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Cui S, Xin W, Wang F, Shao X, Shao X, Niu R, Zhang F, Shi Y, Liu B, Gu W, Wang Y. Metabolic tumour area: a novel prognostic indicator based on 18F-FDG PET/CT in patients with diffuse large B-cell lymphoma in the R-CHOP era. BMC Cancer 2024; 24:895. [PMID: 39054508 PMCID: PMC11270790 DOI: 10.1186/s12885-024-12668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 07/22/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The metabolic tumour area (MTA) was found to be a promising predictor of prostate cancer. However, the role of MTA based on 18F-FDG PET/CT in diffuse large B-cell lymphoma (DLBCL) prognosis remains unclear. This study aimed to elucidate the prognostic significance of MTA and evaluate its incremental value to the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) for DLBCL patients treated with first-line R-CHOP regimens. METHODS A total of 280 consecutive patients with newly diagnosed DLBCL and baseline 18F-FDG PET/CT data were retrospectively evaluated. Lesions were delineated via a semiautomated segmentation method based on a 41% SUVmax threshold to estimate semiquantitative metabolic parameters such as total metabolic tumour volume (TMTV) and MTA. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values. Progression-free survival (PFS) and overall survival (OS) were the endpoints that were used to evaluate the prognosis. PFS and OS were estimated via Kaplan‒Meier curves and compared via the log-rank test. RESULTS Univariate analysis revealed that patients with high MTA, high TMTV and NCCN-IPI ≥ 4 were associated with inferior PFS and OS (P < 0.0001 for all). Multivariate analysis indicated that MTA remained an independent predictor of PFS and OS [hazard ratio (HR), 2.506; 95% confidence interval (CI), 1.337-4.696; P = 0.004; and HR, 1.823; 95% CI, 1.005-3.310; P = 0.048], whereas TMTV was not. Further analysis using the NCCN-IPI model as a covariate revealed that MTA and NCCN-IPI were still independent predictors of PFS (HR, 2.617; 95% CI, 1.494-4.586; P = 0.001; and HR, 2.633; 95% CI, 1.650-4.203; P < 0.0001) and OS (HR, 2.021; 95% CI, 1.201-3.401; P = 0.008; and HR, 3.869; 95% CI, 1.959-7.640; P < 0.0001; respectively). Furthermore, MTA was used to separate patients with high NCCN-IPI risk scores into two groups with significantly different outcomes. CONCLUSIONS Pre-treatment MTA based on 18F-FDG PET/CT and NCCN-IPI were independent predictor of PFS and OS in DLBCL patients treated with R-CHOP. MTA has additional predictive value for the prognosis of patients with DLBCL, especially in high-risk patients with NCCN-IPI ≥ 4. In addition, the combination of MTA and NCCN-IPI may be helpful in further improving risk stratification and guiding individualised treatment options. TRIAL REGISTRATION This research was retrospectively registered with the Ethics Committee of the Third Affiliated Hospital of Soochow University, and the registration number was approval No. 155 (approved date: 31 May 2022).
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Affiliation(s)
- Silu Cui
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, China
- Yangzhou University, Yangzhou, Jiangsu, China
| | - Wenchong Xin
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, China
- Department of Nuclear Medicine, Linyi People's Hospital, Linyi, Shandong, China
| | - Fei Wang
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, China.
| | - Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, China
| | - Rong Niu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, China
| | - Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, China
| | - Bao Liu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, China
| | - Weiying Gu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, China.
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2
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Yadgarov MY, Dunaykin MM, Shestopalov GI, Kailash C, Kireeva ED, Myakova NV, Likar YN. Prognostic value of baseline and interim [ 18F]FDG PET metabolic parameters in pediatric Hodgkin's lymphoma. Eur J Nucl Med Mol Imaging 2024; 51:1955-1964. [PMID: 38351389 DOI: 10.1007/s00259-024-06643-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/05/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Hodgkin lymphoma (HL) in pediatric populations has a high survival rate but poses risks for long-term morbidities. Although [18F]fluoro‑2‑deoxy‑2‑d‑glucose positron emission tomography ([18F]FDG PET) scans offer potential for improved risk stratification, the definitive prognostic value of quantitative [18F]FDG PET parameters remains unclear for pediatric HL. METHODS A single-center, retrospective study included pediatric patients diagnosed with HL between 2016 and 2023 treated according to EuroNet-PHL-C1 and DAL/GPOH-HD protocols. Patients underwent baseline and interim PET/CT scans after two chemotherapy cycles. Event-free survival (EFS) was the primary endpoint, Deauville score was the secondary endpoint. Quantitative [18F]FDG PET parameters included SUVmax, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) that were evaluated using two segmentation methods (SUV 2.5, 41% SUVmax). Survival outcomes were assessed using Cox regression analysis. RESULTS A total of 115 patients (50 males, median age 14.2 years) were studied, with a median follow-up period of 35 months. During this period, 16 cases (13.9%) of relapse or progression were noted. Baseline and interim MTV 2.5, MTV 41%, TLG 2.5, and TLG 41%, along with interim SUVmax, were significantly associated with worse EFS and correlated with post-treatment Deauville scores. In multivariable analysis, interim MTV 2.5 > 0 ml (adj. hazard ratio, HR: 3.89, p = 0.009) and interim TLG 41% ≥ 30 g (adj. HR: 7.98, p = 0.006) were independent risk factors for EFS. CONCLUSION Baseline and interim [18F]FDG PET parameters can serve as significant prognostic indicators for EFS and treatment response in pediatric HL. These quantitative measures could enhance individualized, risk-adapted treatment strategies for children and adolescents with HL.
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Affiliation(s)
- Mikhail Ya Yadgarov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia.
- Department of PET and Radionuclide Diagnostics, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samory Mashela Str. 1, 117997, Moscow, Russia.
| | - M M Dunaykin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - G I Shestopalov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Russian Children's Clinical Hospital, N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - C Kailash
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - E D Kireeva
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - N V Myakova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Yu N Likar
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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3
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Parihar AS, Pant N, Subramaniam RM. Quarter-Century PET/CT Transformation of Oncology: Lymphoma. PET Clin 2024; 19:281-290. [PMID: 38403384 DOI: 10.1016/j.cpet.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
The clinical landscape of lymphomas has changed dramatically over the last 2 decades, including significant progress made in the understanding and utilization of imaging modalities and the available treatment options for both indolent and aggressive lymphomas. Since the introduction of hybrid PET/CT scanners in 2001, the indications of 18F-fluorodeoxyglucose (FDG) PET/CT in the management of lymphomas have grown rapidly. In today's clinical practice, FDG PET/CT is used in successful management of the vast majority patients with lymphomas.
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Affiliation(s)
- Ashwin Singh Parihar
- Mallinckrodt Institute of Radiology; Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA.
| | | | - Rathan M Subramaniam
- Faculty of Medicine, Nursing, Midwifery & Health Sciences, The University of Notre Dame Australia, Sydney, Australia; Department of Radiology, Duke University, Durham, NC, USA; Department of Medicine, University of Otago Medical School, Dunedin, New Zealand
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4
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Santos FM, Marin JFG, Lima MS, Silva-Junior WF, Alves LBO, Moreira FR, Velasques RD, Atanazio MJ, Maia ACA, Buchpiguel CA, Buccheri V, Rocha V. Impact of baseline and interim quantitative PET parameters on outcomes of classical Hodgkin Lymphoma. Ann Hematol 2024; 103:175-183. [PMID: 37796339 DOI: 10.1007/s00277-023-05461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023]
Abstract
Currently, analysis of interim PET (iPET) according to the Deauville score (DS) is the most important predictive factor in Hodgkin lymphoma (HL); however, there is room for improvement in its prognostic power. This study aimed to evaluate the prognostic value of quantitative PET analysis (maximum standard uptake value [SUVmax], total metabolic tumor volume [TMTV] and total lesion glicolysis [TLG]) at baseline (PET0) and iPET in a retrospective cohort of newly diagnosed classical HL. For positive iPET (+ iPET), the reduction of quantitative parameters in relation to PET0 (ΔSUVmax, ΔTMTV and ΔTLG) was calculated. Between 2011 and 2017, 234 patients treated with ABVD were analyzed. Median age was 30 years-old, 59% had advanced stage disease, 57% a bulky mass and 25% a + iPET (DS 4-5). At baseline, high TLG was associated with an increased cumulative incidence of failure (CIF) (p = 0.032) while neither SUVmax, TMTV or TLG were associated with overall survival (OS) or progression-free survival (PFS). In multivariate analysis, only iPET was associated with CIF (p < 0.001). Among ΔSUVmax, ΔTMTV and ΔTLG, only a ΔSUVmax ≥ 68.8 was significant for PFS (HR: 0.31, CI95%: 0.11-0.86, p = 0.024). A subset of patients with improved PFS amongst + iPET was identified by the quantitative (ΔSUVmax ≥ 68.8%) analysis. In this real-world Brazilian cohort, with prevalent high-risk patients, quantitative analysis of PET0 did not demonstrate to be prognostic, while a dynamic approach incorporating the ΔSUVmax to + iPET succeeded in refining a subset with better prognosis. These findings warrant validation in larger series and indicate that not all patients with + iPET might need treatment intensification.
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Affiliation(s)
- Fernanda Maria Santos
- Instituto Do Cancer Do Estado de Sao Paulo (ICESP), Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo-SP, Brazil.
| | - Jose Flavio Gomes Marin
- Nuclear Medicine Medical Investigation Laboratory LIM43, Hospital das Clinicas, FMUSP (HCFMUSP), Sao Paulo-SP, Brazil
| | - Marcos Santos Lima
- Instituto Do Cancer Do Estado de Sao Paulo (ICESP), Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo-SP, Brazil
- Nuclear Medicine Medical Investigation Laboratory LIM43, Hospital das Clinicas, FMUSP (HCFMUSP), Sao Paulo-SP, Brazil
| | - Wellington Fernandes Silva-Junior
- Instituto Do Cancer Do Estado de Sao Paulo (ICESP), Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo-SP, Brazil
- Division of Hematology and Cell Therapy, HCFMUSP, Sao Paulo-SP, Brazil
| | | | | | - Rodrigo Dolphini Velasques
- Instituto Do Cancer Do Estado de Sao Paulo (ICESP), Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo-SP, Brazil
- Division of Hematology and Cell Therapy, HCFMUSP, Sao Paulo-SP, Brazil
| | - Marcelo Junqueira Atanazio
- Instituto Do Cancer Do Estado de Sao Paulo (ICESP), Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo-SP, Brazil
- Division of Hematology and Cell Therapy, HCFMUSP, Sao Paulo-SP, Brazil
| | - Ana Carolina Arrais Maia
- Instituto Do Cancer Do Estado de Sao Paulo (ICESP), Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo-SP, Brazil
- Division of Hematology and Cell Therapy, HCFMUSP, Sao Paulo-SP, Brazil
| | - Carlos A Buchpiguel
- Nuclear Medicine Medical Investigation Laboratory LIM43, Hospital das Clinicas, FMUSP (HCFMUSP), Sao Paulo-SP, Brazil
| | - Valeria Buccheri
- Instituto Do Cancer Do Estado de Sao Paulo (ICESP), Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo-SP, Brazil
- Division of Hematology and Cell Therapy, HCFMUSP, Sao Paulo-SP, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Internal Medicine, Division of Hematology, HCFMUSP, Sao Paulo-SP, Brazil
| | - Vanderson Rocha
- Instituto Do Cancer Do Estado de Sao Paulo (ICESP), Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo-SP, Brazil
- Division of Hematology and Cell Therapy, HCFMUSP, Sao Paulo-SP, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Internal Medicine, Division of Hematology, HCFMUSP, Sao Paulo-SP, Brazil
- Department of Hematology, Churchill Hospital, NHS BT, Oxford University, Oxford, UK
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5
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Mouheb M, Pierre-Jean M, Devillers A, Fermé C, Benchalal M, Manson G, Le Jeune F, Houot R, Palard-Novello X. Prognostic Value of Baseline Tumor Burden and Tumor Dissemination Extracted From 18 F-FDG PET/CT in a Cohort of Adult Patients With Early or Advanced Hodgkin Lymphoma. Clin Nucl Med 2024; 49:e1-e5. [PMID: 38015041 DOI: 10.1097/rlu.0000000000004930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE We aimed to assess the prognostic value of baseline tumor burden and dissemination parameters extracted from 18 F-FDG PET/CT in patients with early or advanced Hodgkin lymphoma (HL) treated with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or escalated BEACOPP (increased bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). PATIENTS AND METHODS Patients aged ≥18 years with classical Hodgkin lymphoma were retrospectively included. Progression-free survival (PFS) analysis of dichotomized clinicobiological and PET/CT parameters (SUV max , TMTV, TLG, D max , and D bulk ) was performed. Optimal cutoff values for quantitative metrics were defined as the values maximizing the Youden index from receiver operating characteristic analysis. PFS rates were estimated with Kaplan-Meier curves, and the log-rank test was used to assess statistical significance. Hazard ratios were calculated using Cox proportional hazards models. RESULTS With a median age of 32 years, 166 patients were enrolled. A total of 111 patients had ABVD or ABVD-like treatment with or without radiotherapy and 55 patients with escalated BEACOPP treatment. The median follow-up was 55 months. Only International Prognostic Score (IPS >1), TMTV >107 cm 3 , and TLG >1628 were found to be significant prognostic factors for PFS on univariate analysis. Multivariate analysis revealed that IPS and TLG were independently prognostic and, combined, identified 4 risk groups ( P < 0.001): low (low TLG and low IPS; 4-year PFS, 95%), intermediate-low (high IPS and low TLG; 4-year PFS, 79%), intermediate-high (low IPS and high TLG; 4-year PFS, 78%), and high (high TLG and high IPS; 4-year PFS, 71%). CONCLUSIONS Combining baseline TLG with IPS could improve PFS prediction.
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Affiliation(s)
| | | | | | | | | | - Guillaume Manson
- Univ Rennes, CHU de Rennes, INSERM, MOBIDIC-UMR 1236, Rennes, France
| | | | - Roch Houot
- Univ Rennes, CHU de Rennes, INSERM, MOBIDIC-UMR 1236, Rennes, France
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De Re V, Lopci E, Brisotto G, Elia C, Mussolin L, Mascarin M, d’Amore ESG. Preliminary Study of the Relationship between Osteopontin and Relapsed Hodgkin's Lymphoma. Biomedicines 2023; 12:31. [PMID: 38275392 PMCID: PMC10813762 DOI: 10.3390/biomedicines12010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
The primary objective of this study was to investigate the potential role of tissue osteopontin, also known as secreted phosphoprotein 1 (SPP1), as a contributing factor to an unfavorable prognosis in classical Hodgkin's lymphoma (HL) patients who received the same treatment protocol. The study involved 44 patients aged 4-22 years, with a median follow-up period of 3 years. Patients with higher levels of SPP1 were associated with tissue necrosis and inflammation, and there was a trend toward a poorer prognosis in this group. Before therapy, we found a correlation between positron emission tomography (PET) scans and logarithmic SPP1 levels (p = 0.035). However, the addition of SPP1 levels did not significantly enhance the predictive capacity of PET scans for recurrence or progression. Elevated SPP levels were associated with tissue mRNA counts of chemotactic and inflammatory chemokines, as well as specific monocyte/dendritic cell subtypes, defined by IL-17RB, PLAUR, CXCL8, CD1A, CCL13, TREM1, and CCL24 markers. These findings contribute to a better understanding of the potential factors influencing the prognosis of HL patients and the potential role of SPP1 in the disease. While the predictive accuracy of PET scans did not substantially improve during the study, the results underscore the complexity of HL and highlight the relationships between SPP1 and other factors in the context of HL relapse.
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Affiliation(s)
- Valli De Re
- Immunopatologia e Biomarcatori Oncologici, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, 33081 Aviano, Italy
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS—Humanitas Research Hospital, Rozzano, 20089 Milano, Italy
| | - Giulia Brisotto
- Immunopatologia e Biomarcatori Oncologici, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, 33081 Aviano, Italy
| | - Caterina Elia
- AYA Oncology and Pediatric Radiotherapy Unit, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, 33081 Aviano, Italy
| | - Lara Mussolin
- Pediatric Hemato-Oncology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padua, Italy
- Clinica di Oncoematologia Pediatrica, Azienda Ospedaliera—Università di Padova, 35128 Padova, Italy
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, 33081 Aviano, Italy
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van Heek L, Weindler J, Gorniak C, Kaul H, Müller H, Mettler J, Baues C, Fuchs M, Borchmann P, Ferdinandus J, Dietlein M, Voltin CA, Kobe C, Roth KS. Prognostic value of baseline metabolic tumor volume (MTV) for forecasting chemotherapy outcome in early-stage unfavorable Hodgkin lymphoma: Data from the phase III HD17 trial. Eur J Haematol 2023; 111:881-887. [PMID: 37644732 DOI: 10.1111/ejh.14093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES The prognostic relevance of metabolic tumor volume (MTV) having recently been demonstrated in patients with early-stage favorable and advanced-stage Hodgkin lymphoma. The current study aimed to assess the potential prognostic value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in early-stage unfavorable Hodgkin lymphoma patients treated within the German Hodgkin Study Group HD17 trial. METHODS 18 F-FDG PET/CT images were available for MTV analysis in 154 cases. We used three different threshold methods (SUV2.5 , SUV4.0 , and SUV41% ) to calculate MTV. Receiver-operating-characteristic analysis was performed to describe the value of these parameters in predicting an adequate therapy response. Therapy response was evaluated as PET negativity after 2 cycles of eBEACOPP followed by 2 cycles of ABVD. RESULTS All three threshold methods analyzed for MTV showed a positive correlation with the PET response after chemotherapy. Areas under the curve (AUC) were 0.70 (95% CI 0.53-0.87) and 0.65 (0.50-0.80) using the fixed thresholds of SUV4.0 and SUV2.5 , respectively, for MTV- calculation. The calculation of MTV using a relative threshold of SUV41% showed an AUC of 0.63 (0.47-0.79). CONCLUSIONS MTV does have predictive value after chemotherapy in early-stage unfavorable Hodgkin lymphoma, particularly when the fixed threshold of SUV4.0 is used for MTV calculation. TRIAL REGISTRATION ClinicalTrials.gov NCT01356680.
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Affiliation(s)
- Lutz van Heek
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jasmin Weindler
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Claudia Gorniak
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Helen Kaul
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Horst Müller
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jasmin Mettler
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Baues
- Department of Radiooncology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Michael Fuchs
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Justin Ferdinandus
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Conrad-Amadeus Voltin
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katrin S Roth
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Alderuccio JP, Kuker RA, Yang F, Moskowitz CH. Quantitative PET-based biomarkers in lymphoma: getting ready for primetime. Nat Rev Clin Oncol 2023; 20:640-657. [PMID: 37460635 DOI: 10.1038/s41571-023-00799-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 08/20/2023]
Abstract
The use of functional quantitative biomarkers extracted from routine PET-CT scans to characterize clinical responses in patients with lymphoma is gaining increased attention, and these biomarkers can outperform established clinical risk factors. Total metabolic tumour volume enables individualized estimation of survival outcomes in patients with lymphoma and has shown the potential to predict response to therapy suitable for risk-adapted treatment approaches in clinical trials. The deployment of machine learning tools in molecular imaging research can assist in recognizing complex patterns and, with image classification, in tumour identification and segmentation of data from PET-CT scans. Initial studies using fully automated approaches to calculate metabolic tumour volume and other PET-based biomarkers have demonstrated appropriate correlation with calculations from experts, warranting further testing in large-scale studies. The extraction of computer-based quantitative tumour characterization through radiomics can provide a comprehensive view of phenotypic heterogeneity that better captures the molecular and functional features of the disease. Additionally, radiomics can be integrated with genomic data to provide more accurate prognostic information. Further improvements in PET-based biomarkers are imminent, although their incorporation into clinical decision-making currently has methodological shortcomings that need to be addressed with confirmatory prospective validation in selected patient populations. In this Review, we discuss the current knowledge, challenges and opportunities in the integration of quantitative PET-based biomarkers in clinical trials and the routine management of patients with lymphoma.
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Affiliation(s)
- Juan Pablo Alderuccio
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Russ A Kuker
- Department of Radiology, Division of Nuclear Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Fei Yang
- Department of Radiation Oncology, Division of Medical Physics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Craig H Moskowitz
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Constantino CS, Leocádio S, Oliveira FPM, Silva M, Oliveira C, Castanheira JC, Silva Â, Vaz S, Teixeira R, Neves M, Lúcio P, João C, Costa DC. Evaluation of Semiautomatic and Deep Learning-Based Fully Automatic Segmentation Methods on [ 18F]FDG PET/CT Images from Patients with Lymphoma: Influence on Tumor Characterization. J Digit Imaging 2023; 36:1864-1876. [PMID: 37059891 PMCID: PMC10407010 DOI: 10.1007/s10278-023-00823-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 04/16/2023] Open
Abstract
The objective is to assess the performance of seven semiautomatic and two fully automatic segmentation methods on [18F]FDG PET/CT lymphoma images and evaluate their influence on tumor quantification. All lymphoma lesions identified in 65 whole-body [18F]FDG PET/CT staging images were segmented by two experienced observers using manual and semiautomatic methods. Semiautomatic segmentation using absolute and relative thresholds, k-means and Bayesian clustering, and a self-adaptive configuration (SAC) of k-means and Bayesian was applied. Three state-of-the-art deep learning-based segmentations methods using a 3D U-Net architecture were also applied. One was semiautomatic and two were fully automatic, of which one is publicly available. Dice coefficient (DC) measured segmentation overlap, considering manual segmentation the ground truth. Lymphoma lesions were characterized by 31 features. Intraclass correlation coefficient (ICC) assessed features agreement between different segmentation methods. Nine hundred twenty [18F]FDG-avid lesions were identified. The SAC Bayesian method achieved the highest median intra-observer DC (0.87). Inter-observers' DC was higher for SAC Bayesian than manual segmentation (0.94 vs 0.84, p < 0.001). Semiautomatic deep learning-based median DC was promising (0.83 (Obs1), 0.79 (Obs2)). Threshold-based methods and publicly available 3D U-Net gave poorer results (0.56 ≤ DC ≤ 0.68). Maximum, mean, and peak standardized uptake values, metabolic tumor volume, and total lesion glycolysis showed excellent agreement (ICC ≥ 0.92) between manual and SAC Bayesian segmentation methods. The SAC Bayesian classifier is more reproducible and produces similar lesion features compared to manual segmentation, giving the best concordant results of all other methods. Deep learning-based segmentation can achieve overall good segmentation results but failed in few patients impacting patients' clinical evaluation.
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Affiliation(s)
- Cláudia S Constantino
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal.
| | - Sónia Leocádio
- Hematology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Francisco P M Oliveira
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Mariana Silva
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Carla Oliveira
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Joana C Castanheira
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Ângelo Silva
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Sofia Vaz
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Ricardo Teixeira
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Manuel Neves
- Hematology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Paulo Lúcio
- Hematology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Cristina João
- Hematology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Durval C Costa
- Nuclear Medicine - Radiopharmacology Department, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
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Lopci E, Mascarin M. Role of volumetric analyses on [ 18F]FDG PET/CT in pediatric Hodgkin lymphoma. Expert Rev Hematol 2023; 16:629-631. [PMID: 37453051 DOI: 10.1080/17474086.2023.2238125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Egesta Lopci
- Nuclear Medicine, IRCCS - Humanitas Research Hospital, Rozzano, MI, Italy
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, PN, Italy
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11
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Milgrom SA, Kim J, Pei Q, Lee I, Hoppe BS, Wu Y, Hodgson D, Kessel S, McCarten KM, Roberts K, Lo AC, Cole PD, Kelly KM, Cho SY. Baseline metabolic tumour burden improves risk stratification in Hodgkin lymphoma: A Children's Oncology Group study. Br J Haematol 2023; 201:1192-1199. [PMID: 36922022 PMCID: PMC10247420 DOI: 10.1111/bjh.18734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/17/2023]
Abstract
The Children's Oncology Group AHOD0831 study used a positron emission tomography (PET) response-adapted approach in high-risk Hodgkin lymphoma, whereby slow early responders (SERs) received more intensive therapy than rapid early responders (RERs). We explored if baseline PET-based characteristics would improve risk stratification. Of 166 patients enrolled in the COG AHOD0831 study, 94 (57%) had baseline PET scans evaluable for quantitative analysis. For these patients, total body metabolic tumour volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake value (SUVmax ) and peak SUV (SUVpeak ) were obtained. MTV/TLG thresholds were an SUV of 2.5 (MTV2.5 /TLG2.5 ) and 40% of the tumour SUVmax (MTV40% /TLG40% ). TLG2.5 was associated with event-free survival (EFS) in the complete cohort (p = 0.04) and in RERs (p = 0.01), but not in SERs (p = 0.8). The Youden index cut-off for TLG2.5 was 1841. Four-year EFS was 92% for RER/TLG2.5 up to 1841, 60% for RER/TLG2.5 greater than 1841, 74% for SER/TLG2.5 up to 1841 and 79% for SER/TLG2.5 greater than 1841. Second EFS for RER/TLG2.5 up to 1841 was 100%. Thus, RERs with a low baseline TLG2.5 experienced excellent EFS with less intensive therapy, whereas RERs with a high baseline TLG2.5 experienced poor EFS. These findings suggest that patients with a high upfront tumour burden may benefit from intensified therapy, even if they achieve a RER.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado, USA
| | - Jihyun Kim
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Qinglin Pei
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Inki Lee
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Yue Wu
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | | | - Sandy Kessel
- Imaging and Radiation Oncology Core, Lincoln, Rhode Island, USA
| | | | - Kenneth Roberts
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrea C Lo
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Peter D Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Kara M Kelly
- Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Steve Y Cho
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
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12
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Pepper NB, Oertel M, Rehn S, Kobe C, Eich HT. Modern PET-Guided Radiotherapy Planning and Treatment for Malignant Lymphoma. Semin Nucl Med 2023; 53:389-399. [PMID: 36241473 DOI: 10.1053/j.semnuclmed.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022]
Abstract
Malignant lymphoma comprises a broad spectrum of diverse entities originating from different types of lymphocytes. In the last century, successive improvements of treatment possibilities have led to an continuous amelioration of patient prognosis from lethal outcome to high rates of disease control and long-term survivors. PET/CT-based imaging plays a key role in stratification of stage and treatment response. Especially for radiotherapy, an essential treatment modality for lymphoma patients, functional imaging and the reevaluation of disease activity after frontline chemotherapy has led to major improvements regarding size of treatment fields and toxicity. International expert groups like the International Lymphoma Radiation Oncology Group (ILROG) develop guidelines for the optimal use of imaging for treatment planning. The shift from uniform large-field treatment volumes to complex individual setups taking into account biological response-assessments based on functional imaging resulted in a further de-escalation of side effects and modernization of lymphoma treatment. This paper aims to summarize the use of FDG-PET-imaging for radiation therapy planning in malignant lymphoma in the context of historic and future developments, as well as associated limitations and challenges ahead. We will discuss the contemporary standard of care as recommended by international expert guidelines like the ILROG, the national comprehensive cancer network (NCCN), as well as the newly updated German S3-guidelines.
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Affiliation(s)
| | - Michael Oertel
- University Hospital Muenster, Department of Radiation Oncology, Muenster, Germany
| | - Stephan Rehn
- University Hospital Muenster, Department of Radiation Oncology, Muenster, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hans Theodor Eich
- University Hospital Muenster, Department of Radiation Oncology, Muenster, Germany.
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13
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Pomykala KL, Fendler WP, Vermesh O, Umutlu L, Herrmann K, Seifert R. Molecular Imaging of Lymphoma: Future Directions and Perspectives. Semin Nucl Med 2023; 53:449-456. [PMID: 36344325 DOI: 10.1053/j.semnuclmed.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
More than 250,000 patients die from Hodgkin or non-Hodgkin lymphoma each year. Currently, molecular imaging with 18F-FDG-PET/CT is the standard of care for lymphoma staging and therapy response assessment. In this review, we will briefly summarize the role of molecular imaging for lymphoma diagnosis, staging, outcome prediction, and prognostication. We discuss future directions in response assessment and surveillance with quantitative PET parameters, the utility of interim assessment, and the differences with response assessment to immunomodulatory therapy. Lastly, we will cover innovations in the field regarding novel tracers and artificial intelligence.
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Affiliation(s)
- Kelsey L Pomykala
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Ophir Vermesh
- Division of Nuclear Medicine in the Department of Radiology at Stanford University, Stanford, CA
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany.
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
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14
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Ortega C, Eshet Y, Prica A, Anconina R, Johnson S, Constantini D, Keshavarzi S, Kulanthaivelu R, Metser U, Veit-Haibach P. Combination of FDG PET/CT Radiomics and Clinical Parameters for Outcome Prediction in Patients with Hodgkin’s Lymphoma. Cancers (Basel) 2023; 15:cancers15072056. [PMID: 37046717 PMCID: PMC10093084 DOI: 10.3390/cancers15072056] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose: The aim of the study is to evaluate the prognostic value of a joint evaluation of PET and CT radiomics combined with standard clinical parameters in patients with HL. Methods: Overall, 88 patients (42 female and 46 male) with a median age of 43.3 (range 21–85 years) were included. Textural analysis of the PET/CT images was performed using freely available software (LIFE X). 65 radiomic features (RF) were evaluated. Univariate and multivariate models were used to determine the value of clinical characteristics and FDG PET/CT radiomics in outcome prediction. In addition, a binary logistic regression model was used to determine potential predictors for radiotherapy treatment and odds ratios (OR), with 95% confidence intervals (CI) reported. Features relevant to survival outcomes were assessed using Cox proportional hazards to calculate hazard ratios with 95% CI. Results: albumin (p = 0.034) + ALP (p = 0.028) + CT radiomic feature GLRLM GLNU mean (p = 0.012) (Area under the curve (AUC): 95% CI (86.9; 100.0)—Brier score: 3.9, 95% CI (0.1; 7.8) remained significant independent predictors for PFS outcome. PET-SHAPE Sphericity (p = 0.033); CT grey-level zone length matrix with high gray-level zone emphasis (GLZLM SZHGE mean (p = 0.028)); PARAMS XSpatial Resampling (p = 0.0091) as well as hemoglobin results (p = 0.016) remained as independent factors in the final model for a binary outcome as predictors of the need for radiotherapy (AUC = 0.79). Conclusion: We evaluated the value of baseline clinical parameters as well as combined PET and CT radiomics in HL patients for survival and the prediction of the need for radiotherapy treatment. We found that different combinations of all three factors/features were independently predictive of the here evaluated endpoints.
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15
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Yang T, Liu S, Zuo R, Liang H, Xu L, Wang Z, Chen X, Pang H. Prognostic role of pretreatment 18F-FDG PET/CT and hematological parameters in relapsed/refractory Hodgkin lymphoma patients treated with immune checkpoint inhibitors and chemotherapy: a dual-center cohort study. BMC Med Imaging 2023; 23:12. [PMID: 36681824 PMCID: PMC9867864 DOI: 10.1186/s12880-023-00967-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The combination of anti-programmed death-1 antibodies and chemotherapy is effective; however, there are no reliable outcome prediction factors. We investigated the prognostic factors based on 18Fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) quantitative and hematological parameters to predict progression-free survival (PFS) in relapsed/refractory classical Hodgkin lymphoma (R/R cHL) patients treated with immune checkpoint inhibitors (ICIs) and chemotherapy. METHODS This retrospective study included 31 patients who underwent 18F-FDG PET/CT before and during treatment. Pretreatment metabolic and hematological parameters were evaluated using Cox regression analysis to identify predictors of PFS. Based on the cut-off values calculated using the receiver operating characteristic (ROC) curve, patients were classified into low-, intermediate-, and high-risk groups. Kaplan-Meier curves and the log-rank test were used to compare survival differences between the groups. RESULTS Cox multivariable analysis indicted that the treatment response based on Lactate dehydrogenase (LDH), Lugano classification and SUVmax were independent predictors of PFS (P = 0.004, 0.007 and 0.039, respectively). The optimal cut-off values for SUVmax and LDH were 11.62 and 258.5 U/L, respectively (P < 0.01). Survival curves showed that LDH ≥ 258.5U/L and SUVmax ≥ 11.62 were correlated to shorter PFS (P < 0.001, P = 0.003, respectively). The differences in PFS between the low-, intermediate-, and high-risk groups were statistically significant (P = 0.0043). CONCLUSION In R/R cHL patients treated with ICIs and chemotherapy, Lugano classification, SUVmax, and LDH were significantly correlated with PFS. The combination of metabolic and hematological parameters predicts PFS and may help to improve patient selection.
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Affiliation(s)
- Tianyu Yang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Shuang Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Rui Zuo
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Hongwei Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Lu Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Zhengjie Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Xiaoliang Chen
- Department of Nuclear Medicine, Chongqing University Cancer Hospital, Chongqing, 400030 China
| | - Hua Pang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
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16
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Mohite A, Rangarajan V, Goda J, Chugh S, Agrawal A, Sengar M. Metabolic tumor parameters complement clinicopathological factors in prognosticating advanced stage Hodgkin Lymphoma. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2023; 11:111-121. [PMID: 37324230 PMCID: PMC10261693 DOI: 10.22038/aojnmb.2023.69260.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 06/17/2023]
Abstract
Objectives Advanced Hodgkin Lymphoma has a higher probability of relapse and recurrence. Classical clinicopathological parameters including the International Prognostic Score (IPS) have not been reliable in predicting prognosis or tailoring treatment. Since FDG PET/CT is the standard of care in staging Hodgkin Lymphoma, this study attempted to evaluate the clinical utility of baseline metabolic tumor parameters in a cohort of advanced Hodgkin lymphoma (stage III and IV). Methods Histology-proven advanced Hodgkin Patients presenting to our institute between 2012-2016 and treated with chemo-radiotherapy (ABVD / AEVD) were followed up till 2019. Quantitative PET/CT and clinicopathological parameters were used to estimate the Event Free Survival (EFS) in 100 patients. Kaplan-Meier method with log-rank test was used to compare the survival times of prognostic factors. Results At a median follow-up of 48.83 months (IQR:33.31-63.05 months), the five-year-EFS was 81%. Of the 100 patients, 16 had relapsed (16%) and none died at the last follow-up. On Univariate analysis, among non-PET parameters bulky disease (P=0.03) and B-symptoms (P=0.04) were significant while among PET/CT parameters SUVmax (p=0.001), SUVmean (P=0.002), WBMTV2.5 (P<0.001), WBMTV41% (P<0.001), WBTLG2.5 (P<0.001) and WBTLG41% (P <0.001) predicted poorer EFS. 5-year EFS for patients with low WBMTV2.5 [<1038.3 cm3] was 89% and 35% for patients with high WBMTV2.5 [≥1038.3 cm3] (p <0.001). In a multivariate model, only WBMTV2.5 (P=0.03) independently predicted poorer EFS. Conclusion PET-based metabolic parameter (WBMTV2.5) was able to prognosticate and complement the classical clinical prognostic factors in advanced Hodgkin Lymphoma. This parameter could have a surrogate value for prognosticating advanced Hodgkin lymphoma. Better prognostication at baseline translates to tailored or risk-modified treatment and hence higher survival.
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Affiliation(s)
- Ashish Mohite
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
| | - Jayant Goda
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
| | - Swati Chugh
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Haematooncology, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
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Vergote VKJ, Verhoef G, Janssens A, Woei-A-Jin FJSH, Laenen A, Tousseyn T, Dierickx D, Deroose CM. [ 18F]FDG-PET/CT volumetric parameters can predict outcome in untreated mantle cell lymphoma. Leuk Lymphoma 2023; 64:161-170. [PMID: 36223113 DOI: 10.1080/10428194.2022.2131415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several studies have shown a strong predictive value for pretreatment [18F]FDG-PET/CT metabolic parameters in different lymphoma subtypes. However, few publications exist concerning the role of metabolic parameters in mantle cell lymphoma (MCL). We retrospectively investigated the prognostic value of baseline metabolic tumor volume (MTV) and lesion dissemination in untreated MCL. We compared it to currently used prognostic factors such as stage, mantle cell lymphoma international prognostic index (MIPI) and KI-67. We report that a higher baseline MTV is a risk factor for worse overall survival (OS), progression-free survival (PFS), and disease-specific survival (DSS) in univariate analysis. In multivariate analysis, MTV was significantly associated with DSS, but not with OS and PFS. We found no correlation between lesion dissemination and outcome. The MIPI score remains the strongest predictor of outcome. These results show that MTV is an important prognostic tool and can improve patient risk stratification at staging of untreated MCL.
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Affiliation(s)
| | - Gregor Verhoef
- Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Ann Janssens
- Hematology, University Hospitals Leuven, Leuven, Belgium
| | | | - Annouschka Laenen
- Biostatistics and Statistical Bioinformatics Center, Leuven, Belgium
| | | | - Daan Dierickx
- Hematology, University Hospitals Leuven, Leuven, Belgium
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Ali HY, Mohammad SA, Ali AH, Monib AM, Shalaby MH. Can positron emission tomography–computed tomography-based three target lesions' total lesion glycolysis predict therapeutic response in Hodgkin Lymphoma? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Universally maximum standardized uptake value (SUVmax) and lactate dehydrogenase (LDH) are used as tools for response assessment in Hodgkin Lymphoma (HL) patients. Our objectives are to evaluate the predictive potential and response assessment of total lesion glycolysis (TLG) and metabolic tumor volume (MTV)—maximum three target lesions—as another alternatives and to investigate the correlation between TLG and MTV with LDH.
Results
Both initial SUVmax and TLG were significantly associated with early patient response (p value 0.03, 0.047, respectively). An optimal threshold for SUVmax and TLG less than or equal 19.52, and 158.6, respectively, correlated with better therapeutic response. Initial LDH was moderately correlated with initial values of TLG (rs = 0.4, p value 0.01), MTV (rs = 0.44, p value 0.01) and SUVmax (rs = 0.42, p value 0.01).
Conclusion
TLG in correlation with LDH can be significant prognostic factors of therapeutic response in HL. They can be used for the identification of a subset of HL patients with a better outcome.
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Lopci E, Elia C, Catalfamo B, Burnelli R, De Re V, Mussolin L, Piccardo A, Cistaro A, Borsatti E, Zucchetta P, Bianchi M, Buffardi S, Farruggia P, Garaventa A, Sala A, Vinti L, Mauz-Koerholz C, Mascarin M. Prospective Evaluation of Different Methods for Volumetric Analysis on [ 18F]FDG PET/CT in Pediatric Hodgkin Lymphoma. J Clin Med 2022; 11:jcm11206223. [PMID: 36294544 PMCID: PMC9605658 DOI: 10.3390/jcm11206223] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/30/2022] Open
Abstract
Rationale: Therapy response evaluation by 18F-fluorodeoxyglucose PET/CT (FDG PET) has become a powerful tool for the discrimination of responders from non-responders in pediatric Hodgkin lymphoma (HL). Recently, volumetric analyses have been regarded as a valuable tool for disease prognostication and biological characterization in cancer. Given the multitude of methods available for volumetric analysis in HL, the AIEOP Hodgkin Lymphoma Study Group has designed a prospective analysis of the Italian cohort enrolled in the EuroNet-PHL-C2 trial. Methods: Primarily, the study aimed to compare the different segmentation techniques used for volumetric assessment in HL patients at baseline (PET1) and during therapy: early (PET2) and late assessment (PET3). Overall, 50 patients and 150 scans were investigated for the current analysis. A dedicated software was used to semi-automatically delineate contours of the lesions by using different threshold methods. More specifically, four methods were applied: (1) fixed 41% threshold of the maximum standardized uptake value (SUVmax) within the respective lymphoma site (V41%), (2) fixed absolute SUV threshold of 2.5 (V2.5); (3) SUVmax(lesion)/SUVmean liver >1.5 (Vliver); (4) adaptive method (AM). All parameters obtained from the different methods were analyzed with respect to response. Results: Among the different methods investigated, the strongest correlation was observed between AM and Vliver (rho > 0.9; p < 0.001 for SUVmean, MTV and TLG at all scan timing), along with V2.5 and AM or Vliver (rho 0.98, p < 0.001 for TLG at baseline; rho > 0.9; p < 0.001 for SUVmean, MTV and TLG at PET2 and PET3, respectively). To determine the best segmentation method, we applied logistic regression and correlated different results with Deauville scores at late evaluation. Logistic regression demonstrated that MTV (metabolic tumor volume) and TLG (total lesion glycolysis) computation according to V2.5 and Vliver significantly correlated to response to treatment (p = 0.01 and 0.04 for MTV and 0.03 and 0.04 for TLG, respectively). SUVmean also resulted in significant correlation as absolute value or variation. Conclusions: The best correlation for volumetric analysis was documented for AM and Vliver, followed by V2.5. The volumetric analyses obtained from V2.5 and Vliver significantly correlated to response to therapy, proving to be preferred thresholds in our pediatric HL cohort.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine Unit, IRCCS—Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Correspondence: or
| | - Caterina Elia
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Barbara Catalfamo
- Nuclear Medicine Unit, University Hospital “Mater Domini, 88100 Catanzaro, Italy
| | - Roberta Burnelli
- Pediatric Onco-Hematologic Unit, University Hospital S. Anna, 44121 Ferrara, Italy
| | - Valli De Re
- Immunopathology and Cancer Biomarkers Unit, Department of Translational Research, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Lara Mussolin
- Pediatric Hemato-Oncology Clinic, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
- Institute of Pediatric Research-Fondazione Città della Speranza, 35127 Padua, Italy
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, Galliera Hospital, 16128 Genoa, Italy
| | - Angelina Cistaro
- Nuclear Medicine Division, Salus Alliance Medical, 16128 Genoa, Italy
| | - Eugenio Borsatti
- Nuclear Medicine Department, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Pietro Zucchetta
- Nuclear Medicine Department, Padova University Hospital, 35128 Padua, Italy
| | - Maurizio Bianchi
- Onco-Hematology Division, Regina Margherita Hospital, 10126 Torino, Italy
| | - Salvatore Buffardi
- Department of Oncology, Hospital Santobono-Pausilipon, 80123 Naples, Italy
| | - Piero Farruggia
- Department of Pediatric Onco-Hematology, A.R.N.A.S. Ospedali Civico, 90127 Palermo, Italy
| | - Alberto Garaventa
- Pediatric Oncology Unit, I RCCS G.Gaslini Hospital, 16147 Genoa, Italy
| | - Alessandra Sala
- Pediatric Division, Hospital San Gerardo, 20900 Monza, Italy
| | - Luciana Vinti
- Department of Pediatric Hematology and Oncology, Ospedale Bambino Gesù, IRCSS, 00165 Rome, Italy
| | - Christine Mauz-Koerholz
- Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Gießen, 35392 Giessen, Germany
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, 06120 Halle, Germany
| | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
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Eisazadeh R, Mirshahvalad SA. 18F-FDG PET/CT prognostic role in predicting response to salvage therapy in relapsed/refractory Hodgkin's lymphoma. Clin Imaging 2022; 92:25-31. [PMID: 36179394 DOI: 10.1016/j.clinimag.2022.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the response predictors, both clinical and 18F-FDG PET/CT parameters, in Hodgkin's lymphoma (HL) patients diagnosed with refractory/relapsed disease who were planned to receive salvage therapy. METHODS In this retrospective study, all HL patients referred to our center between March 2015 and July 2021 were reviewed. Patients with refractory/relapsed disease who were candidates for salvage therapy were included. 18F-FDG PET/CT measurements at the time of diagnosis were extracted as the predictors, and the lesions' response at the end of the salvage therapy was considered the outcomes. The Kaplan-Meier method and multiple Cox regression were utilized to find the significant parameters to predict the time to reach the complete response. The statistical significance level was set at a two-sided p-value <0.05. RESULTS A total of 303 tumoral lesions from 64 patients were included. Regarding the factors associated with the response, B symptoms (p-value < 0.01), pathologic subtype (p-value < 0.001), and patient stage (p-value < 0.01) were the significant clinical parameters. In addition, SUVmax (p-value = 0.03), SUVmax/hepatic background SUVmax (p-value = 0.04), SUVmean (in all thresholds; 41% p-value = 0.02, 51% p-value = 0.04, 61% p-value = 0.01), and MTV (in all thresholds; 41% p-value = 0.04, 51% p-value = 0.04, 61% p-value = 0.05) were the significant parameters in the 18F-FDG PET/CT scans. At the median follow-up of 9 months, we found that pathologic subtype (p-value < 0.01), patient stage (p-value = 0.03), SUVmax (p-value = 0.02), SUVmax/hepatic background SUVmax (p-value = 0.03), SUVmean (in all thresholds; 41% p-value = 0.01, 51% p-value = 0.02, 61% p-value = 0.02), and MTV ≥ 41% (p-value = 0.02) were significant predictive factors. Multiple Cox regression showed the pathologic subtype (p-value = 0.02), SUVmax (p-value = 0.02), and MTV ≥ 41% (p-value = 0.04) were the most significant predictors. CONCLUSION Our study demonstrated that by knowing the histopathology of the lesions, the pre-treatment 18F-FDG PET/CT might be able to predict response after salvage therapy in the relapsed/refractory HL.
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Affiliation(s)
- Roya Eisazadeh
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Mirshahvalad
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran; Joint Department of Medical Imaging, University Health Network, University of Toronto, Canada.
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21
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Morland D, Triumbari EKA, Maiolo E, Cuccaro A, Treglia G, Hohaus S, Annunziata S. Healthy Organs Uptake on Baseline 18F-FDG PET/CT as an Alternative to Total Metabolic Tumor Volume to Predict Event-Free Survival in Classical Hodgkin's Lymphoma. Front Med (Lausanne) 2022; 9:913866. [PMID: 35814740 PMCID: PMC9256984 DOI: 10.3389/fmed.2022.913866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeHealthy organs uptake, including cerebellar and liver SUVs have been reported to be inversely correlated to total metabolic tumor volume (TMTV), a controversial predictor of event-free survival (EFS) in classical Hodgkin's Lymphoma (cHL). The objective of this study was to estimate TMTV by using healthy organs SUV measurements and assess the performance of this new index (UF, Uptake Formula) to predict EFS in cHL.MethodsPatients with cHL were retrospectively included. SUV values and TMTV derived from baseline 18F-FDG PET/CT were harmonized using ComBat algorithm across PET/CT systems. UF was estimated using ANOVA analysis. Optimal thresholds of TMTV and UF were calculated and tested using Cox models.Results163 patients were included. Optimal UF model of TMTV included age, lymphoma maximum SUVmax, hepatic SUVmean and cerebellar SUVmax (R2 14.0% - p < 0.001). UF > 236.8 was a significant predictor of EFS (HR: 2.458 [1.201–5.030], p = 0.01) and was not significantly different from TMTV > 271.0 (HR: 2.761 [1.183–5.140], p = 0.001). UF > 236.8 remained significant in a bivariate model including IPS score (p = 0.02) and determined two populations with different EFS (63.7 vs. 84.9%, p = 0.01).ConclusionThe Uptake Formula, a new index including healthy organ SUV values, shows similar performance to TMTV in predicting EFS in Hodgkin's Lymphoma. Validation cohorts will be needed to confirm this new prognostic parameter.
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Affiliation(s)
- David Morland
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Service de Médecine Nucléaire, Institut Godinot, Reims, France
- Laboratoire de Biophysique, UFR de Médecine, Université de Reims Champagne-Ardenne, Reims, France
- CReSTIC (Centre de Recherche en Sciences et Technologies de l'Information et de la Communication), EA 3804, Université de Reims Champagne-Ardenne, Reims, France
- *Correspondence: David Morland
| | - Elizabeth Katherine Anna Triumbari
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Elena Maiolo
- Unità di Ematologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Annarosa Cuccaro
- Unità di Ematologia, ASL Toscana N/O Spedali Riuniti Livorno, Livorno, Italy
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Stefan Hohaus
- Unità di Ematologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Section of Hematology, Department of Radiological Sciences, Radiotherapy and Hematology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Salvatore Annunziata
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
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22
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van Heek L, Stuka C, Kaul H, Müller H, Mettler J, Hitz F, Baues C, Fuchs M, Borchmann P, Engert A, Dietlein M, Voltin CA, Kobe C. Predictive value of baseline metabolic tumor volume in early-stage favorable Hodgkin Lymphoma - Data from the prospective, multicenter phase III HD16 trial. BMC Cancer 2022; 22:672. [PMID: 35717166 PMCID: PMC9206242 DOI: 10.1186/s12885-022-09758-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background 18F -fluorodeoxyglucose (FDG) positron emission tomography (PET) plays an important role in the staging and response assessment of lymphoma patients. Our aim was to explore the predictive relevance of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with early stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD16 trial. Methods 18F-FDG PET/CT images were available for MTV and TLG analysis in 107 cases from the HD16 trial. We calculated MTV and TLG using three different threshold methods (SUV4.0, SUV41% and SUV140%L), and then performed receiver-operating-characteristic analysis to assess the predictive impact of these parameters in predicting an adequate therapy response with PET negativity after 2 cycles of chemotherapy. Results All three threshold methods analyzed for MTV and TLG calculation showed a positive correlation with the PET response after 2 cycles chemotherapy. The largest area under the curve (AUC) was observed using the fixed threshold of SUV4.0 for MTV- calculation (AUC 0.69 [95% CI 0.55–0.83]) and for TLG-calculation (AUC 0.69 [0.55–0.82]). The calculations for MTV and TLG with a relative threshold showed a lower AUC: using SUV140%L AUCs of 0.66 [0.53–0.80] for MTV and 0.67 for TLG [0.54–0.81]) were observed, while with SUV41% an AUC of 0.61 [0.45–0.76] for MTV, and an AUC 0.64 [0.49–0.80]) for TLG were seen. Conclusions MTV and TLG do have a predictive value after two cycles ABVD in early stage Hodgkin lymphoma, particularly when using the fixed threshold of SUV4.0 for MTV and TLG calculation. Trial registration ClinicalTrials.gov NCT00736320.
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Affiliation(s)
- Lutz van Heek
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Colin Stuka
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Helen Kaul
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Center for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Horst Müller
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Center for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jasmin Mettler
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Felicitas Hitz
- Swiss Group for Clinical Cancer Research, Bern, Switzerland.,Department of Medical Oncology and Haematology, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Christian Baues
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and UniversityHospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Fuchs
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Center for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Center for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andreas Engert
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), Center for Integrated Oncology Aachen - Bonn - Cologne - Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Conrad-Amadeus Voltin
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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23
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Rossi C, André M, Dupuis J, Morschhauser F, Joly B, Lazarovici J, Ghesquières H, Stamatoullas A, Nicolas-Virelizier E, Feugier P, Gac AC, Moatti H, Fornecker LM, Deau B, Joubert C, Fortpied C, Raemaekers J, Federico M, Kanoun S, Meignan M, Traverse-Glehen A, Cottereau AS, Casasnovas RO. High-risk stage IIB Hodgkin lymphoma treated in the H10 and AHL2011 trials: total metabolic tumor volume is a useful risk factor to stratify patients at baseline. Haematologica 2022; 107:2897-2904. [PMID: 35638548 PMCID: PMC9713544 DOI: 10.3324/haematol.2021.280004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Indexed: 12/14/2022] Open
Abstract
Stage IIB Hodgkin lymphoma (HL) patients, with a mediastinum-to-thorax (M/T) ratio of ≥0.33 or extranodal localization have a poor prognosis and are treated either as limited or advanced stage. We compared these two approaches in patients included in two randomized phase III trials enrolling previously untreated early (H10) or advanced stage HL (AHL2011). We included HL patients with Ann-Arbor stage IIB with M/T ≥0.33 or extranodal involvement enrolled in the H10 or AHL2011 trials with available positron emission tomography at baseline (PET0) and after two cycles of chemotherapy (PET2). Baseline total metabolic tumor volume (TMTV) was calculated using the 41% SUVmax method. PET2 response assessment used the Deauville score. One hundred and fourty-eight patients were eligible, including 83 enrolled in the AHL2011 trial and 65 in the H10 trial. The median TMTV value was 155.5 mL (range, 8.3-782.9 mL), 165.6 mL in AHL2011 and 147 mL in H10. PET2 positivity rates were 16.9% (n=14) and 9.2% (n=6) in AHL2011 and H10 patients, respectively. With a median follow-up of 4.1 years (95% confidence interval [CI]: 3.9-4.4), overall 4-year PFS was 88.0%, 87.0% in AHL2011 and 89.2% in H10. In univariate and mutivariate analyses, baseline TMTV and PET2 response influenced significantly progression-free survival (hazard ratio [HR]=4.94, HR=3.49 respectively). Notably, among the 16 patients who relapsed, 13 (81%) had a baseline TMTV baseline ≥155 mL. Upfront ABVD plus radiation therapy or upfront escBEACOPP without radiotherapy provide similar patient's outcome in high-risk stage IIB HL. TMTV is useful to stratify these patients at baseline.
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Affiliation(s)
- Cédric Rossi
- Department of Hematology, Dijon-Bourgogne University Hospital, Dijon, France,INSERM 1231, University of Burgundy Franche-Comté, Franche-Comté, France,C. Rossi
| | - Marc André
- Department of Hematology, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital (AP-HP), Créteil, France
| | - Franck Morschhauser
- Groupe de Recherche sur les Formes Injectables et les Technologies Associees (GRITA), Department of Hematology, CHU Lille, Université de Lille, Lille, France
| | - Bertrand Joly
- Department of Hematology, Hospital Sud Francilien, Corbeille-Essonnes, France
| | - Julien Lazarovici
- Department of Hematology, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Hervé Ghesquières
- Department of Hematology, Centre Hospitalier Lyon Sud and Université Claude Bernard Lyon-1, Pierre-Bénite, France
| | | | | | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Anne-Claire Gac
- Department of Hematology, Institut d'Hématologie de Basse Normandie, Caen, France
| | - Hannah Moatti
- Department of Hematology, CHU Paris-GH St-Louis Lariboisière F-Widal - Hôpital Saint-Louis, Paris, France
| | | | | | | | - Catherine Fortpied
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - John Raemaekers
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Massimo Federico
- CHIMOMO Department, University of Modena and Reggio Emilia, Policlinico, Modena, Italy
| | - Salim Kanoun
- Nuclear Medecine Unit, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Michel Meignan
- LYSA Imaging, University Hospital H Mondor, Creteil, France
| | - Alexandra Traverse-Glehen
- Department of Pathology, Centre Hospitalier Lyon Sud and Université Claude Bernard Lyon-1, Pierre-Bénite, France and
| | | | - René-Olivier Casasnovas
- Department of Hematology, Dijon-Bourgogne University Hospital, Dijon, France,INSERM 1231, University of Burgundy Franche-Comté, Franche-Comté, France
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24
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[Efficacy and safety of Camrelizumab and AVD in the first-line treatment of classic Hodgkin's lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:431-434. [PMID: 35680603 PMCID: PMC9250959 DOI: 10.3760/cma.j.issn.0253-2727.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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25
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Feres CCP, Nunes RF, Teixeira LLC, Arcuri LJ, Perini GF. Baseline total metabolic tumor volume (TMTV) application in Hodgkin lymphoma: a review article. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00481-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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26
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Lundgaard AY, Dejanovic D, Berthelsen AK, Andersen FL, Rechner LA, Borgwardt L, Hjalgrim LL, Specht L, Maraldo MV. Baseline FDG PET/CT in free breathing versus deep inspiration breath-hold for pediatric patients with mediastinal lymphoma. Acta Oncol 2022; 61:239-246. [PMID: 34533416 DOI: 10.1080/0284186x.2021.1974554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The prospective TEDDI protocol investigates the feasibility of radiotherapy delivery in deep inspiration breath-hold (DIBH) for pediatric patients. To secure optimal radiotherapy planning, a diagnostic baseline FDG PET/CT in free breathing (FB) and DIBH was acquired. The anatomical changes in the mediastinum and the effect on PET metrics between the two breathing conditions were assessed for pediatric patients with mediastinal lymphoma. MATERIAL AND METHODS Ten patients aged 5-17 were included and had a PET/CT in FB and DIBH. Metabolic active lymphoma volumes were manually delineated with a visually based segmentation method and the PET metrics were extracted. The anatomical lymphoma, lung and heart volumes were delineated on CT. RESULTS The lung volume increased while the heart was displaced caudally and separated from the lymphoma in DIBH compared to FB. Both the anatomical and the metabolically active lymphoma volumes appeared different regarding shape and configuration in the two breathing conditions. The image quality of the DIBH PET was equal to the FB PET regarding interpretation and delineation of lymphoma lesions. All PET metrics increased on the DIBH PET compared to the FB PET with the highest increase observed for the maximum standardized uptake value (33%, range 7-56%). CONCLUSION Diminished respiratory motion together with anatomical changes within the lymphoma increased all PET metrics in DIBH compared to FB. The anatomical changes observed in DIBH compared to FB are expected to reduce radiation doses to the heart and lungs in pediatric patients with mediastinal lymphoma referred for radiotherapy delivery in DIBH and, thereby, reduce their risk of late effects. TRIAL REGISTRATION The Danish Ethical Committee (H-16035870, approved November 24th 2016), the Danish Data Protection Agency (2012-58-0004, approved 1 January 2017). Registered retrospectively at clinicaltrials.gov (NCT03315546, 20 October 2017).
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Affiliation(s)
- Anni Young Lundgaard
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Littrup Andersen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura Ann Rechner
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lisa Lyngsie Hjalgrim
- Department of Pediatric Haematology and Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lena Specht
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Maja Vestmø Maraldo
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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27
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Louarn N, Galicier L, Bertinchamp R, Lussato D, Montravers F, Oksenhendler É, Merlet P, Gérard L, Vercellino L. First Extensive Analysis of 18F-Labeled Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in a Large Cohort of Patients With HIV-Associated Hodgkin Lymphoma: Baseline Total Metabolic Tumor Volume Affects Prognosis. J Clin Oncol 2022; 40:1346-1355. [PMID: 35073166 DOI: 10.1200/jco.21.01228] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE 18F-labeled fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET-CT) data in HIV-associated Hodgkin lymphoma (HIV-HL) are scarcely reported. In addition to the description of the characteristics of both baseline and interim 18F-FDG PET-CT examinations (PET1 and iPET, respectively), the aim of this study was to assess the prognostic value of PET1 and previously identified clinical parameters in this population. PATIENTS AND METHODS PET1 of 109 patients with HIV-HL, treated with doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy regimen since 2007, and 104 iPET were centrally reviewed. All the patients were enrolled in an ongoing prospective single-center cohort of HIV-associated lymphoma. RESULTS Most patients had a disseminated disease according to the Ann Arbor classification (30% stage III and 43% stage IV), with especially bone marrow and liver as extranodal localizations. After a median follow-up of 6.7 years, 12 patients relapsed (11%) and 13 died (12%). Five-year progression-free survival (PFS) was 75.1%, and 5-year overall survival was 86.1%. Median total metabolic tumor volume (TMTV) was 121.4 cm3. The optimal TMTV cutoff identified for prognostic analysis was 527 cm3, with a 2-year PFS of 71% in the 20 patients with TMTV > 527 cm3, compared with 91% in the 89 patients with TMTV ≤ 527 cm3 (P = .004). On multivariate analysis, a high TMTV was the only parameter independently associated with PFS. CONCLUSION In this large series of HIV-HL patients with a homogeneous management, high TMTV on PET1 examination was associated with a poor prognosis.
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Affiliation(s)
- Nicolas Louarn
- Service de Médecine Nucléaire, Hôpital Saint-Louis, APHP, Paris, France.,Service de Médecine Nucléaire, Hôpital Henri Mondor, APHP, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - Lionel Galicier
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France.,Service de Médecine Interne, Hôpital Saint-Joseph, Marseille, France
| | - Rémi Bertinchamp
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - David Lussato
- Service de Médecine Nucléaire, Centre Cardiologique du Nord, Saint-Denis, France
| | - Françoise Montravers
- Service de Médecine Nucléaire, Hôpital Tenon, APHP, Paris, France.,Sorbonne Université, Paris, France
| | - Éric Oksenhendler
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France.,Université de Paris, Paris, France
| | - Pascal Merlet
- Service de Médecine Nucléaire, Hôpital Saint-Louis, APHP, Paris, France.,Université de Paris, Paris, France
| | - Laurence Gérard
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - Laetitia Vercellino
- Service de Médecine Nucléaire, Hôpital Saint-Louis, APHP, Paris, France.,Université de Paris, INSERM, UMR_S942 MASCOT, F-75006, Paris, France
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El-Galaly TC, Villa D, Cheah CY, Gormsen LC. Pre-treatment total metabolic tumour volumes in lymphoma: Does quantity matter? Br J Haematol 2022; 197:139-155. [PMID: 35037240 DOI: 10.1111/bjh.18016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 11/28/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT) is used for the staging of lymphomas. Clinical information, such as Ann Arbor stage and number of involved sites, is derived from baseline staging and correlates with tumour volume. With modern imaging software, exact measures of total metabolic tumour volumes (tMTV) can be determined, in a semi- or fully-automated manner. Several technical factors, such as tumour segmentation and PET/CT technology influence tMTV and there is no consensus on a standardized uptake value (SUV) thresholding method, or how to include the volumes in the bone marrow and spleen. In diffuse large B-cell lymphoma, follicular lymphoma, peripheral T-cell lymphoma, and Hodgkin lymphoma, tMTV has been shown to predict progression-free survival and/or overall survival, after adjustments for clinical risk scores. However, most studies have used receiver operating curves to determine the optimal cut-off for tMTV and many studies did not include a training-validation approach, which led to the risk of overestimation of the independent prognostic value of tMTV. The identified cut-off values are heterogeneous, even when the same SUV thresholding method is used. Future studies should focus on testing tMTV in homogeneously-treated cohorts and seek to validate identified cut-off values externally so that a prognostic value can be documented, over and above currently used clinical surrogates for tumour volume.
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Affiliation(s)
- Tarec Christoffer El-Galaly
- Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, British Columbia, Canada
| | - Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Lars C Gormsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
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Hasani N, Paravastu SS, Farhadi F, Yousefirizi F, Morris MA, Rahmim A, Roschewski M, Summers RM, Saboury B. Artificial Intelligence in Lymphoma PET Imaging:: A Scoping Review (Current Trends and Future Directions). PET Clin 2022; 17:145-174. [PMID: 34809864 PMCID: PMC8735853 DOI: 10.1016/j.cpet.2021.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Malignant lymphomas are a family of heterogenous disorders caused by clonal proliferation of lymphocytes. 18F-FDG-PET has proven to provide essential information for accurate quantification of disease burden, treatment response evaluation, and prognostication. However, manual delineation of hypermetabolic lesions is often a time-consuming and impractical task. Applications of artificial intelligence (AI) may provide solutions to overcome this challenge. Beyond segmentation and detection of lesions, AI could enhance tumor characterization and heterogeneity quantification, as well as treatment response prediction and recurrence risk stratification. In this scoping review, we have systematically mapped and discussed the current applications of AI (such as detection, classification, segmentation as well as the prediction and prognostication) in lymphoma PET.
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Affiliation(s)
- Navid Hasani
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 1C455, Bethesda, MD 20892, USA; University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA 70121, USA
| | - Sriram S Paravastu
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 1C455, Bethesda, MD 20892, USA
| | - Faraz Farhadi
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 1C455, Bethesda, MD 20892, USA
| | - Fereshteh Yousefirizi
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Michael A Morris
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 1C455, Bethesda, MD 20892, USA; Department of Computer Science and Electrical Engineering, University of Maryland-Baltimore Country, Baltimore, MD, USA
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada; Department of Radiology, BC Cancer Research Institute, University of British Columbia, 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, Canada
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Ronald M Summers
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 1C455, Bethesda, MD 20892, USA.
| | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 1C455, Bethesda, MD 20892, USA; Department of Computer Science and Electrical Engineering, University of Maryland-Baltimore Country, Baltimore, MD, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Naguib MM, Botros SM, Louka AL, Hussein RS. Role of PET/CT in initial evaluation of lymphoma patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021; 52:291. [DOI: https:/doi.org/10.1186/s43055-021-00670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/22/2021] [Indexed: 08/30/2023] Open
Abstract
Abstract
Background
Accurate radiologic assessment of treatment response in lymphoma patients is important to evaluate the effectiveness of treatment and consequently predict the relapse; the value of PET/CT for post-treatment prognosis prediction has been recently investigated. The aim of this study is to highlight the prognostic value of PET-CT metabolic volumetric parameters in the evaluation of lymphoma patients.
Results
Among the included 40 patients, post-treatment SUV, MTV, and TLG were significantly lower in a responsive group than the non-responsive group. % changes of all quantitative PET/CT parameters were significantly higher in the responsive group than the non-responsive group.
Conclusions
This study suggests that pre-treatment PET/CT quantitative measures (except baseline SUVmax) are not conclusive in the prediction of patient response to treatment; however, the ΔSUVmax, ΔMTV, and ΔTLG% from the baseline to the end of therapy could be used in predicting patient response to treatment, determining patient prognosis, and suggesting the relapse.
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Role of PET/CT in initial evaluation of lymphoma patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00670-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Accurate radiologic assessment of treatment response in lymphoma patients is important to evaluate the effectiveness of treatment and consequently predict the relapse; the value of PET/CT for post-treatment prognosis prediction has been recently investigated. The aim of this study is to highlight the prognostic value of PET-CT metabolic volumetric parameters in the evaluation of lymphoma patients.
Results
Among the included 40 patients, post-treatment SUV, MTV, and TLG were significantly lower in a responsive group than the non-responsive group. % changes of all quantitative PET/CT parameters were significantly higher in the responsive group than the non-responsive group.
Conclusions
This study suggests that pre-treatment PET/CT quantitative measures (except baseline SUVmax) are not conclusive in the prediction of patient response to treatment; however, the ΔSUVmax, ΔMTV, and ΔTLG% from the baseline to the end of therapy could be used in predicting patient response to treatment, determining patient prognosis, and suggesting the relapse.
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Albano D, Cuocolo R, Patti C, Ugga L, Chianca V, Tarantino V, Faraone R, Albano S, Micci G, Costa A, Paratore R, Ficola U, Lagalla R, Midiri M, Galia M. Whole-body MRI radiomics model to predict relapsed/refractory Hodgkin Lymphoma: A preliminary study. Magn Reson Imaging 2021; 86:55-60. [PMID: 34808304 DOI: 10.1016/j.mri.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/15/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE A strong prognostic score that enables a stratification of newly diagnosed Hodgkin Lymphoma (HL) to identify patients at high risk of refractory/relapsed disease is still needed. Our aim was to investigate the potential value of a radiomics analysis pipeline from whole-body MRI (WB-MRI) exams for clinical outcome prediction in patients with HL. MATERIALS AND METHODS Index lesions from baseline WB-MRIs of 40 patients (22 females; mean age 31.7 ± 11.4 years) with newly diagnosed HL treated by ABVD chemotherapy regimen were manually segmented on T1-weighted, STIR, and DWI images for texture analysis feature extraction. A machine learning approach based on the Extra Trees classifier and incorporating clinical variables, 18F-FDG-PET/CT-derived metabolic tumor volume, and WB-MRI radiomics features was tested using cross-validation to predict refractory/relapsed disease. RESULTS Relapsed disease was observed in 10/40 patients (25%), two of whom died due to progression of disease and graft versus host disease, while eight reached the complete remission. In total, 1403 clinical and radiomics features were extracted, of which 11 clinical variables and 171 radiomics parameters from both original and filtered images were selected. The 3 best performing Extra Trees classifier models obtained an equivalent highest mean accuracy of 0.78 and standard deviation of 0.09, with a mean AUC of 0.82 and standard deviation of 0.08. CONCLUSIONS Our preliminary results demonstrate that a combined machine learning and texture analysis model to predict refractory/relapsed HL on WB-MRI exams is feasible and may help in the clinical outcome prediction in HL patients.
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Affiliation(s)
- Domenico Albano
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy.
| | - Renato Cuocolo
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Via Pansini 5, 80131 Naples, Italy; Laboratory of Augmented Reality for Health Monitoring (ARHeMLab), Dipartimento di Ingegneria Elettrica e delle Tecnologie dell'Informazione, Università degli Studi di Napoli "Federico II", Via Claudio 21, 80125 Naples, Italy
| | - Caterina Patti
- Unità Operativa di Oncoematologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146 Palermo, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Vito Chianca
- Ospedale Evangelico Betania, Via Argine 604, 80147 Napoli, Italy; Clinica di Radiologia EOC IIMSI, 6900 Lugano, Switzerland
| | - Vittoria Tarantino
- Unità Operativa di Oncoematologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146 Palermo, Italy; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Roberta Faraone
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Silvia Albano
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Giuseppe Micci
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Alessandro Costa
- Unità Operativa di Oncoematologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146 Palermo, Italy
| | - Rosario Paratore
- Nuclear Medicine Department, La Maddalena Hospital, Via San Lorenzo 312/D, 90146 Palermo, Italy
| | - Umberto Ficola
- Nuclear Medicine Department, La Maddalena Hospital, Via San Lorenzo 312/D, 90146 Palermo, Italy
| | - Roberto Lagalla
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Massimo Midiri
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Massimo Galia
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
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Milgrom SA, Rechner L, Berthelsen A. The optimal use of PET/CT in the management of lymphoma patients. Br J Radiol 2021; 94:20210470. [PMID: 34415777 DOI: 10.1259/bjr.20210470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
18F-fluoro-deoxyglucose positron emission tomography (PET)/computed tomography (CT) scans play an important role in the management of lymphoma patients. They are critical to accurately stage disease and assess its response to therapy. In addition, PET/CT scans enable precise target delineation for radiation therapy planning. In this review, we describe the use of PET/CT scans in lymphoma, with a focus on their role in staging disease, assessing response to therapy, predicting prognosis, and planning RT.
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Affiliation(s)
| | - Laura Rechner
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - Anne Berthelsen
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
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34
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Modiri A, Vogelius I, Rechner LA, Nygård L, Bentzen SM, Specht L. Outcome-based multiobjective optimization of lymphoma radiation therapy plans. Br J Radiol 2021; 94:20210303. [PMID: 34541859 PMCID: PMC8553178 DOI: 10.1259/bjr.20210303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 02/04/2023] Open
Abstract
At its core, radiation therapy (RT) requires balancing therapeutic effects against risk of adverse events in cancer survivors. The radiation oncologist weighs numerous disease and patient-level factors when considering the expected risk-benefit ratio of combined treatment modalities. As part of this, RT plan optimization software is used to find a clinically acceptable RT plan delivering a prescribed dose to the target volume while respecting pre-defined radiation dose-volume constraints for selected organs at risk. The obvious limitation to the current approach is that it is virtually impossible to ensure the selected treatment plan could not be bettered by an alternative plan providing improved disease control and/or reduced risk of adverse events in this individual. Outcome-based optimization refers to a strategy where all planning objectives are defined by modeled estimates of a specific outcome's probability. Noting that various adverse events and disease control are generally incommensurable, leads to the concept of a Pareto-optimal plan: a plan where no single objective can be improved without degrading one or more of the remaining objectives. Further benefits of outcome-based multiobjective optimization are that quantitative estimates of risks and benefit are obtained as are the effects of choosing a different trade-off between competing objectives. Furthermore, patient-level risk factors and combined treatment modalities may be integrated directly into plan optimization. Here, we present this approach in the clinical setting of multimodality therapy for malignant lymphoma, a malignancy with marked heterogeneity in biology, target localization, and patient characteristics. We discuss future research priorities including the potential of artificial intelligence.
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Affiliation(s)
- Arezoo Modiri
- Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Ivan Vogelius
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura Ann Rechner
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Nygård
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Lena Specht
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Al Tabaa Y, Bailly C, Kanoun S. FDG-PET/CT in Lymphoma: Where Do We Go Now? Cancers (Basel) 2021; 13:cancers13205222. [PMID: 34680370 PMCID: PMC8533807 DOI: 10.3390/cancers13205222] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 01/06/2023] Open
Abstract
18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) is an essential part of the management of patients with lymphoma at staging and response evaluation. Efforts to standardize PET acquisition and reporting, including the 5-point Deauville scale, have enabled PET to become a surrogate for treatment success or failure in common lymphoma subtypes. This review summarizes the key clinical-trial evidence that supports PET-directed personalized approaches in lymphoma but also points out the potential place of innovative PET/CT metrics or new radiopharmaceuticals in the future.
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Affiliation(s)
- Yassine Al Tabaa
- Scintidoc Nuclear Medicine Center, 25 rue de Clémentville, 34070 Montpellier, France
- Correspondence:
| | - Clement Bailly
- CRCINA, INSERM, CNRS, Université d’Angers, Université de Nantes, 44093 Nantes, France;
- Nuclear Medicine Department, University Hospital, 44093 Nantes, France
| | - Salim Kanoun
- Nuclear Medicine Department, Institute Claudius Regaud, 31100 Toulouse, France;
- Cancer Research Center of Toulouse (CRCT), Team 9, INSERM UMR 1037, 31400 Toulouse, France
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Total Lesion Glycolysis Improves Tumor Burden Evaluation and Risk Assessment at Diagnosis in Hodgkin Lymphoma. J Clin Med 2021; 10:jcm10194396. [PMID: 34640418 PMCID: PMC8509690 DOI: 10.3390/jcm10194396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 11/20/2022] Open
Abstract
Hodgkin lymphoma (HL) is a hematological malignancy with an excellent prognosis. However, we still need to identify those patients that could experience failed standard frontline chemotherapy. Tumor burden evaluation and standard decisions are based on Ann Arbor (AA) staging, but this approach may be insufficient in predicting outcomes. We aim to study new ways to assess tumor burden through volume-based PET parameters to improve the risk assessment of HL patients. We retrospectively analyzed 101 patients with HL from two hospitals in the Balearic Islands between 2011 and 2018. Higher metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were significantly associated with a higher incidence of III-IV AA stages, B-symptoms, hypoalbuminemia, lymphopenia, and higher IPS. Standardized uptake value (SUVmax) was significantly related to AA stage and hypoalbuminemia. We found that TLG or the combination of SUVmax, TLG, and MTV significantly improved the risk assessment when compared to AA staging. We conclude that TLG is the best single PET/CT-related tumor-load parameter that significantly improves HL risk assessment when compared to AA staging. If confirmed in a larger and validated sample, this information could be used to modify standard frontline therapy and justifies the inclusion of TLG inside an HL prognostic score.
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Milgrom SA, Kim J, Chirindel A, Kim J, Pei Q, Chen L, Buxton A, Kessel S, Leal J, McCarten KM, Hoppe BS, Wolden SL, Schwartz CL, Friedman DL, Kelly KM, Cho SY. Prognostic value of baseline metabolic tumor volume in children and adolescents with intermediate-risk Hodgkin lymphoma treated with chemo-radiation therapy: FDG-PET parameter analysis in a subgroup from COG AHOD0031. Pediatr Blood Cancer 2021; 68:e29212. [PMID: 34245210 PMCID: PMC8809108 DOI: 10.1002/pbc.29212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/20/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Positron emission tomography (PET)-based measures of baseline total-body tumor burden may improve risk stratification in intermediate-risk Hodgkin lymphoma (HL). MATERIALS AND METHODS Evaluable patients were identified from a cohort treated homogeneously with the same combined modality regimen on the Children's Oncology Group AHOD0031 study. Eligible patients had high-quality baseline PET scans. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were each measured based on 15 thresholds for every patient. Univariate and multivariable Cox regression and Kaplan-Meier survival analyses assessed for an association of MTV and TLG with event-free survival (EFS). RESULTS From the AHOD0031 cohort (n = 1712), 86 patients were identified who (i) were treated with four cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide (ABVE-PC) chemotherapy followed by involved field radiotherapy, and (ii) had a baseline PET scan that was amenable to quantitative analysis. Based on univariate Cox regression analysis, six PET-derived parameters were significantly associated with EFS. For each of these, Kaplan-Meier analyses and the log-rank test were used to compare patients with highest tumor burden (i.e., highest 15%) to the remainder of the cohort. EFS was significantly associated with all six PET parameters (all p < .029). In a multivariable model controlling for important covariates including disease bulk and response to chemotherapy, MTV2BP was significantly associated with EFS (p = .012). CONCLUSION Multiple baseline PET-derived volumetric parameters were associated with EFS. MTV2BP was highly associated with EFS when controlling for disease bulk and response to chemotherapy. Incorporation of baseline MTV into risk-based treatment algorithms may improve outcomes in intermediate-risk HL.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado, USA
| | - Jihyun Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Alin Chirindel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jongho Kim
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Qinglin Pei
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Lu Chen
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Allen Buxton
- Children's Oncology Group, Statistics and Data Center, Monrovia, California, USA
| | - Sandy Kessel
- Imaging and Radiation Oncology Core Group, Lincoln, Rhode Island, USA
| | - Jeffrey Leal
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cindy L Schwartz
- Division of Pediatric Hematology, Oncology, and BMT, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Debra L Friedman
- Division of Pediatric Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, and University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Steve Y Cho
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
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Juweid ME, Mueller M, Alhouri A, A-Risheq MZ, Mottaghy FM. Positron emission tomography/computed tomography in the management of Hodgkin and B-cell non-Hodgkin lymphoma: An update. Cancer 2021; 127:3727-3741. [PMID: 34286864 DOI: 10.1002/cncr.33772] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 01/20/2023]
Abstract
18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is now an integral part of lymphoma staging and management. Because of its greater accuracy compared with CT alone, PET/CT is currently routinely performed for staging and for response assessment at the end of treatment in the vast majority of FDG-avid lymphomas and is the cornerstone of response classification for these lymphomas according to the Lugano classification. Interim PET/CT, typically performed after 2 to 4 of 6 to 8 chemotherapy/chemoimmunotherapy cycles with or without radiation, is commonly performed for prognostication and potential treatment escalation or de-escalation early in the course of therapy, a concept known as response-adapted or risk-adapted treatment. Quantitative PET is an area of growing interest. Metrics, such as the standardized uptake value, changes (Δ) in the standardized uptake value, metabolic tumor volume, and total lesion glycolysis, are being investigated as more reproducible and potentially more accurate predictors of response and prognosis. Despite the progress made in standardizing the use of PET/CT in lymphoma, challenges remain, particularly with respect to its limited positive predictive value, emphasizing the need for more specific molecular probes. This review highlights the most relevant applications of PET/CT in Hodgkin and B-cell non-Hodgkin lymphoma, its strengths and limitations, as well as recent efforts at implementing PET/CT-based metrics as promising tools for precision medicine.
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Affiliation(s)
- Malik E Juweid
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Marguerite Mueller
- Department of Nuclear Medicine, University Hospital Rheinish-Westphalian Technical University, Aachen University, Aachen, Germany
| | - Abdullah Alhouri
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - M Ziad A-Risheq
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital Rheinish-Westphalian Technical University, Aachen University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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Lopci E, Burnelli R, Elia C, Piccardo A, Castello A, Borsatti E, Zucchetta P, Cistaro A, Mascarin M. Additional value of volumetric and texture analysis on FDG PET assessment in paediatric Hodgkin lymphoma: an Italian multicentric study protocol. BMJ Open 2021; 11:e041252. [PMID: 33782017 PMCID: PMC8009231 DOI: 10.1136/bmjopen-2020-041252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Assessment of response to therapy in paediatric patients with Hodgkin lymphoma (HL) by 18F-fluorodeoxyglucose positron emission tomography/CT has become a powerful tool for the discrimination of responders from non-responders. The addition of volumetric and texture analyses can be regarded as a valuable help for disease prognostication and biological characterisation. Based on these premises, the Hodgkin Lymphoma Study Group of the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) has designed a prospective evaluation of volumetric and texture analysis in the Italian cohort of patients enrolled in the EuroNet-PHL-C2. METHODS AND ANALYSIS The primary objective is to compare volumetric assessment in patiens with HL at baseline and during the course of therapy with standard visual and semiquantitative analyses. The secondary objective is to identify the impact of volumetric and texture analysis on bulky masses. The tertiary objective is to determine the additional value of multiparametric assessment in patients having a partial response on morphological imaging.The overall cohort of the study is expected to be round 400-500 patients, with approximately half presenting with bulky masses. All PET scans of the Italian cohort will be analysed for volumetric assessment, comprising metabolic tumour volume and total lesion glycolysis at baseline and during the course of therapy. A dedicated software will delineate semiautomatically contours using different threshold methods, and the impact of each segmentation techniques will be evaluated. Bulky will be defined on contiguous lymph node masses ≥200 mL on CT/MRI. All bulky masses will be outlined and analysed by the same software to provide textural features. Morphological assessment will be based on RECIL 2017 for response definition. ETHICS AND DISSEMINATION The current study has been ethically approved (AIFA/SC/P/27087 approved 09/03/2018; EudraCT 2012-004053-88, EM-04). The results of the different analyses performed during and after study completion the will be actively disseminated through peer-reviewed journals, conference presentations, social media, print media and internet.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine Department, IRCCS - Humanitas Research Hospital, Rozzano, Italy
| | - Roberta Burnelli
- Pediatric Onco-hematologic Unit, University Hospital Arcispedale Sant'Anna of Ferrara, Ferrara, Italy
| | - Caterina Elia
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Arnoldo Piccardo
- Nuclear Medicine Department, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Angelo Castello
- Nuclear Medicine Department, IRCCS - Humanitas Research Hospital, Rozzano, Italy
| | - Eugenio Borsatti
- Nuclear Medicine Department, Centro di Riferimento Oncologico, Aviano, Italy
| | - Pietro Zucchetta
- Nuclear Medicine Department, Padua University Hospital, Padova, Italy
| | - Angelina Cistaro
- Nuclear Medicine Department, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
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Tutino F, Puccini G, Linguanti F, Puccini B, Rigacci L, Kovalchuk S, Sciagrà R, Berti V. Baseline metabolic tumor volume calculation using different SUV thresholding methods in Hodgkin lymphoma patients: interobserver agreement and reproducibility across software platforms. Nucl Med Commun 2021; 42:284-291. [PMID: 33306623 DOI: 10.1097/mnm.0000000000001324] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Although it is not yet used in clinical practice, metabolic tumor volume (MTV) assessed on the baseline FDG-PET has shown consistent prognostic value in various lymphoma types. The aim of our study was to compare interobserver agreement and reproducibility across platforms of MTV calculation using different SUV thresholding methods in a large series of patients with newly diagnosed Hodgkin lymphoma. MATERIALS AND METHODS We retrospectively studied 121 patients. MTV at baseline FDG-PET was independently computed by three readers with three programs of semi-automatic segmentation, Fiji, LifeX, and Accurate. MTV measurement was performed with different thresholds: SUV >2.5, SUV >4, and SUV >41% of SUV max. RESULTS At inter-observer agreement analysis all Intraclass Correlation Coefficients (ICCs) were excellent (ICC >0.9), except for Accurate SUV >41% of SUV max (ICC = 0.8). The highest correlations were obtained at the SUV >4 threshold. The second best was SUV >2.5 threshold. Regarding reproducibility across software, we found statistically significant differences between Fiji versus LifeX and Accurate at fixed thresholds and between LifeX and Accurate at SUV >41% of SUV max, while no significant differences emerged between LifeX and Accurate using fixed thresholds. CONCLUSION The three SUV thresholds studied are all suitable for MTV calculation in terms of reproducibility. The best reproducibility is achieved using fixed thresholds, both SUV >4 and SUV >2.5. If more than one software has to be used in a study, we suggest the use of fixed thresholds and the platforms LifeX and Accurate.
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Affiliation(s)
- Francesca Tutino
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence
| | - Giulia Puccini
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence
| | - Flavia Linguanti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence
| | | | - Luigi Rigacci
- Haematology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence
| | - Valentina Berti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence
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41
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Frood R, Burton C, Tsoumpas C, Frangi AF, Gleeson F, Patel C, Scarsbrook A. Baseline PET/CT imaging parameters for prediction of treatment outcome in Hodgkin and diffuse large B cell lymphoma: a systematic review. Eur J Nucl Med Mol Imaging 2021; 48:3198-3220. [PMID: 33604689 PMCID: PMC8426243 DOI: 10.1007/s00259-021-05233-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
Purpose To systematically review the literature evaluating clinical utility of imaging metrics derived from baseline fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for prediction of progression-free (PFS) and overall survival (OS) in patients with classical Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL). Methods A search of MEDLINE/PubMed, Web of Science, Cochrane, Scopus and clinicaltrials.gov databases was undertaken for articles evaluating PET/CT imaging metrics as outcome predictors in HL and DLBCL. PRISMA guidelines were followed. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results Forty-one articles were included (31 DLBCL, 10 HL). Significant predictive ability was reported in 5/20 DLBCL studies assessing SUVmax (PFS: HR 0.13–7.35, OS: HR 0.83–11.23), 17/19 assessing metabolic tumour volume (MTV) (PFS: HR 2.09–11.20, OS: HR 2.40–10.32) and 10/13 assessing total lesion glycolysis (TLG) (PFS: HR 1.078–11.21, OS: HR 2.40–4.82). Significant predictive ability was reported in 1/4 HL studies assessing SUVmax (HR not reported), 6/8 assessing MTV (PFS: HR 1.2–10.71, OS: HR 1.00–13.20) and 2/3 assessing TLG (HR not reported). There are 7/41 studies assessing the use of radiomics (4 DLBCL, 2 HL); 5/41 studies had internal validation and 2/41 included external validation. All studies had overall moderate or high risk of bias. Conclusion Most studies are retrospective, underpowered, heterogenous in their methodology and lack external validation of described models. Further work in protocol harmonisation, automated segmentation techniques and optimum performance cut-off is required to develop robust methodologies amenable for clinical utility. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05233-2.
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Affiliation(s)
- R Frood
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK. .,Leeds Institute of Health Research, University of Leeds, Leeds, UK.
| | - C Burton
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C Tsoumpas
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - A F Frangi
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing and School of Medicine, University of Leeds, Leeds, UK.,Medical Imaging Research Center (MIRC), University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Patel
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Scarsbrook
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Health Research, University of Leeds, Leeds, UK
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Vlachopoulos CV, Koutagiar IP, Georgakopoulos AT, Pouli AG, Sioni AΚ, Giannouli SΕ, Chondropoulos SD, Stergiou IΕ, Solomou EG, Terentes-Printzios DG, Karakitsios IG, Kafouris PP, Gaitanis A, Pianou NK, Petrocheilou A, Aggeli CI, Stroumpouli E, Marinakis TP, Voulgarelis M, Tousoulis DM, Anagnostopoulos CD. Lymphoma Severity and Type Are Associated With Aortic FDG Uptake by 18F-FDG PET/CT Imaging. JACC: CARDIOONCOLOGY 2020; 2:758-770. [PMID: 34396292 PMCID: PMC8352324 DOI: 10.1016/j.jaccao.2020.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 12/27/2022]
Abstract
Background There is evidence that metabolic disease burden in lymphoma influences patient outcome. However, the impact of disease severity on the cardiovascular system is unknown. Objectives The aim of this study was to examine whether lymphoma is associated with arterial inflammation by investigating the relationship between disease metabolic burden and arterial fluorodeoxyglucose (FDG) uptake. Methods Sixty-two chemotherapy-naïve patients with active Hodgkin’s or non-Hodgkin’s lymphoma were matched (2:1) to individual control groups of lymphoma patients previously treated and free of active disease. All groups underwent 18F-FDG position emission tomography–computed tomography imaging. Disease severity was quantified by metabolic tumor volume (MTV) and total lesion glycolysis corresponding to standardized uptake values (SUVs) ≥41% or ≥2.5 of the maximum SUV within lymphoma regions, and aortic FDG uptake was quantified through the target-to-background ratio (TBR). Inflammatory and disease severity biomarkers were also measured. Results MTV and total lesion glycolysis measurements were significantly correlated with inflammatory and disease biomarkers. Aortic TBR was higher in patients with active non-Hodgkin’s lymphoma compared with control subjects (median difference 0.51; 95% confidence interval [CI]: 0.28 to 0.78; p < 0.001). Similarly, patients with active Hodgkin’s lymphoma had higher values of aortic TBR compared with control subjects (median difference 0.31; 95% CI: 0.15 to 0.49; p < 0.001). In addition, aortic TBR was modestly increased in patients with stage III to IV disease compared with those with stage I to II disease (median aortic TBR: 2.23 [interquartile range: 2.01 to 2.54] vs. 2.06 [interquartile range: 1.83 to 2.27; p = 0.050). In multivariable analysis, aortic FDG uptake and MTV≥2.5 values were independently associated (β = 0.425; 95% CI: 0.189 to 0.662; p = 0.001; R2 = 0.208), as were aortic FDG uptake and MTV≥41% (β = 0.407; 95% CI: 0.167 to 0.649, p = 0.001; R2 = 0.191). Conclusions Aortic wall FDG uptake is related with disease severity indicative of a possible vascular effect of lymphoma. This work highlights a new potential role of molecular imaging in cardio-oncology for evaluating disease severity and its consequences on the vasculature.
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Key Words
- 18F-FDG, 18F-fluorodeoxyglucose
- BMI, body mass index
- CI, confidence interval
- CT, computed tomography
- CVD, cardiovascular disease
- LDH, lactate dehydrogenase
- MTV, metabolic tumor burden
- PET, positron emission tomography
- SUV, standardized uptake value
- SUVmax, maximum standardized uptake value
- SUVmean, mean standardized uptake value
- TBR, target-to-background ratio
- TLG, total lesion glycolysis
- WBC, white blood cell count
- arterial inflammation
- hsCRP, high-sensitivity C-reactive protein
- lymphoma
- metabolic burden
- positron emission tomography
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Affiliation(s)
- Charalambos V Vlachopoulos
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Iosif P Koutagiar
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros T Georgakopoulos
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | | | | | - Stavroula Ε Giannouli
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ioanna Ε Stergiou
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - Eirini G Solomou
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios G Terentes-Printzios
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis G Karakitsios
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Pavlos P Kafouris
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece.,Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Gaitanis
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Nikoletta K Pianou
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Aikaterini Petrocheilou
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantina I Aggeli
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Euaggelia Stroumpouli
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Michael Voulgarelis
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - Dimitrios M Tousoulis
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos D Anagnostopoulos
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
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Weisman AJ, Kim J, Lee I, McCarten KM, Kessel S, Schwartz CL, Kelly KM, Jeraj R, Cho SY, Bradshaw TJ. Automated quantification of baseline imaging PET metrics on FDG PET/CT images of pediatric Hodgkin lymphoma patients. EJNMMI Phys 2020; 7:76. [PMID: 33315178 PMCID: PMC7736382 DOI: 10.1186/s40658-020-00346-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE For pediatric lymphoma, quantitative FDG PET/CT imaging features such as metabolic tumor volume (MTV) are important for prognosis and risk stratification strategies. However, feature extraction is difficult and time-consuming in cases of high disease burden. The purpose of this study was to fully automate the measurement of PET imaging features in PET/CT images of pediatric lymphoma. METHODS 18F-FDG PET/CT baseline images of 100 pediatric Hodgkin lymphoma patients were retrospectively analyzed. Two nuclear medicine physicians identified and segmented FDG avid disease using PET thresholding methods. Both PET and CT images were used as inputs to a three-dimensional patch-based, multi-resolution pathway convolutional neural network architecture, DeepMedic. The model was trained to replicate physician segmentations using an ensemble of three networks trained with 5-fold cross-validation. The maximum SUV (SUVmax), MTV, total lesion glycolysis (TLG), surface-area-to-volume ratio (SA/MTV), and a measure of disease spread (Dmaxpatient) were extracted from the model output. Pearson's correlation coefficient and relative percent differences were calculated between automated and physician-extracted features. RESULTS Median Dice similarity coefficient of patient contours between automated and physician contours was 0.86 (IQR 0.78-0.91). Automated SUVmax values matched exactly the physician determined values in 81/100 cases, with Pearson's correlation coefficient (R) of 0.95. Automated MTV was strongly correlated with physician MTV (R = 0.88), though it was slightly underestimated with a median (IQR) relative difference of - 4.3% (- 10.0-5.7%). Agreement of TLG was excellent (R = 0.94), with median (IQR) relative difference of - 0.4% (- 5.2-7.0%). Median relative percent differences were 6.8% (R = 0.91; IQR 1.6-4.3%) for SA/MTV, and 4.5% (R = 0.51; IQR - 7.5-40.9%) for Dmaxpatient, which was the most difficult feature to quantify automatically. CONCLUSIONS An automated method using an ensemble of multi-resolution pathway 3D CNNs was able to quantify PET imaging features of lymphoma on baseline FDG PET/CT images with excellent agreement to reference physician PET segmentation. Automated methods with faster throughput for PET quantitation, such as MTV and TLG, show promise in more accessible clinical and research applications.
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Affiliation(s)
- Amy J Weisman
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Jihyun Kim
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Inki Lee
- Department of Nuclear Medicine Korea Cancer Centre Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | | | | | | | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Robert Jeraj
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Steve Y Cho
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI, USA
| | - Tyler J Bradshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
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44
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Prieto Prieto JC, Vallejo Casas JA, Hatzimichael E, Fotopoulos A, Kiortsis DN, Sioka C. The contribution of metabolic parameters of FDG PET/CT prior and during therapy of adult patients with lymphomas. Ann Nucl Med 2020; 34:707-717. [DOI: 10.1007/s12149-020-01521-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
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45
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Nielsen K, Maraldo MV, Berthelsen AK, Loft A, de Nully Brown P, Vogelius IR, Petersen PM, Specht L. Involved node radiation therapy in the combined modality treatment for early-stage Hodgkin lymphoma: Analysis of relapse location and long-term outcome. Radiother Oncol 2020; 150:236-244. [DOI: 10.1016/j.radonc.2020.06.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
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Intratumor Heterogeneity Assessed by 18F-FDG PET/CT Predicts Treatment Response and Survival Outcomes in Patients with Hodgkin Lymphoma. Acad Radiol 2020; 27:e183-e192. [PMID: 31761665 DOI: 10.1016/j.acra.2019.10.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/16/2019] [Accepted: 10/14/2019] [Indexed: 12/15/2022]
Abstract
RATIONALE AND OBJECTIVES Radiomic analysis of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) images enables the extraction of quantitative information of intratumour heterogeneity. This study investigated whether the baseline 18F-FDG PET/CT radiomics can predict treatment response and survival outcomes in patients with Hodgkin lymphoma (HL). MATERIALS AND METHODS Thirty-five patients diagnosed with HL who underwent 18F-FDG PET/CT scans before and during chemotherapy were retrospectively enrolled in this investigation. For each patient, we extracted 709 radiomic features from pretreatment PET/CT images. Clinical variables (age, gender, B symptoms, bulky tumor, and disease stage) and radiomic signatures (intensity, texture, and wavelet) were analyzed according to response to therapy, progression-free survival (PFS), and overall survival (OS). Receiver operating characteristic curve, logistic regression, and Cox proportional hazards model were used to examine potential predictive and prognostic factors. RESULTS High-intensity run emphasis (HIR) of PET and run-length nonuniformity (RLNU) of CT extracted from gray-level run-length matrix (GLRM) in high-frequency wavelets were independent predictive factors for the treatment response (odds ratio [OR] = 36.4, p = 0.014; OR = 30.4, p = 0.020). Intensity nonuniformity (INU) of PET and wavelet short run emphasis (SRE) of CT from GLRM and Ann Arbor stage were independently related to PFS (hazard ratio [HR] = 9.29, p = 0.023; HR = 18.40, p = 0.012; HR = 7.46, p = 0.049). Zone-size nonuniformity (ZSNU) of PET from gray-level size zone matrix (GLSZM) was independently associated with OS (HR = 41.02, p = 0.001). Based on these factors, a prognostic stratification model was devised for the risk stratification of patients. The proposed model allowed the identification of four risk groups for PFS and OS (p < 0.001 and p < 0.001). CONCLUSION HIR_GLRMPET and RLNU_GLRMCT in high-frequency wavelets serve as independent predictive factors for treatment response. ZSNU_GLSZMPET, INU_GLRMPET, and wavelet SRE_GLRMCT serve as independent prognostic factors for survival outcomes. The present study proposes a prognostic stratification model that may be clinically beneficial in guiding risk-adapted treatment strategies for patients with HL.
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47
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Barrington SF, Zwezerijnen BGJC, de Vet HCW, Heymans MW, Mikhaeel NG, Burggraaff CN, Eertink JJ, Pike LC, Hoekstra OS, Zijlstra JM, Boellaard R. Automated Segmentation of Baseline Metabolic Total Tumor Burden in Diffuse Large B-Cell Lymphoma: Which Method Is Most Successful? A Study on Behalf of the PETRA Consortium. J Nucl Med 2020; 62:332-337. [PMID: 32680929 DOI: 10.2967/jnumed.119.238923] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/17/2020] [Indexed: 12/22/2022] Open
Abstract
Metabolic tumor volume (MTV) is a promising biomarker of pretreatment risk in diffuse large B-cell lymphoma (DLBCL). Different segmentation methods can be used that predict prognosis equally well but give different optimal cutoffs for risk stratification. Segmentation can be cumbersome; a fast, easy, and robust method is needed. Our aims were to evaluate the best automated MTV workflow in DLBCL; determine whether uptake time, compliance or noncompliance with standardized recommendations for 18F-FDG scanning, and subsequent disease progression influence the success of segmentation; and assess differences in MTVs and discriminatory power of segmentation methods. Methods: One hundred forty baseline 18F-FDG PET/CT scans were selected from U.K. and Dutch studies on DLBCL to provide a balance between scans at 60 and 90 min of uptake, parameters compliant and noncompliant with standardized recommendations for scanning, and patients with and without progression. An automated tool was applied for segmentation using an SUV of 2.5 (SUV2.5), an SUV of 4.0 (SUV4.0), adaptive thresholding (A50P), 41% of SUVmax (41%), a majority vote including voxels detected by at least 2 methods (MV2), and a majority vote including voxels detected by at least 3 methods (MV3). Two independent observers rated the success of the tool to delineate MTV. Scans that required minimal interaction were rated as a success; scans that missed more than 50% of the tumor or required more than 2 editing steps were rated as a failure. Results: One hundred thirty-eight scans were evaluable, with significant differences in success and failure ratings among methods. The best performing was SUV4.0, with higher success and lower failure rates than any other method except MV2, which also performed well. SUV4.0 gave a good approximation of MTV in 105 (76%) scans, with simple editing for a satisfactory result in additionally 20% of cases. MTV was significantly different for all methods between patients with and without progression. The 41% segmentation method performed slightly worse, with longer uptake times; otherwise, scanning conditions and patient outcome did not influence the tool's performance. The discriminative power was similar among methods, but MTVs were significantly greater using SUV4.0 and MV2 than using other thresholds, except for SUV2.5. Conclusion: SUV4.0 and MV2 are recommended for further evaluation. Automated estimation of MTV is feasible.
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Affiliation(s)
- Sally F Barrington
- King's College London and Guy's and St. Thomas' PET Center, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ben G J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - N George Mikhaeel
- Department of Clinical Oncology, Guy's and St. Thomas' NHS Foundation Trust and School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom; and
| | - Coreline N Burggraaff
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jakoba J Eertink
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lucy C Pike
- King's College London and Guy's and St. Thomas' PET Center, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Guo R, Xu P, Xu H, Miao Y, Li B. The predictive value of pre-treatment 18F-FDG PET/CT on treatment outcome in early-stage extranodal natural killer/T-cell lymphoma. Leuk Lymphoma 2020; 61:2659-2664. [PMID: 32573298 DOI: 10.1080/10428194.2020.1783446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The diagnostic value of pretreatment 18F-FDG PET/CT in early-stage extranodal natural killer/T-cell lymphoma (ENKTL) is established, but its prognostic value is still unclear. We conducted 18F-FDG PET/CT-based quantitative and qualitative analysis as well as assessed related clinical parameters in 50 patients with recently diagnosed ENKTL and treated with methotrexate, etoposide, dexamethasone, and pegaspargase (MESA)-based therapy. Patients were followed-up for 38.6 ± 17.8 months. Six patients died of tumor-related disease, and six patients presented with persistence or recurrence. The estimates of the 2-year OS and PFS for the patients were 90.0% (SE: 4.0%) and 82.0% (SE: 5.0%), respectively. Survival curves were obtained using Kaplan-Meier analysis and compared using log rank test. Based on signifiacnt results of univariate analysis, we selected Epstein-Barr virus DNA (EB-DNA), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for multivariate analysis. Finally, MTV was found to be the significant independent predictor of both OS (p = .038) and PFS (p = .039).
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Affiliation(s)
- Rui Guo
- Department of Nuclear Medicine, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Pengpeng Xu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai, China
| | - Haoping Xu
- Department of Radiation, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Ying Miao
- Department of Nuclear Medicine, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Biao Li
- Department of Nuclear Medicine, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
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49
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Abstract
Hybrid imaging using the tracer [18F]FDG (2‑deoxy-2-fluoro-D-glucose) is regarded as the backbone of the diagnostic workup of lymphomas. All international guidelines, and especially the Lugano and RECIL (Response Evaluation Criteria in Lymphoma) guidelines, currently recommend [18F]FDG-PET/CT (positron emission tomography/computed tomography) for staging and treatment response assessment. With the exception of pediatric lymphomas, neither PET/MRI (magnetic resonance imaging) nor whole-body MRI are currently endorsed by international guidelines, despite the fact that both techniques have clear advantages over [18F]FDG-PET/CT in the assessment of lymphomas with variable FDG avidity. Of the new, more specific PET tracers that are being evaluated for the use in lymphomas, the CXCR4 (CXC motif chemokine receptor 4) tracer [68Ga]Pentixafor is of particular interest, as initial studies have shown that it may be used to visualize frequently non-FDG-avid lymphomas such as small-cell lymphocytic lymphoma, mucosa-associated lymphoid tissue (MALT) lymphoma and lymphomplasmacytic lymphoma.
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Affiliation(s)
- Marius E Mayerhöfer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 10065, New York, USA.
- Univ.-Klinik für Radiologie und Nuklearmedizin, Abteilung für Allgemeine und Kinderradiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, Wien, 1090, Österreich.
| | - Alexander Haug
- Univ.-Klinik für Radiologie und Nuklearmedizin, Abteilung für Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, Wien, 1090, Österreich
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50
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Voltin CA, Mettler J, Grosse J, Dietlein M, Baues C, Schmitz C, Borchmann P, Kobe C, Hellwig D. FDG-PET Imaging for Hodgkin and Diffuse Large B-Cell Lymphoma-An Updated Overview. Cancers (Basel) 2020; 12:cancers12030601. [PMID: 32150986 PMCID: PMC7139791 DOI: 10.3390/cancers12030601] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 01/07/2023] Open
Abstract
Since the mid-1990s, 18F-fluorodeoxglucose (FDG)-positron emission tomography (PET) in combination with computed tomography has come to play a prominent role in the management of malignant lymphomas. One of the first PET applications in oncology was the detection of lymphoma manifestations at staging, where it has shown high sensitivity. Nowadays, this imaging modality is also used during treatment to evaluate the individual chemosensitivity and adapt further therapy accordingly. If the end-of-treatment PET is negative, irradiation in advanced-stage Hodgkin lymphoma patients can be safely omitted after highly effective chemotherapy. Thus far, lymphoma response assessment has mainly been performed using visual criteria, such as the Deauville five-point scale, which became the international standard in 2014. However, novel measures such as metabolic tumor volume or total lesion glycolysis have recently been recognized by several working groups and may further increase the diagnostic and prognostic value of FDG-PET in the future.
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Affiliation(s)
- Conrad-Amadeus Voltin
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (M.D.); (C.K.)
- Correspondence: ; Tel.: +49-221-478-7534
| | - Jasmin Mettler
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (M.D.); (C.K.)
| | - Jirka Grosse
- Department of Nuclear Medicine, University Hospital Regensburg, 93053 Regensburg, Germany; (J.G.); (D.H.)
| | - Markus Dietlein
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (M.D.); (C.K.)
| | - Christian Baues
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Christine Schmitz
- Department of Hematology, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Peter Borchmann
- Department of Internal Medicine I, Center for Integrated Oncology Aachen-Bonn-Cologne-Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (M.D.); (C.K.)
| | - Dirk Hellwig
- Department of Nuclear Medicine, University Hospital Regensburg, 93053 Regensburg, Germany; (J.G.); (D.H.)
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