patients with a PR on CT, PET was able to differentiate those with a longer TTP. In paediatric HL patients with a bulky mass and in patients with a PR on CT, response on FDG PET was an independent predictive factor.
PURPOSE: We present the results of an investigation of the role of FDG PET in response evaluation of bulky masses in paediatric patients with Hodgkin's lymphoma (HL) enrolled in the Italian AIEOP-LH2004 trial. METHODS: We analysed data derived from 703 patients (388 male, 315 female; mean age 13 years) with HL and enrolled in 41 different Italian centres from March 2004 to September 2012, all treated with the AIEOP-LH2004 protocol. The cohort comprised 309 patients with a bulky mass, of whom 263 were evaluated with FDG PET at baseline and after four cycles of chemotherapy. Responses were determined according to combined functional and morphological criteria. Patients were followed up for a mean period of 43 months and for each child we calculated time-to-progression (TTP) and relapse rates considering clinical monitoring, and instrumental and histological data as the reference standard. Statistical analyses were performed for FDG PET and morphological responses with respect to TTP. Multivariate analysis was used to define independent predictive factors. RESULTS: Overall, response evaluation revealed 238 PET-negative patients (90.5%) and 25 PET-positive patients (9.5%), with a significant difference in TTP between these groups (mean TTP: 32.67 months for negative scans, 23.8 months for positive scans; p < 0.0001, log-rank test). In the same cohort, computed tomography showed a complete response (CR) in 85 patients (32.3%), progressive disease (PD) in 6 patients (2.3%), and a partial response (PR) in 165 patients (62.7%), with a significant difference in TTP between patients with CR and patients with PD (31.1 months and 7.9 months, respectively; p < 0.001, log-rank test). Similarly, there was a significant difference in relapse rates between PET-positive and PET-negative patients (p = 0000). In patients with PR, there was also a significant difference in TTP between PET-positive and PET-negative patients (24.6 months and 34.9 months, respectively; p < 0.0001). In the multivariate analysis with correction for multiple testing, only the PET result was an independent predictive factor in both the entire cohort of patients and the subgroup showing PR on CT (p < 0.01). CONCLUSION: After four cycles of chemotherapy, FDG PET response assessment in paediatric HL patients with a bulky mass is a good predictor of TTP and disease outcome. Moreover, in patients with a PR on CT, PET was able to differentiate those with a longer TTP. In paediatric HL patients with a bulky mass and in patients with a PR on CT, response on FDG PET was an independent predictive factor.
Authors: Debra L Friedman; Lu Chen; Suzanne Wolden; Allen Buxton; Kathleen McCarten; Thomas J FitzGerald; Sandra Kessel; Pedro A De Alarcon; Allen R Chen; Nathan Kobrinsky; Peter Ehrlich; Robert E Hutchison; Louis S Constine; Cindy L Schwartz Journal: J Clin Oncol Date: 2014-10-13 Impact factor: 44.544
Authors: Bruce D Cheson; Beate Pfistner; Malik E Juweid; Randy D Gascoyne; Lena Specht; Sandra J Horning; Bertrand Coiffier; Richard I Fisher; Anton Hagenbeek; Emanuele Zucca; Steven T Rosen; Sigrid Stroobants; T Andrew Lister; Richard T Hoppe; Martin Dreyling; Kensei Tobinai; Julie M Vose; Joseph M Connors; Massimo Federico; Volker Diehl Journal: J Clin Oncol Date: 2007-01-22 Impact factor: 44.544
Authors: M R Weihrauch; D Re; K Scheidhauer; S Ansén; M Dietlein; S Bischoff; H Bohlen; J Wolf; H Schicha; V Diehl; H Tesch Journal: Blood Date: 2001-11-15 Impact factor: 22.113
Authors: I Buchmann; M Reinhardt; K Elsner; D Bunjes; C Altehoefer; J Finke; E Moser; G Glatting; J Kotzerke; C A Guhlmann; H Schirrmeister; S N Reske Journal: Cancer Date: 2001-03-01 Impact factor: 6.860
Authors: J N Talbot; C Haioun; J D Rain; M Meignan; M Wioland; J L Misset; D Grahek; K Kerrou; F Montravers Journal: Crit Rev Oncol Hematol Date: 2001-06 Impact factor: 6.312
Authors: H Schöder; J Meta; C Yap; M Ariannejad; J Rao; M E Phelps; P E Valk; J Sayre; J Czernin Journal: J Nucl Med Date: 2001-08 Impact factor: 10.057
Authors: M Hill; D Cunningham; D MacVicar; A Roldan; J Husband; R McCready; J Mansi; S Milan; T Hickish Journal: J Clin Oncol Date: 1993-11 Impact factor: 44.544