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Abstract
Lymphoma represent the third most common malignant disease in childhood and adolescence. They are divided into pediatric Hodgkin lymphoma (P-HL) and pediatric non-Hodgkin lymphoma (P-NHL). In P-HL, excellent cure rates are achieved through combined modality treatment using chemotherapy and radiotherapy. For more than 20 years, FDG-PET has been an integral part of the treatment and guides its intensity through improved staging and precise assessment of chemotherapy response. In P-NHL, good cure rates are achieved with chemotherapy alone. At present FDG-PET plays only a subordinate role in the treatment setting. Its potential to contribute to treatment management is far from being fully utilised. In this article, the current status of FDG-PET in pediatric lymphoma is presented in detail. The core elements are the sections on staging and response assessment. In addition, challenges and pitfalls are discussed and future developments are outlined.
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Affiliation(s)
- Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany -
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
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Youssef Y, Roschke E, Dietze N, Dahse AJ, Chaberny IF, Ranft D, Pempe C, Goralski S, Ghanem M, Kluge R, Lübbert C, Rodloff AC, Roth A. Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections-A Retrospective Single-Center Study. Antibiotics (Basel) 2024; 13:198. [PMID: 38534633 DOI: 10.3390/antibiotics13030198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 03/28/2024] Open
Abstract
Periprosthetic joint infections (PJI) are serious complications after arthroplasty, associated with high morbidity, mortality, and complex treatment processes. The outcomes of different PJI entities are largely unknown. The aim of this study was to access the early outcomes of different PJI entities. A retrospective, single-center study was conducted. The characteristics and outcomes of patients with PJI treated between 2018 and 2019 were evaluated 12 months after the completion of treatment. Primary endpoints were mortality, relapse free survival (RFS) and postoperative complications (kidney failure, sepsis, admission to ICU). A total of 115 cases were included [19.1% early (EI), 33.0% acute late (ALI), and 47.8% chronic infections (CI)]. Patients with ALI were older (p = 0.023), had higher ASA scores (p = 0.031), preoperative CRP concentrations (p = 0.011), incidence of kidney failure (p = 0.002) and sepsis (p = 0.026). They also tended towards higher in-house mortality (ALI 21.1%, 13.6% EI, 5.5% CI) and admission to ICU (ALI 50.0%, 22.7% EI, 30.9% CI). At 12 months, 15.4% of patients with EI had a relapse, compared to 38.1% in ALI and 36.4% in CI. There are differences in patient characteristics and early outcomes between PJI entities. Patients with EI have better early clinical outcomes. Patients with ALI require special attention during follow-up because they have higher occurrences of relapses and postoperative complications than patients with EI and CI.
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Affiliation(s)
- Yasmin Youssef
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Elisabeth Roschke
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Nadine Dietze
- Institute of Medical Microbiology and Virology, University Hospital Leipzig, Liebigstraße 21, 04103 Leipzig, Germany
| | - Anna-Judith Dahse
- Hospital Pharmacy, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Health, University Hospital Leipzig, Liebigstraße 22, 04103 Leipzig, Germany
- Institute of Hospital Epidemiology and Environmental Hygiene, University Medical Center Schleswig-Holstein, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Donald Ranft
- Hospital Pharmacy, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Christina Pempe
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Szymon Goralski
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Mohamed Ghanem
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Arne C Rodloff
- Institute of Medical Microbiology and Virology, University Hospital Leipzig, Liebigstraße 21, 04103 Leipzig, Germany
| | - Andreas Roth
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
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3
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Tran-Gia J, Eberlein U, Lassmann M, Mauz-Körholz C, Körholz D, Zuccetta P, Bar-Sever Z, Rosner U, Georgi TW, Sabri O, Kluge R, Piccardo A, Kurch L. Analysis of image data from the EuroNet PHL-C2 trial indicates a potential reduction in injected F-18 FDG activities in children: a proposal to update the EANM Paediatric Dosage Card. Eur J Nucl Med Mol Imaging 2024; 51:405-411. [PMID: 37728668 PMCID: PMC10774179 DOI: 10.1007/s00259-023-06396-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The aim of this work is to provide the currently missing evidence that may allow an update of the Paediatric Dosage Card provided by the European Association of Nuclear Medicine (EANM) for conventional PET/CT systems. METHODS In a total of 2082 consecutive [18F]FDG-PET scans performed within the EuroNet-PHL-C2 trial, the administered [18F]FDG activity was compared to the activity recommended by the EANM Paediatric Dosage Card. None of these scans had been rejected beforehand by the reference nuclear medicine panel of the trial because of poor image quality. For detailed quality assessment, a subset of 91 [18F]FDG-PET scans, all performed in different patients at staging, was selected according to pre-defined criteria, which (a) included only patients who had received substantially lower activities than those recommended by the EANM Paediatric Dosage Card, and (b) included as wide a range of different PET systems and imaging parameters as possible to ensure that the conclusions drawn in this work are as generally valid as possible. The image quality of the subset was evaluated visually by two independent readers using a quality scoring system as well as analytically based on a volume-of-interest analysis in 244 lesions and the healthy liver. Finally, recommendations for an update of the EANM Paediatric Dosage Card were derived based on the available data. RESULTS The activity recommended by the EANM Paediatric Dosage Card was undercut by a median of 99.4 MBq in 1960 [18F]FDG-PET scans and exceeded by a median of 15.1 MBq in 119 scans. In the subset analysis (n = 91), all image data were visually classified as clinically useful. In addition, only a very weak correlation (r = 0.06) between activity reduction and tumour-to-background ratio was found. Due to the intended heterogeneity of the dataset, the noise could not be analysed statistically sound as the high range of different imaging variables resulted in very small subsets. Finally, a suggestion for an update of the EANM Paediatric Dosage Card was developed, based on the analysis presented, resulting in a mean activity reduction by 39%. CONCLUSION The results of this work allow for a conservative update of the EANM Paediatric Dosage Card for [18F]FDG-PET/CT scans performed with conventional PET/CT systems.
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Affiliation(s)
- Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany.
| | - Uta Eberlein
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | | | - Dieter Körholz
- Department of Paediatric Oncology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Pietro Zuccetta
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padua, Padua, Italy
| | - Zvi Bar-Sever
- Schneider Children's Medical Center, Petach Tikva, Israel
| | - Ute Rosner
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | | | - Osama Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
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Pötzsch C, Kurch L, Naumann S, Georgi TW, Sabri O, Stoevesandt D, Cepelova M, Körholz D, Mauz-Körholz C, Hasenclever D, Kluge R. Prevention of activated brown adipose tissue on 18F-FDG-PET scans of young lymphoma patients: results of an ancillary study within the EuroNet-PHL-C2 trial. Sci Rep 2023; 13:21944. [PMID: 38081864 PMCID: PMC10713612 DOI: 10.1038/s41598-023-48871-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Activated brown fat (aBAT) is known to affect the evaluation of 18F-FDG PET scans, especially in young patients. The aim of this study was to determine factors influencing the occurrence of aBAT, and to investigate the effectiveness of the two preventive measures, warming and beta-blocker (propranolol) administration. Five-hundred-twenty-eight 18F-FDG-PET scans of 241 EuroNet-PHL-C2 trial patients from 41 nuclear medicine departments in Germany and Czech Republic were screened for aBAT. The occurrence of aBAT was analyzed with patient characteristics (age, sex, body mass index, predisposition to aBAT), weather data at the day of 18F-FDG PET scanning as well as the preventive measures taken. Potentially important factors from univariate analyses were included into a logistic regression model. Warming as a preventive measure was used in 243 18F-FDG-PET scans, propranolol was administered in 36, warming and propranolol were combined in 84, and no preventive measures were taken in 165 scans. Whereas age, sex and body mass index had no clear impact, there was an individual predisposition to aBAT. Logistic regression model revealed that the frequency of aBAT mainly depends on the outside temperature (p = 0.005) and can be effectively reduced by warming (p = 0.004), the administration of unselective beta-blocker or the combination of both. Warming is a simple, cheap and non-invasive method to reduce the frequency of aBAT. However, the effect of warming decreases with increasing outside temperatures. Administration of propranolol seems to be equally effective and provides advantages whenever the positive effect of warming is compromised. The combination of both preventive measures could have an additive effect.
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Affiliation(s)
- C Pötzsch
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany.
| | - S Naumann
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - T W Georgi
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - O Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - D Stoevesandt
- Department of Radiology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - M Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol and Second Medical Faculty of Charles University, Prague, Czech Republic
| | - D Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University Giessen, Giessen, Germany
| | - C Mauz-Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University Giessen, Giessen, Germany
| | - D Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - R Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
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5
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Franke FC, Damek A, Steglich J, Kurch L, Hasenclever D, Georgi TW, Wohlgemuth WA, Mauz-Körholz C, Körholz D, Kluge R, Landman-Parker J, Wallace WH, Fosså A, Vordermark D, Karlen J, Fernández-Teijeiro A, Cepelova M, Klekawka T, Attarbaschi A, Ceppi F, Hraskova A, Uyttebroeck A, Beishuizen A, Dieckmann K, Leblanc T, Moellers M, Buerke B, Stoevesandt D. Differentiation between rebound thymic hyperplasia and thymic relapse after chemotherapy in pediatric Hodgkin lymphoma. Pediatr Blood Cancer 2023; 70:e30421. [PMID: 37243889 DOI: 10.1002/pbc.30421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Rebound thymic hyperplasia (RTH) is a common phenomenon caused by stress factors such as chemotherapy (CTX) or radiotherapy, with an incidence between 44% and 67.7% in pediatric lymphoma. Misinterpretation of RTH and thymic lymphoma relapse (LR) may lead to unnecessary diagnostic procedures including invasive biopsies or treatment intensification. The aim of this study was to identify parameters that differentiate between RTH and thymic LR in the anterior mediastinum. METHODS After completion of CTX, we analyzed computed tomographies (CTs) and magnetic resonance images (MRIs) of 291 patients with classical Hodgkin lymphoma (CHL) and adequate imaging available from the European Network for Pediatric Hodgkin lymphoma C1 trial. In all patients with biopsy-proven LR, an additional fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT was assessed. Structure and morphologic configuration in addition to calcifications and presence of multiple masses in the thymic region and signs of extrathymic LR were evaluated. RESULTS After CTX, a significant volume increase of new or growing masses in the thymic space occurred in 133 of 291 patients. Without biopsy, only 98 patients could be identified as RTH or LR. No single finding related to thymic regrowth allowed differentiation between RTH and LR. However, the vast majority of cases with thymic LR presented with additional increasing tumor masses (33/34). All RTH patients (64/64) presented with isolated thymic growth. CONCLUSION Isolated thymic LR is very uncommon. CHL relapse should be suspected when increasing tumor masses are present in distant sites outside of the thymic area. Conversely, if regrowth of lymphoma in other sites can be excluded, isolated thymic mass after CTX likely represents RTH.
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Affiliation(s)
| | - Adrian Damek
- Department of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Jonas Steglich
- Department of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Dirk Hasenclever
- Institute of Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Thomas W Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - Christine Mauz-Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University, Gießen, Germany
| | - Dieter Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University, Gießen, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - William Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, UK
| | - Alexander Fosså
- Department of Medical Oncology and Radiotherapy, Oslo University Hospital, Oslo, Norway
| | - Dirk Vordermark
- Department of Radiation Oncology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - Jonas Karlen
- Karolinska University Hospital, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden
| | | | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol and Second Medical Faculty of Charles University, Prague, Czech Republic
| | - Tomasz Klekawka
- Pediatric Oncology and Hematology Department, University Children's Hospital of Krakow, Krakow, Poland
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Francesco Ceppi
- Division of Pediatrics, Department of Woman-Mother-Child, Pediatric Hematology-Oncology Unit, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Andrea Hraskova
- Department of Pediatric Hematology and Oncology, National Institute of Paediatric Diseases, Bratislava, Slovakia
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Auke Beishuizen
- Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Karin Dieckmann
- Department of Radiation Oncology, University Hospital Vienna, Vienna, Austria
| | - Thierry Leblanc
- Service d'Hématologie Pédiatrique, Hôpital Robert-Debré, Paris, France
| | - Martin Moellers
- Department Department of Pediatric Radiology, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Boris Buerke
- Department of Clinical Radiology, University Hospital of Münster, Münster, Germany
| | - Dietrich Stoevesandt
- Department of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
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Körholz D, Mauz-Körholz C, Wallace WH, Landman-Parker J, Kluge R, Hasenclever D. Radiotherapy for children and adolescents with early-stage classical Hodgkin lymphoma - Authors' reply. Lancet Oncol 2023; 24:e231. [PMID: 37269849 DOI: 10.1016/s1470-2045(23)00235-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Dieter Körholz
- Department of Paediatric Oncology, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Children and Young People, University of Edinburgh, Edinburgh EH16 4TJ, UK.
| | - Judith Landman-Parker
- Department of Paediatric Haematology-Oncology, Sorbonne Université and Assistance Publique des Hopitaux de Paris, Hôpital a Trousseau, Paris, France
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
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7
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Mauz-Körholz C, Landman-Parker J, Fernández-Teijeiro A, Attarbaschi A, Balwierz W, Bartelt JM, Beishuizen A, Boudjemaa S, Cepelova M, Ceppi F, Claviez A, Daw S, Dieckmann K, Fosså A, Gattenlöhner S, Georgi T, Hjalgrim LL, Hraskova A, Karlén J, Kurch L, Leblanc T, Mann G, Montravers F, Pears J, Pelz T, Rajić V, Ramsay AD, Stoevesandt D, Uyttebroeck A, Vordermark D, Körholz D, Hasenclever D, Wallace WH, Kluge R. Response-adapted omission of radiotherapy in children and adolescents with early-stage classical Hodgkin lymphoma and an adequate response to vincristine, etoposide, prednisone, and doxorubicin (EuroNet-PHL-C1): a titration study. Lancet Oncol 2023; 24:252-261. [PMID: 36858722 DOI: 10.1016/s1470-2045(23)00019-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Children and adolescents with early-stage classical Hodgkin lymphoma have a 5-year event-free survival of 90% or more with vincristine, etoposide, prednisone, and doxorubicin (OEPA) plus radiotherapy, but late complications of treatment affect survival and quality of life. We investigated whether radiotherapy can be omitted in patients with adequate morphological and metabolic responses to OEPA. METHODS The EuroNet-PHL-C1 trial was designed as a titration study and recruited patients at 186 hospital sites across 16 European countries. Children and adolescents with newly diagnosed stage IA, IB, and IIA classical Hodgkin lymphoma younger than 18 years of age were assigned to treatment group 1 to be treated with two cycles of OEPA (vincristine 1·5 mg/m2 intravenously, capped at 2 mg, on days 1, 8, and 15; etoposide 125 mg/m2 intravenously, on days 1-5; prednisone 60 mg/m2 orally on days 1-15; and doxorubicin 40 mg/m2 intravenously on days 1 and 15). If no adequate response (a partial morphological remission or greater and PET negativity) had been achieved after two cycles of OEPA, involved-field radiotherapy was administered at a total dose of 19·8 Gy (usually in 11 fractions of 1·8 Gy per day). The primary endpoint was event-free survival. The primary objective was maintaining a 5-year event-free survival rate of 90% in patients with an adequate response to OEPA without radiotherapy. We performed intention-to-treat and per-protocol analyses. The trial was registered at ClinicalTrials.gov (NCT00433459) and with EUDRACT, (2006-000995-33) and is completed. FINDINGS Between Jan 31, 2007, and Jan 30, 2013, 2131 patients were registered and 2102 patients were enrolled onto EuroNet-PHL-C1. Of these 2102 patients, 738 with early-stage disease were allocated to treatment group 1. Median follow-up was 63·3 months (IQR 60·1-69·8). We report on 714 patients assigned to and treated on treatment group 1; the intention-to-treat population comprised 713 patients with 323 (45%) male and 390 (55%) female patients. In 440 of 713 patients in the intention-to-treat group who had an adequate response and did not receive radiotherapy, 5-year event-free survival was 86·5% (95% CI 83·3-89·8), which was less than the 90% target rate. In 273 patients with an inadequate response who received radiotherapy, 5-year event-free survival was 88·6% (95% CI 84·8-92·5), for which the 95% CI included the 90% target rate. The most common grade 3-4 adverse events were neutropenia (in 597 [88%] of 680 patients) and leukopenia (437 [61%] of 712). There were no treatment-related deaths. INTERPRETATION On the basis of all the evidence, radiotherapy could be omitted in patients with early-stage classical Hodgkin lymphoma and an adequate response to OEPA, but patients with risk factors might need more intensive treatment. FUNDING Deutsche Krebshilfe, Elternverein für Krebs-und leukämiekranke Kinder, Gießen, Kinderkrebsstiftung Mainz of the Journal Oldtimer Markt, Tour der Hoffnung, Menschen für Kinder, Mitteldeutsche Kinderkrebsforschung, Programme Hospitalier de Recherche Clinique, and Cancer Research UK.
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Affiliation(s)
| | - Judith Landman-Parker
- Department of Paediatric Haematology-Oncology, Sorbonne Université and Assistance Publique des Hopitaux de Paris, Hôpital a Trousseau, Paris, France
| | | | - Andishe Attarbaschi
- Department of Paediatric Haematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Walentyna Balwierz
- Department of Paediatric Oncology and Haematology, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Jörg M Bartelt
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - Auke Beishuizen
- Princess Máxima Centre for Paediatric Oncology, Utrecht and Erasmus, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Sabah Boudjemaa
- Department of Pathology, Armand Trousseau Hospital, Paris, France
| | - Michaela Cepelova
- Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Francesco Ceppi
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Alexander Claviez
- Department of Paediatrics, University of Schleswig-Holstein, Kiel, Germany
| | - Stephen Daw
- Children and Young People's Cancer Service, University College Hospital London, London, UK
| | - Karin Dieckmann
- Strahlentherapie Allgemeines Krankenhaus Wien, Medizinische Universitätsklinik Wien, Vienna, Austria
| | | | | | - Thomas Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Lisa L Hjalgrim
- Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andrea Hraskova
- Department of Paediatric Haematology and Oncology, National Institute of Children's Disease and Comenius University, Bratislava, Slovakia
| | - Jonas Karlén
- Department of Paediatric Oncology at Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Thierry Leblanc
- Service d'Hématologie Pédiatrique, Hôpital Robert-Debré, Paris, France
| | - Georg Mann
- St Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Francoise Montravers
- Department of Nuclear Medicine, Tenon Hospital, APHP and Sorbonne Université, Paris, France
| | - Jane Pears
- Our Lady's Hospital for Children's Health, Dublin, Ireland
| | - Tanja Pelz
- Medical Faculty (Prof C Mauz-Körholz) and Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Vladan Rajić
- Clinical Department of Paediatric Haematology, Oncology, and Stem Cell Transplantation, University Medical Centre Ljubljana and University Children's Hospital, Ljubljana, Slovenia
| | - Alan D Ramsay
- Department of Cellular Pathology, University College Hospital London, London, UK
| | | | - Anne Uyttebroeck
- Paediatric Haematology and Oncology, Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Dirk Vordermark
- Medical Faculty (Prof C Mauz-Körholz) and Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Dieter Körholz
- Department of Paediatric Oncology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - William H Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Children and Young People, University of Edinburgh, Edinburgh, UK.
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
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Georgi TW, Kurch L, Hasenclever D, Warbey VS, Pike L, Radford J, Sabri O, Kluge R, Barrington SF. Interobserver variability in interim PET assessment in Hodgkin lymphoma-reasons and solutions. PLoS One 2023; 18:e0283694. [PMID: 36976821 PMCID: PMC10047538 DOI: 10.1371/journal.pone.0283694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Interim PET (iPET) assessment is important for response adaptation in Hodgkin lymphoma (HL). The current standard for iPET assessment is the Deauville score (DS). The aim of our study was to evaluate the causes of interobserver variability in assigning the DS for iPET in HL patients and to make suggestions for improvement. METHODS All evaluable iPET scans from the RAPID study were re-read by two nuclear physicians, blinded to the results and patient outcomes in the RAPID trial. The iPET scans were assessed visually according to the DS and, thereafter, quantified using the qPET method. All discrepancies of more than one DS level were re-evaluated by both readers to find the reason for the discordant result. RESULTS In 249/441 iPET scans (56%) a concordant visual DS result was achieved. A "minor discrepancy" of one DS level occurred in 144 scans (33%) and a "major discrepancy" of more than one DS level in 48 scans (11%). The main causes for major discrepancies were 1) different interpretation of PET-positive lymph nodes-malignant vs. inflammatory; 2) lesions missed by one reader and 3) different assessment of lesions in activated brown fat tissue. In 51% of the minor discrepancy scans with residual lymphoma uptake, additional quantification resulted in a concordant quantitative DS result. CONCLUSION Discordant visual DS assessment occurred in 44% of all iPET scans. The main reason for major discrepancies was the different interpretation of PET positive lymph nodes as malignant or inflammatory. Disagreements in evaluation of the hottest residual lymphoma lesion can be solved by the use of semi-quantitative assessment.
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Affiliation(s)
- Thomas W Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Victoria S Warbey
- King's College London and Guy's & St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Lucy Pike
- King's College London and Guy's & St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - John Radford
- University of Manchester and Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Sally F Barrington
- King's College London and Guy's & St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
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Georgi TW, Stoevesandt D, Kurch L, Bartelt JM, Hasenclever D, Dittmann H, Ferda J, Francis P, Franzius C, Furth C, Gräfe D, Gussew A, Hüllner M, Menezes LJ, Mustafa M, Stegger L, Umutlu L, Zöphel K, Zucchetta P, Körholz D, Sabri O, Mauz-Körholz C, Kluge R. Optimized Whole-Body PET MRI Sequence Workflow in Pediatric Hodgkin Lymphoma Patients. J Nucl Med 2023; 64:96-101. [PMID: 35835583 PMCID: PMC9841249 DOI: 10.2967/jnumed.122.264112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023] Open
Abstract
18F-FDG PET/MRI might be the diagnostic method of choice for Hodgkin lymphoma patients, as it combines significant metabolic information from PET with excellent soft-tissue contrast from MRI and avoids radiation exposure from CT. However, a major issue is longer examination times than for PET/CT, especially for younger children needing anesthesia. Thus, a targeted selection of suitable whole-body MRI sequences is important to optimize the PET/MRI workflow. Methods: The initial PET/MRI scans of 84 EuroNet-PHL-C2 study patients from 13 international PET centers were evaluated. In each available MRI sequence, 5 PET-positive lymph nodes were assessed. If extranodal involvement occurred, 2 splenic lesions, 2 skeletal lesions, and 2 lung lesions were also assessed. A detection rate was calculated dividing the number of visible, anatomically assignable, and measurable lesions in the respective MRI sequence by the total number of lesions. Results: Relaxation time-weighted (T2w) transverse sequences with fat saturation (fs) yielded the best result, with detection rates of 95% for nodal lesions, 62% for splenic lesions, 94% for skeletal lesions, and 83% for lung lesions, followed by T2w transverse sequences without fs (86%, 49%, 16%, and 59%, respectively) and longitudinal relaxation time-weighted contrast-enhanced transverse sequences with fs (74%, 35%, 57%, and 55%, respectively). Conclusion: T2w transverse sequences with fs yielded the highest detection rates and are well suited for accurate whole-body PET/MRI in lymphoma patients. There is no evidence to recommend the use of contrast agents.
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Affiliation(s)
- Thomas W. Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Jörg M. Bartelt
- Department of Radiology, University of Halle, Halle/Saale, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Helmut Dittmann
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Tuebingen, Germany
| | - Jiri Ferda
- Department of Imaging, University Hospital Pilsen, Pilsen, Czech Republic
| | - Peter Francis
- Department of Nuclear Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Christiane Franzius
- Center for Modern Diagnostics–MRI and PET/MRI and Center for Nuclear Medicine and PET/CT, Bremen, Germany
| | - Christian Furth
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Department of Nuclear Medicine, Berlin Institute of Health, Berlin, Germany
| | - Daniel Gräfe
- Paediatric Radiology, Department of Radiology, University of Leipzig, Leipzig, Germany
| | - Alexander Gussew
- Department of Radiology, University of Halle, Halle/Saale, Germany
| | - Martin Hüllner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Leon J. Menezes
- UCL Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Mona Mustafa
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Klaus Zöphel
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Padova, Italy
| | - Dieter Körholz
- Department of Pediatric Oncology, Justus Liebig University, Giessen, Germany; and
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Christine Mauz-Körholz
- Department of Pediatric Oncology, Justus Liebig University, Giessen, Germany; and,Medical Faculty, Martin Luther University of Halle–Wittenberg, Halle/Saale, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
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Rozwod K, Mauz-Körholz C, Heine P, Gattenlöhner S, Langer C, Steiner D, Krombach G, Georgi TW, Kallenberg K, Sabri O, Körholz D, Kluge R, Bartelt JM, Stoevesandt D, Kurch L. Waldeyer's ring involvement in a young patient with Hodgkin lymphoma: Challenges, interdisciplinary findings, and reliability check of the image-based algorithm for diagnosis and response assessment. Pediatr Blood Cancer 2022; 69:e29560. [PMID: 34971071 DOI: 10.1002/pbc.29560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Krystyna Rozwod
- Department of Pediatric Hematology and Oncology, Justus-Liebig University, Giessen, Germany
| | - Christine Mauz-Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University, Giessen, Germany.,Medical Faculty, Martin-Luther-University, Halle (Saale), Germany
| | - Philipp Heine
- Department of Ear, Nose and Throat Medicine, Hospital Fulda, Fulda, Germany
| | | | - Christine Langer
- Department of Otorhinolaryngology, Head and Neck Surgery, Justus-Liebig University, Giessen, Germany
| | - Dagmar Steiner
- Department of Nuclear Medicine, Justus-Liebig University, Giessen, Germany
| | | | | | - Kai Kallenberg
- Department of Neuroradiology, Hospital Fulda, Fulda, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Dieter Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University, Giessen, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | | | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
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Kroese TE, van Hillegersberg R, Schoppmann S, Deseyne PR, Nafteux P, Obermannova R, Nordsmark M, Pfeiffer P, Hawkings MA, Smyth E, Markar S, Hanna GB, Cheong E, Chaudry A, Elme A, Adenis A, Piessen G, Gani C, Bruns CJ, Moehler M, Liakakos T, Reynolds J, Morganti A, Rosati R, Castoro C, D'Ugo D, Roviello F, Bencivenga M, de Manzoni G, Jeene P, van Sandick JW, Muijs C, Slingerland M, Nieuwenhuijzen G, Wijnhoven B, Beerepoot LV, Kolodziejczyk P, Polkowski WP, Alsina M, Pera M, Kanonnikoff TF, Nilsson M, Guckenberger M, Monig S, Wagner D, Wyrwicz L, Berbee M, Gockel I, Lordick F, Griffiths EA, Verheij M, van Rossum PS, van Laarhoven HW, Rosman C, Rütten H, Gootjes EC, Vonken FE, van Dieren JM, Vollebergh MA, van der Sangen M, Creemers GJ, Zander T, Schlößer H, Cascinu S, Mazza E, Nicoletti R, Damascelli A, Slim N, Passoni P, Cossu A, Puccetti F, Barbieri L, Fanti L, Azzolini F, Ventoruzzo F, Szczepanik A, Visa L, Reig A, Roques T, Harrison M, Ciseł B, Pikuła A, Skórzewska M, Vanommeslaeghe H, Van Daele E, Pattyn P, Geboes K, Callebout E, Ribeiro S, van Duijvendijk P, Tromp C, Sosef M, Warmerdam F, Heisterkamp J, Heisterkamp J, Vera A, Jordá E, López-Mozos F, Fernandez-Moreno MC, Barrios-Carvajal M, Huerta M, de Steur W, Lips I, Diez M, Castro S, O'Neill R, Holyoake D, Hacker U, Denecke T, Kuhnt T, Hoffmeister A, Kluge R, Bostel T, Grimminger P, Jedlička V, Křístek J, Pospíšil P, Mourregot A, Maurin C, Starling N, Chong I. Definitions and treatment of oligometastatic oesophagogastric cancer according to multidisciplinary tumour boards in Europe. Eur J Cancer 2022; 164:18-29. [DOI: 10.1016/j.ejca.2021.11.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 12/17/2022]
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Kurch L, Georgi TW, Monecke A, Seehofer D, Borte G, Sabri O, Kluge R, Heyn S, Pierer M, Platzbecker U, Kayser S. Vital Hepatic Lymphoma Residuum or Excessive Immune Response? Challenging Treatment Decisions in a Patient With Systemic Lupus Erythematosus and Liver-Dominant Diffuse Large B-Cell Lymphoma: Case Report. Front Oncol 2022; 11:798757. [PMID: 35117998 PMCID: PMC8803907 DOI: 10.3389/fonc.2021.798757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
A 28-year-old female patient with active and difficult-to-treat systemic lupus erythematosus (SLE) was diagnosed with liver-dominant diffused large B-cell lymphoma. Repeated response 18F-FDG-PET studies showed persistently high, and, despite intensified immunochemotherapy, further increasing metabolic activity of one of the hepatic lymphoma residuals, whereas all other initial lymphoma manifestations had achieved complete metabolic remission. As biopsy of the 18F-FDG-PET-positive liver residual turned out to be inconclusive, complete resection was performed. Subsequent histopathological examination, however, revealed only necrotic tissue. Thus, no further lymphoma treatment was scheduled. The patient undergoes regular surveillance and is disease-free 13 months after resection. Similarly, treatment of SLE is no longer required due to lack of activity already after the first two cycles of lymphoma treatment. The case shows how closely SLE and diffused large B-cell lymphoma can be connected and stresses the importance of interdisciplinary treatment approaches. In the future, artificial intelligence may help to further classify 18F-FDG-PET-positive lymphoma residuals. This could lead to an increase of the positive predictive value of interim- and end-of-treatment 18F-FDG-PET. The patient’s point of view enables another instructive perspective on the course of treatment, which often remains hidden to treating physicians due to lack of time in clinical routine.
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Affiliation(s)
- Lars Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
- *Correspondence: Lars Kurch,
| | - Thomas W. Georgi
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Astrid Monecke
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Gudrun Borte
- Department of Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Simone Heyn
- Department of Hematology, Cellular Therapy and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Pierer
- Department of Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Platzbecker
- Department of Hematology, Cellular Therapy and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Sabine Kayser
- Department of Hematology, Cellular Therapy and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Mauz-Körholz C, Landman-Parker J, Balwierz W, Ammann RA, Anderson RA, Attarbaschi A, Bartelt JM, Beishuizen A, Boudjemaa S, Cepelova M, Claviez A, Daw S, Dieckmann K, Fernández-Teijeiro A, Fosså A, Gattenlöhner S, Georgi T, Hjalgrim LL, Hraskova A, Karlén J, Kluge R, Kurch L, Leblanc T, Mann G, Montravers F, Pears J, Pelz T, Rajić V, Ramsay AD, Stoevesandt D, Uyttebroeck A, Vordermark D, Körholz D, Hasenclever D, Wallace WH. Response-adapted omission of radiotherapy and comparison of consolidation chemotherapy in children and adolescents with intermediate-stage and advanced-stage classical Hodgkin lymphoma (EuroNet-PHL-C1): a titration study with an open-label, embedded, multinational, non-inferiority, randomised controlled trial. Lancet Oncol 2022; 23:125-137. [PMID: 34895479 PMCID: PMC8716340 DOI: 10.1016/s1470-2045(21)00470-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Children and adolescents with intermediate-stage and advanced-stage classical Hodgkin lymphoma achieve an event-free survival at 5 years of about 90% after treatment with vincristine, etoposide, prednisone, and doxorubicin (OEPA) followed by cyclophosphamide, vincristine, prednisone, and procarbazine (COPP) and radiotherapy, but long-term treatment effects affect survival and quality of life. We aimed to investigate whether radiotherapy can be omitted in patients with morphological and metabolic adequate response to OEPA and whether modified consolidation chemotherapy reduces gonadotoxicity. METHODS Our study was designed as a titration study with an open-label, embedded, multinational, non-inferiority, randomised controlled trial, and was carried out at 186 hospital sites across 16 European countries. Children and adolescents with newly diagnosed intermediate-stage (treatment group 2) and advanced-stage (treatment group 3) classical Hodgkin lymphoma who were younger than 18 years and stratified according to risk using Ann Arbor disease stages IIAE, IIB, IIBE, IIIA, IIIAE, IIIB, IIIBE, and all stages IV (A, B, AE, and BE) were included in the study. Patients with early disease (treatment group 1) were excluded from this analysis. All patients were treated with two cycles of OEPA (1·5 mg/m2 vincristine taken intravenously capped at 2 mg, on days 1, 8, and 15; 125 mg/m2 etoposide taken intravenously on days 1-5; 60 mg/m2 prednisone taken orally on days 1-15; and 40 mg/m2 doxorubicin taken intravenously on days 1 and 15). Patients were randomly assigned to two (treatment group 2) or four (treatment group 3) cycles of COPP (500 mg/m2 cyclophosphamide taken intravenously on days 1 and 8; 1·5 mg/m2 vincristine taken intravenously capped at 2 mg, on days 1 and 8; 40 mg/m2 prednisone taken orally on days 1 to 15; and 100 mg/m2 procarbazine taken orally on days 1 to 15) or COPDAC, which was identical to COPP except that 250 mg/m2 dacarbazine administered intravenously on days 1 to 3 replaced procarbazine. The method of randomisation (1:1) was minimisation with stochastic component and was centrally stratified by treatment group, country, trial sites, and sex. The primary endpoint was event-free survival, defined as time from treatment start until the first of the following events: death from any cause, progression or relapse of classical Hodgkin lymphoma, or occurrence of secondary malignancy. The primary objectives were maintaining 90% event-free survival at 5 years in patients with adequate response to OEPA treated without radiotherapy and to exclude a decrease of 8% in event-free survival at 5 years in the embedded COPDAC versus COPP randomisation to show non-inferiority of COPDAC. Efficacy analyses are reported per protocol and safety in the intention-to-treat population. The trial is registered with ClinicalTrials.gov (trial number NCT00433459) and EUDRACT (trial number 2006-000995-33), and is closed to recruitment. FINDINGS Between Jan 31, 2007, and Jan 30, 2013, 2102 patients were recruited. 737 (35%) of the 2102 recruited patients were in treatment group 1 (early-stage disease) and were not included in our analysis. 1365 (65%) of the 2102 patients were in treatment group 2 (intermediate-stage disease; n=455) and treatment group 3 (advanced-stage disease; n=910). Of these 1365, 1287 (94%) patients (435 [34%] of 1287 in treatment group 2 and 852 [66%] of 1287 in treatment group 3) were included in the titration trial per-protocol analysis. 937 (69%) of 1365 patients were randomly assigned to COPP (n=471) or COPDAC (n=466) in the embedded trial. Median follow-up was 66·5 months (IQR 62·7-71·7). Of 1287 patients in the per-protocol group, 514 (40%) had an adequate response to treatment and were not treated with radiotherapy (215 [49%] of 435 in treatment group 2 and 299 [35%] of 852 in treatment group 3). 773 (60%) of 1287 patients with inadequate response were scheduled for radiotherapy (220 [51%] of 435 in the treatment group 2 and 553 [65%] of 852 in treatment group 3. In patients who responded adequately, event-free survival rates at 5 years were 90·1% (95% CI 87·5-92·7). event-free survival rates at 5 years in 892 patients who were randomly assigned to treatment and analysed per protocol were 89·9% (95% CI 87·1-92·8) for COPP (n=444) versus 86·1% (82·9-89·4) for COPDAC (n=448). The COPDAC minus COPP difference in event-free survival at 5 years was -3·7% (-8·0 to 0·6). The most common grade 3-4 adverse events (intention-to-treat population) were decreased haemoglobin (205 [15%] of 1365 patients during OEPA vs 37 [7%] of 528 treated with COPP vs 20 [2%] of 819 treated with COPDAC), decreased white blood cells (815 [60%] vs 231 [44%] vs 84 [10%]), and decreased neutrophils (1160 [85%] vs 223 [42%] vs 174 [21%]). One patient in treatment group 2 died of sepsis after the first cycle of OEPA; no other treatment-related deaths occurred. INTERPRETATION Our results show that radiotherapy can be omitted in patients who adequately respond to treatment, when consolidated with COPP or COPDAC. COPDAC might be less effective, but is substantially less gonadotoxic than COPP. A high proportion of patients could therefore be spared radiotherapy, eventually reducing the late effects of treatment. With more refined criteria for response assessment, the number of patients who receive radiotherapy will be further decreased. FUNDING Deutsche Krebshilfe, Elternverein für Krebs-und leukämiekranke Kinder Gießen, Kinderkrebsstiftung Mainz, Tour der Hoffnung, Menschen für Kinder, Programme Hospitalier de Recherche Clinique, and Cancer Research UK.
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Affiliation(s)
- Christine Mauz-Körholz
- Department of Paediatric Oncology, Justus-Liebig- University Giessen, Giessen, Germany; Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Judith Landman-Parker
- Department of Paediatric Haematology-Oncology, Sorbonne Université and APHP-SIRIC CURAMUS Hôpital a Trousseau, Paris, France
| | - Walentyna Balwierz
- Department of Paediatric Oncology and Haematology, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Roland A Ammann
- Paediatric Haematology and Oncology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern Switzerland
| | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andische Attarbaschi
- Department of Paediatric Haematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Jörg M Bartelt
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - Auke Beishuizen
- Princess Máxima Centre for Paediatric Oncology, Utrecht and Erasmus, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sabah Boudjemaa
- Department of Pathology, Armand Trousseau Hospital, Paris, France
| | - Michaela Cepelova
- Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Alexander Claviez
- Department of Paediatrics, University of Schleswig-Holstein, Kiel, Germany
| | - Stephen Daw
- Children and Young People's Cancer Service, University College Hospital London, London, UK
| | - Karin Dieckmann
- Strahlentherapie AKH Wien Medizinische, Universitätsklinik Wien, Vienna, Austria
| | | | | | | | - Thomas Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Lisa L Hjalgrim
- Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andrea Hraskova
- Department of Paediatric Haematology and Oncology, National Institute of Children's Disease and Comenius University, Bratislava, Slovakia
| | - Jonas Karlén
- Department of Paediatric Oncology at Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Thiery Leblanc
- Service d'Hématologie Pédiatrique, Hôpital Robert-Debré, Paris, France
| | - Georg Mann
- St Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Francoise Montravers
- Department of Nuclear Medicine, Tenon Hospital, APHP and Sorbonne Université, Paris, France
| | - Jean Pears
- Our Lady's Hospital for Children's Health, Dublin, Ireland
| | - Tanja Pelz
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Vladan Rajić
- Clinical Department of Paediatric Haematology, Oncology, and Stem Cell Transplantation, University Medical Centre Ljubljana and University Children's Hospital, Ljubljana, Slovenia
| | - Alan D Ramsay
- Department of Cellular Pathology, University College Hospital London, London, UK
| | | | - Anne Uyttebroeck
- Paediatric Haematology and Oncology, Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Dieter Körholz
- Department of Paediatric Oncology, Justus-Liebig- University Giessen, Giessen, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - William Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Children and Young People and University of Edinburgh, Edinburgh, UK.
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Wichmann G, Pavlychenko M, Willner M, Halama D, Kuhnt T, Kluge R, Gradistanac T, Fest S, Wald T, Lethaus B, Dietz A, Wiegand S, Zebralla V. Standardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma. Front Oncol 2021; 11:737080. [PMID: 34868927 PMCID: PMC8636007 DOI: 10.3389/fonc.2021.737080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background Standardized staging procedures and presentation of oral squamous cell carcinoma (OSCC) patients in multidisciplinary tumor boards (MDTB) before treatment and utilization of elective neck dissection (ND) are expected to improve the outcome, especially in local advanced LAOSCC (UICC stages III–IVB). As standardized diagnostics but also increased heterogeneity in treatment applied so far have not been demonstrated to improve outcome in LAOSCC, a retrospective study was initiated. Methods As MDTB was introduced into clinical routine in 2007, 316 LAOSCC patients treated during 1991-2017 in our hospital were stratified into cohort 1 treated before (n=104) and cohort 2 since 2007 (n=212). Clinical characteristics, diagnostic procedures and treatment modality of patients were compared using Chi-square tests and outcome analyzed applying Kaplan-Meier plots and log-rank tests as well as Cox proportional hazard regression. Propensity scores (PS) were used to elucidate predictors for impaired distant metastasis-free survival (DMFS) in PS-matched patients. Results Most patient characteristics and treatment modalities applied showed insignificant alteration. Surgical treatment included significantly more often resection of the primary tumor plus neck dissection, tracheostomy and percutaneous endoscopic gastrostomy tube use. Cisplatin-based chemo-radiotherapy was the most frequent. Only insignificant improved disease- (DFS), progression- (PFS) and event-free (EFS) as well as tumor-specific (TSS) and overall survival (OS) were found after 2006 as local (LC) and loco-regional control (LRC) were significantly improved but DMFS significantly impaired. Cox regression applied to PS-matched patients elucidated N3, belonging to cohort 2 and cisplatin-based chemo-radiotherapy as independent predictors for shortened DMFS. The along chemo-radiotherapy increased dexamethasone use in cohort 2 correlates with increased DM. Conclusions Despite standardized diagnostic procedures, decision-making considering clear indications and improved therapy algorithms leading to improved LC and LRC, shortened DMFS hypothetically linked to increased dexamethasone use had a detrimental effect on TSS and OS.
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Affiliation(s)
- Gunnar Wichmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Mykola Pavlychenko
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Maria Willner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Dirk Halama
- Department of Maxillofacial Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Kuhnt
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Tanja Gradistanac
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Sandra Fest
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Theresa Wald
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Bernd Lethaus
- Department of Maxillofacial Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Veit Zebralla
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
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Roschke E, Kluge T, Stallkamp F, Roth A, Zajonz D, Hoffmann KT, Sabri O, Kluge R, Ghanem M. Use of PET-CT in diagnostic workup of periprosthetic infection of hip and knee joints: significance in detecting additional infectious focus. Int Orthop 2021; 46:523-529. [PMID: 34618195 PMCID: PMC8840933 DOI: 10.1007/s00264-021-05218-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/12/2021] [Indexed: 12/15/2022]
Abstract
Introduction The diagnosis and management of periprosthetic knee and hip infections as well as the identification and management of possible additional infectious foci is of great importance for successful therapy. This study analyses the importance of 18F deoxyglucose PET-CT (PET-CT) in the identification of additional infectious focus and subsequent impact on management of periprosthetic infection (PPI). Material and methods A retrospective analysis of the clinical data and findings in the period from January 2008 to December 2018 was carried out. One hundred and four patients with in-hospital treatment due to PPI of a hip or knee joint were identified and included in this study. All patients underwent a standardized clinical examination and further surgical and antibiotic therapy. The reevaluation of performed PET-CTs was specifically carried out with regard to the local PPI or detection of secondary foci. Results PET-CT successfully verified the PPI in 84.2% of the patients. A total of 78 possible additional foci were detected in PET-CT in 56 (53.8%) of the examined patients. Predilection sites for possible secondary foci were joints (42.3%), pulmonary (15.4%), ear-nose-throat (15.4%), spine (11.5%), and the musculocutaneous tissues (11.5%). Fifty-four positive PET-CT findings were confirmed clinically with need of additional adequate treatment. Conclusion PET-CT is a valuable diagnostic tool to confirm periprosthetic joint infection. At the same time, the whole-body PET/CT may detect additional foci of infection with impact on subsequent treatment strategy. PET was of special value in detecting infections at distant locations far from the primary infected joint in significant number. These distant infection locations can be potential cause of a re-infection. This clearly reflects the need of their diagnosis.
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Affiliation(s)
- E Roschke
- Klinik Und Poliklinik Für Orthopädie, Unfallchirurgie Und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - T Kluge
- Klinik Und Poliklinik Für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - F Stallkamp
- Klinik Und Poliklinik Für Orthopädie, Unfallchirurgie Und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - A Roth
- Klinik Und Poliklinik Für Orthopädie, Unfallchirurgie Und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - D Zajonz
- Klinik Für Orthopädie, Unfallchirurgie Und Wiederherstellungschirurgie, Zeißigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
| | - K T Hoffmann
- Klinik Und Poliklinik Für Diagnostische Und Interventionelle Radiologie, Institut Für Neuroradiologie, Leipzig, Germany
| | - O Sabri
- Klinik Und Poliklinik Für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - R Kluge
- Klinik Und Poliklinik Für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - M Ghanem
- Klinik Und Poliklinik Für Orthopädie, Unfallchirurgie Und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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16
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Kurch L, Dührsen U, Hüttmann A, Georgi TW, Sabri O, Kluge R, Hasenclever D. Quantitative evaluation of interim positron emission tomography in peripheral T-cell lymphoma. EJNMMI Res 2021; 11:90. [PMID: 34523055 PMCID: PMC8440745 DOI: 10.1186/s13550-021-00827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interim [18F]fluoro-deoxyglucose-positron emission tomography predicts outcome in peripheral T-cell lymphoma (PTCL). We compared two quantitative evaluation methods. METHODS Interim scans from 43 patients with anaplastic lymphoma kinase-negative PTCL from the 'Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas' trial were re-analyzed by qPET (relating residual lymphoma-related uptake to liver uptake) and ∆SUVmax (relating interim scan to baseline scan). The endpoint was progression-free survival. RESULTS qPET and ∆SUVmax were closely correlated (Pearson's r = 0.627). Up to the 60th percentile of values ranked by increasing residual activity, the positive predictive value for progression or death increased from 60 to 95%, with stable negative predictive values (NPV) of 60%. Beyond the 60th percentile, the NPV decreased to 40%. qPET ≥ 2 and ∆SUVmax < 50% identified high-risk populations comprising 41.9% and 39.5% of patients, with 3-year progression-free survival rates of 5.6% (95% confidence interval, 0.8-37.3) and 0%, respectively, as compared to 63.7% (47.4-85.8) and 61.3% (45.1-83.3) in low-risk patients. CONCLUSIONS qPET and ∆SUVmax identify large fractions of PTCL patients destined to experience treatment failure. qPET may be preferred because it requires a single PET scan, halving the diagnostic effort.
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Affiliation(s)
- Lars Kurch
- Klinik Und Poliklinik Für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany.
| | - Ulrich Dührsen
- Klinik Für Hämatologie, Universitätsklinikum Essen, Essen, Germany
| | - Andreas Hüttmann
- Klinik Für Hämatologie, Universitätsklinikum Essen, Essen, Germany
| | - Thomas W Georgi
- Klinik Und Poliklinik Für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Osama Sabri
- Klinik Und Poliklinik Für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Regine Kluge
- Klinik Und Poliklinik Für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Dirk Hasenclever
- Institut Für Medizinische Informatik, Statistik Und Epidemiologie, Universität Leipzig, Leipzig, Germany
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17
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Kurch L, Kluge R, Sabri O, Fischer L, Wendt S, Graf Einsiedel H, Starke S, Kühl JS, Christiansen H, Hirsch FW, Sorge I, Roth C. Whole-body [ 18F]-FDG-PET/MRI for staging of pediatric non-Hodgkin lymphoma: first results from a single-center evaluation. EJNMMI Res 2021; 11:62. [PMID: 34216300 PMCID: PMC8254839 DOI: 10.1186/s13550-021-00804-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/10/2021] [Indexed: 12/17/2022] Open
Abstract
Aim In 2015, the revised International Pediatric Non-Hodgkin Lymphoma Staging System was published. It mentions [18F]-FDG-PET/MRI as the latest method to perform whole-body imaging. However, supporting data are pending. Our aim was to investigate the performance of whole-body [18F]-FDG-PET/MRI in pediatric non-Hodgkin lymphoma patients by using a limited number of MRI sequences. Materials and methods Ten pediatric patients with histologically proven non-Hodgkin lymphoma underwent whole-body [18F]-FDG-PET/MRI at staging. The retrospective analysis included three steps: First, [18F]-FDG-PET and MR scans were evaluated separately by a nuclear medicine physician and a pediatric radiologist. Nineteen nodal and two extranodal regions as well as six organs were checked for involvement. Second, discrepant findings were reviewed together in order to reach consensus. Third, [18F]-FDG-PET/MRI findings were correlated with the results of other clinical investigations. Results Of the 190 lymph node regions evaluated, four were rated controversial. Consensus was reached by considering metabolic, functional and morphologic information combined. Concordantly, [18F]-FDG-PET and MRI detected Waldeyer’s ring involvement in two patients whose Waldeyer’s ring was negative on clinical assessment. In four patients MRI showed pleural effusion. However, in only two of them an increased glucose metabolism as a reliable sign of pleural involvement was detectable. In six patients [18F]-FDG-PET and MRI detected skeletal lesions although bone marrow biopsy was positive in only one of them. Conclusion Despite the small number of cases evaluated, whole-body [18F]-FDG-PET turned out to be a valuable tool for staging of pediatric non-Hodgkin lymphoma.
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Affiliation(s)
- L Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany.
| | - R Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - O Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - L Fischer
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - S Wendt
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - H Graf Einsiedel
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - S Starke
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - J-S Kühl
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - H Christiansen
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - F W Hirsch
- Institute of Pediatric Radiology, University Hospital Leipzig, Leipzig, Germany
| | - I Sorge
- Institute of Pediatric Radiology, University Hospital Leipzig, Leipzig, Germany
| | - C Roth
- Institute of Pediatric Radiology, University Hospital Leipzig, Leipzig, Germany
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Wichmann G, Willner M, Kuhnt T, Kluge R, Gradistanac T, Wald T, Fest S, Lordick F, Dietz A, Wiegand S, Zebralla V. Standardized Diagnostics Including PET-CT Imaging, Bilateral Tonsillectomy and Neck Dissection Followed by Risk-Adapted Post-Operative Treatment Favoring Radio-Chemotherapy Improve Survival of Neck Squamous Cell Carcinoma of Unknown Primary Patients. Front Oncol 2021; 11:682088. [PMID: 34026656 PMCID: PMC8138574 DOI: 10.3389/fonc.2021.682088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND About five to 10% of cancers in the head and neck region are neck squamous cell carcinoma of unknown primary (NSCCUP). Their diagnosis and treatment are challenging given the risk of missing occult tumors and potential relapse. Recently, we described human papillomavirus (HPV)-related NSCCUP-patients (NSCCUP-P) as a subgroup with superior survival. However, standardized diagnostic workup, novel diagnostic procedures, decision-making in the multidisciplinary tumor board (MDTB) and multimodal therapy including surgery and post-operative radio-chemotherapy (PORCT) may also improve survival. METHODS For assessing the impact of standardized diagnostic processes simultaneously established with the MDTB on outcome, we split our sample of 115 NSCCUP-P into two cohorts treated with curative intent from 1988 to 2006 (cohort 1; n = 53) and 2007 to 2018 (cohort 2; n = 62). We compared diagnostic processes and utilized treatment modalities applying Chi-square tests, and outcome by Kaplan-Meier plots and Cox regression. RESULTS In cohort 2, the standardized processes (regular use of [18F]-FDG-PET-CT imaging followed by examination under anesthesia, EUA, bilateral tonsillectomy and neck dissection, ND, at least of the affected site) improved detection of primaries (P = 0.026) mostly located in the oropharynx (P = 0.001). From 66.0 to 87.1% increased ND frequency (P = 0.007) increased the detection of extracapsular extension of neck nodes (ECE+) forcing risk factor-adapted treatment by increased utilization of cisplatin-based PORCT that improved 5-years progression-free and overall survival from 60.4 and 45.3 to 67.7% (P = 0.411) and 66.1% (P = 0.025). CONCLUSIONS Standardized diagnostic workup followed by ND and risk-factor adapted therapy improves survival of NSCCUP-P.
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Affiliation(s)
- Gunnar Wichmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Maria Willner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Kuhnt
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Tanja Gradistanac
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Theresa Wald
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Sandra Fest
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Florian Lordick
- Department of Internal Medicine II, Division of Oncology, University Cancer Center Leipzig (UCCL), Leipzig University Medicine, Leipzig, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Veit Zebralla
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
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Kurch L, Mauz-Körholz C, Fosså A, Georgi TW, Kluge R, Bartelt JM, Kunze C, Wohlgemuth WA, Pelz T, Vordermark D, Plößl S, Hasenclever D, Sabri O, Landman-Parker J, Wallace WH, Karlen J, Fernández-Teijeiro A, Cepelova M, Klekawka T, Løndalen AM, Steiner D, Krombach G, Attarbaschi A, Hoffmann M, Ceppi F, Pears J, Hraskova A, Uyttebroeck A, Beishuizen A, Dieckmann K, Leblanc T, Daw S, Körholz D, Stoevesandt D. Assessment of Waldeyer's ring in pediatric and adolescent Hodgkin lymphoma patients-Importance of multimodality imaging: Results from the EuroNet-PHL-C1 trial. Pediatr Blood Cancer 2021; 68:e28903. [PMID: 33538093 DOI: 10.1002/pbc.28903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the EuroNet Pediatric Hodgkin Lymphoma (EuroNet-PHL) trials, decision on Waldeyer's ring (WR) involvement is usually based on clinical assessment, that is, physical examination and/or nasopharyngoscopy. However, clinical assessment only evaluates mucosal surface and is prone to interobserver variability. Modern cross-sectional imaging technology may provide valuable information beyond mucosal surface, which may lead to a more accurate WR staging. PATIENTS, MATERIALS, AND METHODS The EuroNet-PHL-C1 trial recruited 2102 patients, of which 1752 underwent central review including reference reading of their cross-sectional imaging data. In 14 of 1752 patients, WR was considered involved according to clinical assessment. In these 14 patients, the WR was re-assessed by applying an imaging-based algorithm considering information from 18 F-fluorodeoxyglucose positron emission tomography, contrast-enhanced computed tomography, and/or magnetic resonance imaging. For verification purposes, the imaging-based algorithm was applied to 100 consecutive patients whose WR was inconspicuous on clinical assessment. RESULTS The imaging-based algorithm confirmed WR involvement only in four of the 14 patients. Of the remaining 10 patients, four had retropharyngeal lymph node involvement and six an inconspicuous WR. Applying the imaging-based algorithm to 100 consecutive patients with physiological appearance of their WR on clinical assessment, absence of WR involvement could be confirmed in 99. However, suspicion of WR involvement was raised in one patient. CONCLUSIONS The imaging-based algorithm was feasible and easily applicable at initial staging of young patients with Hodgkin lymphoma. It increased the accuracy of WR staging, which may contribute to a more individualized treatment in the future.
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Affiliation(s)
- Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Christine Mauz-Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University, Gießen, Germany.,Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - Alexander Fosså
- Department of Medical Oncology and Radiotherapy, Oslo University Hospital, Oslo, Norway
| | | | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Jörg Martin Bartelt
- Department of Radiology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - Christian Kunze
- Department of Radiology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | | | - Tanja Pelz
- Department of Radiation Oncology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - Sebastian Plößl
- Department of Ear, Nose and Throat Medicine, Hospital Martha-Maria Halle, Halle (Saale), Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - William Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, UK
| | - Jonas Karlen
- Karolinska University Hospital, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden
| | | | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol and, Second Medical Faculty of Charles University, Prague, Czech Republic
| | - Tomasz Klekawka
- Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | | | - Dagmar Steiner
- Department of Nuclear Medicine, Justus-Liebig University Giessen, Giessen, Germany
| | - Gabriele Krombach
- Department of Radiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | | | - Francesco Ceppi
- Division of Pediatrics, Department of Woman-, Mother-Child, Pediatric Hematology-Oncology Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jane Pears
- Department of Pediatric Hematology and Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Andrea Hraskova
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Bratislava, Slovakia
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Auke Beishuizen
- Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Karin Dieckmann
- Department of Radiation Oncology, University Hospital Vienna, Vienna, Austria
| | - Thierry Leblanc
- Service d'Hématologie Pédiatrique, Hôpital Robert-Debré, Paris, France
| | - Stephen Daw
- Department of Pediatric Hematology and Oncology, University College London Hospitals, London, UK
| | - Dieter Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University, Gießen, Germany
| | - Dietrich Stoevesandt
- Department of Radiology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
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20
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Kurch L, Hüttmann A, Georgi TW, Rekowski J, Sabri O, Schmitz C, Kluge R, Dührsen U, Hasenclever D. Interim PET in Diffuse Large B-Cell Lymphoma. J Nucl Med 2020; 62:1068-1074. [PMID: 33246974 DOI: 10.2967/jnumed.120.255034] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/05/2020] [Indexed: 12/17/2022] Open
Abstract
In diffuse large B-cell lymphoma, early assessment of treatment response by 18F-FDG PET may trigger treatment modification. Reliable identification of good and poor responders is important. We compared 3 competing methods of interim PET evaluation. Methods: Images from 449 patients participating in the "PET-Guided Therapy of Aggressive Non-Hodgkin Lymphomas" trial were reanalyzed by applying the visual Deauville score and the SUV-based qPET (q = quantitative) and ΔSUVmax scales to interim PET scans performed after 2 cycles of chemotherapy. qPET relates residual lymphoma 18F-FDG uptake to physiologic liver uptake, converting the ordinal Deauville scale into a continuous scale and permitting a direct comparison with the continuous ΔSUVmax scale, which is based on SUVmax changes between baseline and interim scans. Positive and negative predictive values were calculated for progression-free survival. Results: When established thresholds were used to distinguish between good and poor responders (visual Deauville score 1-3 vs. 4-5; ΔSUVmax > 66% vs. ≤ 66%), the positive predictive value was significantly lower with Deauville than ΔSUVmax (38.4% vs. 56.6%; P = 0.03). qPET and ΔSUVmax were strongly correlated on the log scale (Pearson r = 0.75). When plotted along corresponding percentiles, the positive predictive value curves for qPET and ΔSUVmax were superimposable, with low values up to the 85th percentile and a steep rise thereafter. The recommended threshold of 66% SUVmax reduction for the identification of poor responders was equivalent to qPET = 2.26, corresponding to score 5 on the visual Deauville scale. The negative predictive value curves were also superimposable but remained flat between 80% and 70%. Conclusion: Continuous scales are better suited for interim PET-based outcome prediction than the ordinal Deauville scale. qPET and ΔSUVmax essentially carry the same information. The proportion of poor-risk patients identified is less than 15%.
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Affiliation(s)
- Lars Kurch
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany;
| | - Andreas Hüttmann
- Klinik für Hämatologie, Universitätsklinikum Essen, Essen, Germany
| | - Thomas W Georgi
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Jan Rekowski
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen, Duisburg, Germany; and
| | - Osama Sabri
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Regine Kluge
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Dührsen
- Klinik für Hämatologie, Universitätsklinikum Essen, Essen, Germany
| | - Dirk Hasenclever
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Universität Leipzig, Leipzig, Germany
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Guntinas-Lichius O, Ihrler S, Freesmeyer M, Gühne F, Kluge R, Bräuer L, Iro H, Paulsen F, Dietz A, Bechmann I. [Is there a new salivary gland? - Rather not!]. Laryngorhinootologie 2020; 100:12-14. [PMID: 33197955 DOI: 10.1055/a-1307-3872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In October 2020, the lay press, but also some medical journals and websites reported the putative discovery of a new salivary gland in the nasopharynx based on prostate-specific membrane antigen positron emission tomography computed tomography (PSMA-PET/CT) examinations. As an interdisciplinary group from the fields of anatomy, pathology, nuclear medicine and otorhinolaryngology, we come to the view that an accumulation of minor salivary glands has been described here. Minor salivary glands in the nasopharynx and in the peritubar region have been described at least since 1866. The current description in PSMA-PET/CT does not justify the definition of a new, independent salivary gland. The PSMA-PET/CT could, however, be suitable to better protect salivary glands in the nasopharynx when planning radiation therapy. This should be evaluated in clinical trials.
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Affiliation(s)
| | | | | | - Falk Gühne
- Klinik für Nuklearmedizin, Universitätsklinikum Jena
| | - Regine Kluge
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig
| | - Lars Bräuer
- Institut für Funktionelle und Klinische Anatomie, Friedrich-Alexander-Universität Erlangen
| | - Heinrich Iro
- Hals-, Nasen- und Ohrenklinik, Kopf- und Halschirurgie, Universitätsklinikum Erlangen
| | - Friedrich Paulsen
- Institut für Funktionelle und Klinische Anatomie, Friedrich-Alexander-Universität Erlangen
| | - Andreas Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Leipzig
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22
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Kluge R, Wittig T, Georgi TW, Kurch L, Sabri O, Wallace WH, Klekawka T, Fernández-Teijeiro A, Ceppi F, Karlén J, Pears J, Cepelová M, Fosså A, Beishuizen A, Hjalgrim LL, Körholz D, Mauz-Körholz C, Hasenclever D. Comparison of Interim PET Response to Second-Line Versus First-Line Treatment in Classic Hodgkin Lymphoma: Contribution to the Development of Response Criteria for Relapsed or Progressive Disease. J Nucl Med 2020; 62:338-341. [PMID: 32764122 DOI: 10.2967/jnumed.120.247924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/30/2020] [Indexed: 12/18/2022] Open
Abstract
In first-line treatment of Hodgkin lymphoma (HL), Deauville scores 1-3 define complete metabolic remission. Interim 18F-FDG PET is also used for relapse-treatment adaptation; however, PET response criteria are not validated for relapse treatment. Methods: We performed a pairwise comparative analysis of early response to first- and second-line treatments in 127 patients with classic HL who experienced relapse. The patients participated in the prospective, multicenter EuroNet-PHL-C1 study. Residual uptake was measured retrospectively using the qPET method, a validated semiautomatic quantitative extension of the Deauville score. Empiric cumulative distribution functions of the qPET values were used to systematically analyze the response to first- and second-line treatments. Results: Individual patients responded variably to first- and second-line treatments. However, the empiric cumulative distribution functions of the qPET values from all patients were nearly superimposable. Conclusion: The findings support that first- and second-line treatments in HL do not require different response criteria.
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Affiliation(s)
- Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Tim Wittig
- Department of Internal Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Thomas W Georgi
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - W Hamish Wallace
- University of Edinburgh and Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Tomasz Klekawka
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Krakow, and Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Ana Fernández-Teijeiro
- Department of Pediatric Oncology and Hematology, University Hospital Virgen Macarena, Sevilla, Spain
| | - Francesco Ceppi
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Woman-Mother-Child Department, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jonas Karlén
- Pediatric Cancer Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Jane Pears
- Our Lady's Children's Hospital, Dublin, Ireland
| | - Michaela Cepelová
- Department of Pediatric Hematology and Oncology, Faculty Hospital Motol, Prague, Czech Republic
| | - Alexander Fosså
- Department of Medical Oncology and Radiotherapy, Rikshospitalet-Radiumhospitalet, Oslo, Norway
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Lisa Lyngsie Hjalgrim
- Department of Childhood and Adolescence Medicine, Department of Pediatric Hematology and Oncology, Juliane Marie Center, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dieter Körholz
- Department of Pediatric Oncology and Hematology, University Hospital Giessen and Marburg, Giessen, Germany; and
| | - Christine Mauz-Körholz
- Department of Pediatric Oncology and Hematology, University Hospital Giessen and Marburg, Giessen, Germany; and
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany
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23
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Hagleitner MM, Metzger ML, Flerlage JE, Kelly KM, Voss SD, Kluge R, Kurch L, Cho S, Mauz-Koerholz C, Beishuizen A. Liver involvement in pediatric Hodgkin lymphoma: A systematic review by an international collaboration on Staging Evaluation and Response Criteria Harmonization (SEARCH) for Children, Adolescent, and Young Adult Hodgkin Lymphoma (CAYAHL). Pediatr Blood Cancer 2020; 67:e28365. [PMID: 32491274 DOI: 10.1002/pbc.28365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/25/2020] [Accepted: 04/10/2020] [Indexed: 12/21/2022]
Abstract
Hepatic involvement in Hodgkin lymphoma (HL) is uncommon (∼5% of patients) but always implies stage IV disease. Accurate staging is mandatory for making the appropriate risk assignment and treatment decisions. The Staging Evaluation and Response Criteria Harmonization for Childhood, Adolescent and Young Adult Hodgkin Lymphoma (SEARCH for CAYAHL) international working group conducted a systematic literature review of liver involvement in HL patients with the aim to propose a universally acceptable definition for liver involvement in pediatric HL. Thirty-three articles describing 6985 pediatric and adult HL patients were reviewed, of which 539 (7.7%) mentioned liver involvement. The literature did not provide a uniform definition of hepatic involvement and we propose consensus criteria derived from the EuroNet and Children's Oncology Group protocols, where liver involvement is defined as any hepatic lesion on computed tomography scan that correlates with 18 F-FDG uptake greater than background liver. A clear definition of liver lesions is necessary to consistently identify liver involvement and compare its impact on outcomes among protocols worldwide.
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Affiliation(s)
| | - Monika L Metzger
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Jamie E Flerlage
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Kara M Kelly
- Roswell Park Cancer Institute, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Stephan D Voss
- DepartmentofRadiology, Boston Children's Hospital Dana Farber Cancer Institute, Boston, Massachusetts
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Steve Cho
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christine Mauz-Koerholz
- Department of Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Gießen, Gießen, Germany.,Medical Faculty, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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24
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Georgi TW, Kurch L, Hasenclever D, Warbey VS, Pike L, Radford J, Sabri O, Kluge R, Barrington SF. Quantitative assessment of interim PET in Hodgkin lymphoma: An evaluation of the qPET method in adult patients in the RAPID trial. PLoS One 2020; 15:e0231027. [PMID: 32240248 PMCID: PMC7117720 DOI: 10.1371/journal.pone.0231027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/15/2020] [Indexed: 01/15/2023] Open
Abstract
Aim qPET is a quantitative method used to assess FDG-PET response in lymphoma. qPET was developed using 898 scans from children with Hodgkin Lymphoma (HL) in the EuroNet-PHL-C1 (C1) trial. The aim of this study was to determine if qPET could be applied as an alternative response method in adults in the RAPID trial. Methods PET-CT scans performed after 3 cycles of ABVD in RAPID were re-evaluated by an independent reader, blinded to PET results and outcome in RAPID. All initially involved regions were assessed visually and by qPET. The distribution of qPET measurements was compared for RAPID and C1 patients. Previously published qPET thresholds corresponding to visual DS (vDS) of 1–5 in C1 were used to derive quantitative DS (qDS) for RAPID patients. Results PET-CT scans were available for 450 patients from RAPID. vDS were 1 (171 scans), 2 (153 scans), 3 (72 scans), 4 (31 scans) and 5 (23 scans) respectively. The distribution of qPET values was similar to C1 patients, with a unimodal ‘normal’ distribution and a long tail to the right, suggestive of favorable response in the majority and less favorable response in the minority with outlying values. qPET thresholds from C1 applied in RAPID patients gave 86% concordance for vDS and qDS. There was 97% concordance for complete metabolic response (CMR; DS 1–3) vs. no-CMR using the Lugano classification. Conclusion qPET which was developed in pediatric patients receiving more intensive OEPA chemotherapy, was a suitable quantitative method for assessing response in adult patients treated with ABVD in a response-adapted setting in the RAPID trial.
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Affiliation(s)
- Thomas W. Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Victoria S. Warbey
- King's College London and Guy's & St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Lucy Pike
- King's College London and Guy's & St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - John Radford
- University of Manchester and Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Sally F. Barrington
- King's College London and Guy's & St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
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25
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Lewis J, McCarten K, Kurch L, Flerlage JE, Kaste SC, Kluge R, Stoevesandt D, Voss SD, Kelly KM, Mauz-Körholz C, Drachtman RA, Metzger ML. Definition of cortical bone involvement in the staging of newly diagnosed pediatric Hodgkin lymphoma: A report from the International Working Group on Staging Evaluation and Response Criteria Harmonization (SEARCH). Pediatr Blood Cancer 2020; 67:e28142. [PMID: 31867838 DOI: 10.1002/pbc.28142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/01/2019] [Accepted: 12/01/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND The International Working Group on Staging Evaluation and Response Criteria Harmonization (SEARCH) seeks to provide a universally acceptable definition of cortical bone involvement in the staging of newly diagnosed pediatric Hodgkin lymphoma. PROCEDURE A comprehensive literature search was performed using PubMed and Google Scholar with the search terms "Hodgkin lymphoma," "osseous lesions," "bony involvement," and "pediatric." Publications reviewed included case reports, retrospective analyses, and literature reviews. Each was evaluated for study design, number of participants, median age and age range at diagnosis, percentage of pediatric patients, criteria of interest definition, diagnostic tools, study objectives, and level of evidence. The final definition was based on the available data and consensus of the SEARCH working group. RESULTS Twenty-five papers specifically addressing cortical bone involvement in Hodgkin lymphoma met the inclusion criteria. Eighteen papers were case reports with literature reviews; the remainder were observational cohort studies. Of these, 14 included pediatric patients (aged 0-21 years). The criteria for cortical bone involvement were not clearly defined in any paper, often varied within a study, and were inconsistent between publications. CONCLUSIONS The SEARCH group for Childhood, Adolescent, and Young Adult Hodgkin Lymphoma (CAYAHL) proposes the following criteria as defining cortical bone involvement: any cortical bone biopsy-proven lesion; a positive bony window lesion on computer tomography (CT), with an FDG-PET positive correlate in a patient with biopsy-proven Hodgkin lymphoma, if there is no other typical skeletal pathology; auspicious skeletal lesions on FDG-PET or magnetic resonance imaging should be confirmed by CT or Tc-99m scan to distinguish cortical lesions from bone marrow involvement. Nodal masses that extend into bone with bony destruction are considered extranodal extension or "E" lesions and do not represent metastatic or stage IV disease.
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Affiliation(s)
- Jocelyn Lewis
- Division of Pediatric Hematology Oncology, Rutgers Cancer, Institute of New Jersey, New Brunswick, New Jersey
| | - Kathleen McCarten
- Rhode Island Hospital/Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Jamie E Flerlage
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sue C Kaste
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Diagnostic Imaging, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | | | - Stephan D Voss
- Department of Radiology, Boston Children's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kara M Kelly
- Roswell Park Cancer Institute, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Christine Mauz-Körholz
- Department of Pediatric Hematology and Oncology, Center for Pediatrics, Justus Liebig University, Giessen, Germany
| | - Richard A Drachtman
- Division of Pediatric Hematology Oncology, Rutgers Cancer, Institute of New Jersey, New Brunswick, New Jersey
| | - Monika L Metzger
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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26
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Daw S, Hasenclever D, Mascarin M, Fernández-Teijeiro A, Balwierz W, Beishuizen A, Burnelli R, Cepelova M, Claviez A, Dieckmann K, Landman-Parker J, Kluge R, Körholz D, Mauz-Körholz C, Wallace WH, Leblanc T. Risk and Response Adapted Treatment Guidelines for Managing First Relapsed and Refractory Classical Hodgkin Lymphoma in Children and Young People. Recommendations from the EuroNet Pediatric Hodgkin Lymphoma Group. Hemasphere 2020; 4:e329. [PMID: 32072145 PMCID: PMC7000476 DOI: 10.1097/hs9.0000000000000329] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 01/21/2023] Open
Abstract
The objective of this guideline is to aid clinicians in making individual salvage treatment plans for pediatric and adolescent patients with first relapse or refractory (R/R) classical Hodgkin lymphoma (cHL). While salvage with standard dose chemotherapy followed by high dose chemotherapy and autologous stem cell transplant is often considered the standard of care in adult practice, pediatric practice adopts a more individualized risk stratified and response adapted approach to salvage treatment with greater use of non-transplant salvage. Here, we present on behalf of the EuroNet Pediatric Hodgkin Lymphoma group, evidence and consensus-based guidelines for standardized diagnostic, prognostic and response procedures to allocate children and adolescents with R/R cHL to stratified salvage treatments.
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Affiliation(s)
- Stephen Daw
- Children and Young People's Cancer Services, University College Hospital London, London, UK
| | - Dirk Hasenclever
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Ana Fernández-Teijeiro
- Unit of Pediatric Onco-Hematology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Auke Beishuizen
- Prinses Máxima Centrum voor Kinderoncologie, Utrecht, The Netherlands
| | - Roberta Burnelli
- Section of Pediatrics, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Czech Republic
| | - Alexander Claviez
- University Hospital Schleswig Holstein, Department of Pediatric and Adolescent Medicine, Pediatric Hematology, Oncology and Stem Cell Transplantation, Kiel, Germany
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna
| | | | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Dieter Körholz
- Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Christine Mauz-Körholz
- Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | - Thierry Leblanc
- University of Edinburgh and Department of Pediatrics, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
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27
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Dralle H, Kluge R, Kaiser GM, Schlitt HJ. [Complicated course after cecal injury during laparoscopic salpingectomy]. Chirurg 2019; 90:671-673. [PMID: 31263911 DOI: 10.1007/s00104-019-0996-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Dralle
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| | - R Kluge
- Gutachterstelle für Arzthaftpflichtfragen, Sächsische Landesärztekammer, Schützenhöhe 16, 01099, Dresden, Deutschland.
| | - G M Kaiser
- Klinik für Allgemein- und Viszeralchirurgie, St. Bernhard-Hospital Kamp-Lintfort GmbH, Bürgermeister-Schmelzing-Str. 90, 47475, Kamp-Lintfort, Deutschland.
| | - H J Schlitt
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
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28
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Flerlage J, Mauz-Körholz C, Kelly K, McCarten K, Punnett A, Kaste S, Dieckmann K, Marks L, Seelisch J, Drachtman R, Lewis J, Beishuzen A, Kluge R, Kurch L, Stroevesandt D, Metzger M. INCLUSION OF A PEDIATRIC PERSPECTIVE INTO RECOMMENDATIONS FOR THE INITIAL EVALUATION AND STAGING OF HODGKIN LYMPHOMA: A CALL TO ACTION FROM THE INTERNATIONAL SEARCH WORKING GROUP. Hematol Oncol 2019. [DOI: 10.1002/hon.24_2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- J. Flerlage
- Oncology; St. Jude Children's Research Hospital; Memphis United States
| | - C. Mauz-Körholz
- Pediatric Hematology and Oncology; Martin-Luther-University; Giessen Germany
| | - K. Kelly
- Hematology/Oncology; Roswell Park Comprehensive Cancer Center; Buffalo United States
| | - K. McCarten
- Diagnostic Imaging; 13Rhode Island Hospital/Warren Alpert Medical School at Brown University; Providence United States
| | - A. Punnett
- Pediatrics; Sickkids Hospital; Toronto Ontario Canada
| | - S. Kaste
- Oncology; St. Jude Children's Research Hospital; Memphis United States
| | - K. Dieckmann
- Radiotherapy; Medizinische Universität Wien; Vienna Austria
| | - L. Marks
- Pediatric Hematology/Oncology; Stanford; Palo Alto United States
| | - J. Seelisch
- Hematology/Oncology; Children's Hospital, London Health Sciences Centre; London Ontario Canada
| | - R. Drachtman
- Hematology/Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
| | - J. Lewis
- Hematology/Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
| | | | - R. Kluge
- Nuclear Medicine; University of Leipzig; Leipzig Germany
| | - L. Kurch
- Nuclear Medicine; University of Leipzig; Leipzig Germany
| | | | - M. Metzger
- Oncology; St. Jude Children's Research Hospital; Memphis United States
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29
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Metzger M, Mauz-Körholz C, Flerlage J, Bartelt J, Billett A, Choi J, Ehrhardt M, Georgi T, Hasenclever D, Wang F, Zhang H, Kaste S, Kluge R, Körholz D, Kurch L, Link M, Stoevesandt D, Hudson M, Krasin M. SAFETY AND RESPONSE AFTER 2 CYCLES OF BRENTUXIMAB VEDOTIN SUBSTITUTING VINCRISTINE IN THE OEPA/COPDAC REGIMEN FOR HIGH RISK PEDIATRIC HODGKIN LYMPHOMA (HL). Hematol Oncol 2019. [DOI: 10.1002/hon.25_2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M. Metzger
- Oncology; St Jude Children's Research Hospital; Memphis United States
| | - C. Mauz-Körholz
- Pediatric Hematology Oncology; Justus Liebig Universität; Giessen Germany
| | - J. Flerlage
- Oncology; St Jude Children's Research Hospital; Memphis United States
| | - J. Bartelt
- Clinic of Radiology; Martin Luther University; Halle (Saale) Germany
| | - A. Billett
- Blood Disorders Center; Dana-Farber/Boston Children's Hospital; Boston United States
| | - J.K. Choi
- Pathology; St Jude Children's Research Hospital; Memphis United States
| | - M. Ehrhardt
- Oncology; St Jude Children's Research Hospital; Memphis United States
| | - T. Georgi
- Nuclear Medicine; University of Leipzig; Leipzig Germany
| | - D. Hasenclever
- Institut for Medical Informatics; University of Leipzig; Leipzig Germany
| | - F. Wang
- Biostatistics; St Jude Children's Research Hospital; Memphis United States
| | - H. Zhang
- Biostatistics; St Jude Children's Research Hospital; Memphis United States
| | - S.C. Kaste
- Diagnostic Imaging; St Jude Children's Research Hospital; Memphis United States
| | - R. Kluge
- Nuclear Medicine; University of Leipzig; Leipzig Germany
| | - D. Körholz
- Pediatric Hematology Oncology; Justus Liebig Universität; Giessen Germany
| | - L. Kurch
- Nuclear Medicine; University of Leipzig; Leipzig Germany
| | - M. Link
- Pediatric Hematology Oncology; Stanford University Medical Center; Palo Alto United States
| | - D. Stoevesandt
- Clinic of Radiology; Martin Luther University; Halle (Saale) Germany
| | - M.M. Hudson
- Oncology; St Jude Children's Research Hospital; Memphis United States
| | - M. Krasin
- Radiation Oncology; St Jude Children's Research Hospital; Memphis United States
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30
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Kewitz-Hempel S, Kurch L, Cepelova M, Volkmer I, Sauerbrey A, Conrad E, Knirsch S, Pöpperl G, Steinbach D, Beer AJ, Kramm CM, Sahlmann CO, Erdlenbruch B, Reinbold WD, Odparlik A, Sabri O, Kluge R, Staege MS. Impact of rs12917 MGMT Polymorphism on [ 18F]FDG-PET Response in Pediatric Hodgkin Lymphoma (PHL). Mol Imaging Biol 2019; 21:1182-1191. [PMID: 30945122 DOI: 10.1007/s11307-019-01350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The enzyme O6-methylguanine-DNA methyltransferase (MGMT) is an important component of the DNA repair machinery. MGMT removes O6-methylguanine from the DNA by transferring the methyl group to a cysteine residue in its active site. Recently, we detected the single nucleotide polymorphism (SNP) rs12917 (C/T) in the MGMT sequence adjacent to the active site in Hodgkin lymphoma (HL) cell line KM-H2. We now investigated whether this SNP is also present in other HL cell lines and patient samples. Furthermore, we asked whether this SNP might have an impact on metabolic response in 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography ([18F]FDG-PET), and on overall treatment outcome based on follow-up intervals of at least 34 months. PROCEDURES We determined the frequency of this MGMT polymorphism in 5 HL cell lines and in 29 pediatric HL (PHL) patients. The patient cohort included 17 female and 12 male patients aged between 4 and 18 years. After characterization of the sequence, we tested a possible association between rs12917 and age, gender, Ann Arbor stage, treatment group, metabolic response following two courses of OEPA (vincristine, etoposide, prednisone, and doxorubicin) chemotherapy, radiotherapy indication, and relapse status. RESULTS We detected the minor T allele in four of five HL cell lines. 11/29 patients carried the minor T allele whereas 18/29 patients showed homozygosity for the major C allele. Interestingly, we observed significantly better metabolic response in PHL patients carrying the rs12917 C allele resulting in a lower frequency of radiotherapy indication. CONCLUSION MGMT polymorphism rs12917 seems to affect chemotherapy response in PHL. The prognostic value of this polymorphism should be investigated in a larger patient cohort.
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Affiliation(s)
- Stefanie Kewitz-Hempel
- Department of Pediatrics I, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Germany.,Department of Pediatric Hematology and Oncology, Justus Liebig University, Giessen, Germany.,Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, 04103, Leipzig, Germany
| | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Praha, Czech Republic
| | - Ines Volkmer
- Department of Pediatrics I, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Germany
| | | | - Elke Conrad
- Department of Nuclear Medicine, Helios Hospital Erfurt, Erfurt, Germany
| | - Stephanie Knirsch
- Pediatrics 5 (Oncology, Hematology, and Immunology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Gabriele Pöpperl
- Department of Nuclear Medicine, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Daniel Steinbach
- Department of Pediatric Hematology and Oncology, University Hospital Ulm, Ulm, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, University Hospital, Ulm, Germany
| | - Christof M Kramm
- Department of Pediatrics I, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Germany.,Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Bernhard Erdlenbruch
- University Hospital for Children and Adolescents, Johannes Wesling Klinikum Minden, Ruhr University Hospital, Bochum, Germany
| | - Wolf-Dieter Reinbold
- Universitätsinstitut für Diagnostische Radiologie, Neuroradiologie und Nuklearmedizin, Johannes Wesling Klinikum Minden, Ruhr University Hospital, Bochum, Germany
| | - Andreas Odparlik
- Department of Nuclear Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, 04103, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, 04103, Leipzig, Germany.
| | - Martin S Staege
- Department of Pediatrics I, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Germany.
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Kurch L, Hasenclever D, Kluge R, Georgi T, Tchavdarova L, Golombeck M, Sabri O, Eggert A, Brenner W, Sykora KW, Bengel FM, Rossig C, Körholz D, Schäfers M, Feuchtinger T, Bartenstein P, Ammann RA, Krause T, Urban C, Aigner R, Gattenlöhner S, Klapper W, Mauz-Körholz C. Only strongly enhanced residual FDG uptake in early response PET (Deauville 5 or qPET ≥ 2) is prognostic in pediatric Hodgkin lymphoma: Results of the GPOH-HD2002 trial. Pediatr Blood Cancer 2019; 66:e27539. [PMID: 30426671 DOI: 10.1002/pbc.27539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 10/11/2018] [Accepted: 10/14/2018] [Indexed: 11/06/2022]
Abstract
PURPOSE In 2014, we published the qPET method to quantify fluorodeoxyglucose positron emission tomography (FDG-PET) responses. Analysis of the distribution of the quantified signals suggested that a clearly abnormal FDG-PET response corresponds to a visual Deauville score (vDS) of 5 and high qPET values ≥ 2. Evaluation in long-term outcome data is still pending. Therefore, we analyzed progression-free survival (PFS) by early FDG-PET response in a subset of the GPOH-HD2002 trial for pediatric Hodgkin lymphoma (PHL). PATIENTS/METHODS Pairwise FDG-PET scans for initial staging and early response assessment after two cycles of chemotherapy were available in 93 PHL patients. vDS and qPET measurement were performed and related to PFS. RESULTS Patients with a qPET value ≥ 2.0 or vDS of 5 had 5-year PFS rates of 44%, respectively 50%. Those with qPET values < 2.0 or vDS 1 to 4 had 5-year PFS rates of 90%, respectively 80%. The positive predictive value of FDG-PET response assessment increased from 18% (9%; 33%) using a qPET threshold of 0.95 (vDS ≤ 3) to 30% (13%; 54%) for a qPET threshold of 1.3 (vDS ≤ 4) and to 56% (23%; 85%) when the qPET threshold was ≥ 2.0 (vDS 5). The negative predictive values remained stable at ≥92% (CI: 82%; 98%). CONCLUSION Only strongly enhanced residual FDG uptake in early response PET (vDS 5 or qPET ≥ 2, respectively) seems to be markedly prognostic in PHL when treatment according to the GPOH-HD-2002 protocol is given.
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Affiliation(s)
- L Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - D Hasenclever
- Institute of Medical Statistics, Informatics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - R Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - T Georgi
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - L Tchavdarova
- Clinic of Nuclear Medicine, National Hospital for Active Treatment in Oncology, Sofia, Bulgaria
| | - M Golombeck
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - O Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - A Eggert
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Charité Berlin, Berlin, Germany
| | - W Brenner
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K W Sykora
- Department of Pediatric Hematology and Oncology, Medizinische Hochschule Hannover, Hannover, Germany
| | - F M Bengel
- Department of Nuclear Medicine, Medizinische Hochschule Hannover, Hannover, Germany
| | - C Rossig
- University Children's Hospital Münster, Pediatric Hematology and Oncology, Münster, Germany
| | - D Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Giessen, Germany
| | - M Schäfers
- Department of Nuclear Medicine, University Hospital of Münster, Münster, Germany
| | - T Feuchtinger
- Dr. von Hauner University Children's Hospital, LMU Munich, Munich, Germany
| | - P Bartenstein
- Department of Nuclear Medicine, LMU Munich, Munich, Germany
| | - R A Ammann
- Division of Pediatric Hematology and Oncology, Department of Pediatrics (Inselspital) Bern University Hospital, University of Bern, Bern, Switzerland
| | - T Krause
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Urban
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Graz, Graz, Austria
| | - R Aigner
- Department of Radiology, Medical University Graz, Graz, Austria
| | - S Gattenlöhner
- Department of Pathology, Justus-Liebig University of Giessen, Giessen, Germany
| | - W Klapper
- Department of Pathology, University Hospital of Kiel, Kiel, Germany
| | - C Mauz-Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Giessen, Germany.,Medical Faculty, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
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Roth C, Sabri O, Kluge R, Fischer L, Monecke A, Wachowiak R, Hirsch FW, Kurch L. Simultaneous F18-FDG-PET/MR Optimized Treatment Planning in a Young Patient with Sacro-Coccygeal Chordoma. Klin Padiatr 2018; 230:326-327. [PMID: 30273943 DOI: 10.1055/a-0715-1768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Christian Roth
- Department of Paediatric Radiology, University Hospital of Leipzig, Leipzig
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig
| | - Lars Fischer
- Department of Paediatrics, University Hospital of Leipzig, Leipzig
| | - Astrid Monecke
- Department of Pathology, University Hospital of Leipzig, Leipzig
| | - Robin Wachowiak
- Department of Paediatric Surgery, University Hospital of Leipzig, Leipzig
| | | | - Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig
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Georgi TW, Kluge R, Kurch L, Chavdarova L, Hasenclever D, Stoevesandt D, Pelz T, Landman-Parker J, Wallace WH, Karlen J, Fernández-Teijeiro A, Cepelova M, Fosså A, Balwierz W, Attarbaschi A, Ammann RA, Pears J, Hraskova A, Uyttebroeck A, Beishuizen A, Dieckmann K, Leblanc T, Daw S, Baumann J, Körholz D, Sabri O, Mauz-Körholz C. 18F-FDG PET Response of Skeletal (Bone Marrow and Bone) Involvement After Induction Chemotherapy in Pediatric Hodgkin Lymphoma: Are Specific Response Criteria Required? J Nucl Med 2018; 59:1524-1530. [PMID: 29653979 DOI: 10.2967/jnumed.117.205633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/23/2018] [Indexed: 11/16/2022] Open
Abstract
To determine whether the current 18F-FDG PET response criterion for skeletal involvement in Hodgkin lymphoma (HL) is suitable, we performed a systematic evaluation of the different types of skeletal involvement and their response on PET after 2 cycles of chemotherapy (PET-2). A secondary objective was to observe the influence of the initial uptake intensity (measured as qPET) and initial metabolic tumor volume (MTV) of skeletal lesions on the PET-2 response. Methods: The initial PET scans of 1,068 pediatric HL patients from the EuroNet-PHL-C1 trial were evaluated for skeletal involvement by central review. Three types of skeletal lesions were distinguished: PET-only lesions (those detected on PET only), bone marrow (BM) lesions (as confirmed by MRI or BM biopsy), and bone lesions. qPET and MTV were calculated for each skeletal lesion. All PET-2 scans were assessed for residual tumor activity. The rates of complete metabolic response for skeletal and nodal involvement on PET-2 were compared. Results: Of the 1,068 patients, 139 (13%) showed skeletal involvement (44 PET-only, 32 BM, and 63 bone). Of the 139 patients with skeletal involvement, 101 (73%) became PET-2-negative in the skeleton and 94 (68%) became PET-2-negative in the lymph nodes. The highest number of PET-2-negative scans in the skeleton was 42 (95%) in the 44 PET-only patients, followed by 22 skeletal lesions (69%) in the 32 BM patients and 37 (59%) in the 63 bone patients. Lesions that became PET-2-negative showed a lower initial median qPET (2.74) and MTV (2 cm3) than lesions that remained PET-2-positive (3.84 and 7 cm3, respectively). Conclusion: In this study with pediatric HL patients, the complete response rate for skeletal involvement on PET-2 was similar to that for nodal involvement. Bone flare seemed to be irrelevant. Overall, the current skeletal PET response criterion-comparison with the local skeletal background-is well suited. The initial qPET and MTV of skeletal lesions were predictive of the PET-2 result. Higher values for both parameters were associated with a worse PET-2 response.
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Affiliation(s)
- Thomas W Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Lidia Chavdarova
- Department of Nuclear Medicine, National Hospital for Active Treatment in Oncology, Sofia, Bulgaria
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | | | - Tanja Pelz
- Department of Radiotherapy, University of Halle, Halle (Saale), Germany
| | | | - W Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonas Karlen
- Karolinska University Hospital, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden
| | - Ana Fernández-Teijeiro
- Pediatric Oncology Unit, Hospitales Universitarios Virgen Macarena y Virgen del Rocio, Sevilla, Spain
| | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol and Second Medical Faculty of Charles University, Prague, Czech Republic
| | - Alexander Fosså
- Department of Medical Oncology and Radiotherapy, Oslo University Hospital, Oslo, Norway
| | - Walentyna Balwierz
- Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Roland A Ammann
- Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jane Pears
- Our Lady's Children's Hospital, Dublin, Ireland
| | | | | | - Auke Beishuizen
- Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Karin Dieckmann
- Universitätsklinik für Strahlentherapie und Strahlenbiologie, Medizinische Universität Wien, Wien, Austria
| | - Thierry Leblanc
- Service d'Hématologie Pédiatrique, Hôpital Robert-Debré, Paris, France
| | - Stephen Daw
- University College London Hospitals, London, United Kingdom; and
| | - Julia Baumann
- Department of Pediatric Oncology, Justus-Liebig-University, Giessen, Germany
| | - Dieter Körholz
- Department of Pediatric Oncology, Justus-Liebig-University, Giessen, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
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Kämpfer I, Seese A, Dannenberg C, Kluge R, Burchert W, Knapp WH, Barthel H. Improvement of Brain SPECT by Stabilization of Tc-99m-HMPAO with Methylene Blue or Cobalt Chloride. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1632196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: This present study was carried out to investigate whether stabilization of Tc-99m-HMPAO with methylene blue (MB) or cobalt chloride (CC) causes a sensible improvement in image quality and how cerebral to noncerebral activity ratios compare with those of Tc-99m-ECD. Methods: 30 minutes after preparation 400-600 MBq unstabilized Tc-99m-HMPAO (N = 35 patients), Tc-99m-HMPAO added with MB (N = 24 patients), added with CC (N = 30 patients) or Tc-99m-ECD (N = 28 patients) were injected. Radiochemical stability was measured in vitro with three chromatographical methods. Image quality was assessed quantitatively using two ratios, one of them determined by count densities of brain/scalp (QS), the other one by count densities of brain/ nose (QN). In addition, image quality (0 = bad, 3 = excellent) and background activity (0 = high, 3 = no) were visually assessed by three independent observers. Results: In contrast to unstabilized Tc-99m-HMPAO the integrity of the complexes of MB-Tc-99m-HMPAO, CC-Tc-99m-HMPAO and Tc-99m-ECD decreased only by a few percent during a period of 2 hours after reconstitution (66.8 ± 9.9 vs. 93.0 ± 2.5, 91.8 ± 1.9 and 96.9 ± 1.4%, p <0.001). Qs and Qn (m.v. ± SD) differed significantly between studies using unstabilized Tc-99m-HMPAO (3.0 ± 0.4 and 2.1 ± 0.3), MB-Tc-99m-HMPAO (3.4 ± 0.4 and 2.3 ± 0.3), CC-Tc-99m-H M PAO (3.6 ± 0.6 and 2.6 ± 0.4) and those using Tc-99m-ECD (4.3 ± 0.7 and 4.8 ± 1.4; p <0.05 and <0.001). Stabilization with CC or MB resulted in significant higher scoring of image quality and lower scoring of background activity in comparison to that of unstabilized Tc-99m-HMPAO, without reaching the scores obtained with Tc-99m-ECD. Conclusions: It is concluded that stabilization of Tc-99m-HMPAO with MB or CC definitely improves image quality in rCBF-SPECT, without reaching that of Tc-99m-ECD. Improvement of image quality results from the reduction of the amount of decomposition products that contribute to considerable extracerebral activity.
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Abstract
Summary
Aim: This study deals with the effect of the non-uniform attenuation correction method on myocardial tomograms of normal subjects. Method: A total of 35 patients (20 female, 15 male) without evidence of cardiac disease underwent SPET with and without attenuation correction using a dual head camera and transmission data obtained by two scanning Gd-153 line sources after administration of 400 MBq Tc-99m-tetrofosmin. Results: In non-corrected (NC) stress studies the lowest count rates were found in the inferior segments with mean differences in count rates between maxima and minima of 35.8 ± 10.8%. In attenuation corrected (AC) images the respective segmental differences averaged only 20.9 ± 3.3% and the images did not show significant count deficiency in the inferior segments. The effects of correction revealed to be sex dependent, but independent of body mass on average. Conclusion: AC using the above technique significantly reduces the variability of count rate distribution in normal subjects and improves the preconditions for accurate diagnostic evaluation of coronary artery disease using SPET.
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Bengel F, Büll U, Burchert W, Kies P, Kluge R, Krause BJ, Lindner O, Nienaber C, Nowak B, Schäfer W, Schober O, Schwaiger M, Silber S, Stegger L, vom Dahl J, Zimmermann R, Schäfers M. Position paper nuclear cardiology: Update 2008. Nuklearmedizin 2018. [DOI: 10.3413/nukmed-0220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SummaryNuclear cardiology is well established in clinical diagnostic algorithms for many years. This is an update 2008 of the first common position paper of the German Association of Nuclear Medicine and the German Association of Cardiology, Heart and Circulation Research published in 2001 aiming at an overview of state-of-the-art scintigraphic methods.
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Burchert W, Bengel FM, Zimmermann R, vom Dahl J, Schäfer W, Büll U, Schober O, Schwaiger M, Kluge R, Schäfers M, Lindner O. Myocardial perfusion scintigraphy in Germany. Nuklearmedizin 2018. [DOI: 10.1055/s-0037-1621023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThe working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine (DGN), in cooperation with the working group Nuclear Cardiology of the German Cardiac Society (DGK), decided to conduct a national survey on myocardial perfusion scintigraphy (MPS). Method: A questionnaire to evaluate MPS for the year 2005 was sent. Results: 346 completed questionnaires had been returned (213 private practices, 99 hospitals and 33 university hospitals). MPS of 112 707 patients were reported with 110 747 stress and 95 878 rest studies. The majority (>75%) was performed with 99mTc-MIBI or tetrofosmin. 201Tl stress-redistribution was used in 22 637 patients (20%). The types of stress were exercise in 78%, vasodilation with adenosine or dipyridamol in 21% and dobutamine in 1%. 99.97% of all MPS were SPECT studies. Gated SPECT was performed in 36% of the stress and in 32% of the rest studies. An attenuation correction was used in 21%. 29 institutions (8%) performed gated SPECT (stress and rest) and attenuation correction. 47% of all MPS were requested by ambulatory care cardiologists, 17% by internists, 12% by primary care physicians, 21% by hospital departments and 2% by others. Conclusion: In Germany, MPS is predominantly performed with 99mTc-perfusion agents. The common type of stress is ergometry. Gated SPECT and attenuation correction do not yet represent standards of MPS practice in Germany, which indicates some potential of optimization.
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Dietlein M, Mauz-Körholz C, Engert A, Borchmann P, Sabri O, Schober O, Schicha H, Kluge R, Kobe C. FDG-PET in Hodgkin lymphoma. Nuklearmedizin 2018; 47:235-8; quiz N75-6. [DOI: 10.3413/nukmed-0216] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SummaryThe high negative predictive value of FDG-PET in therapy control of Hodgkin lymphoma is proven by the data acquired up to now. Thus, the analysis of the HD15 trial has shown that consolidation radiotherapy might be omitted in PET negative patients after effective chemotherapy. Further response adapted therapy guided by PET seems to be a promising approach in reducing the toxicity for patients undergoing chemotherapy. The criteria used for the PET interpretation have been standardized by the German study groups for Hodgkin lymphoma patients and will be reevaluated in the current studies.
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Burchert W, Bengel FM, Zimmermann R, vom Dahl J, Schäfer W, Schober O, Kluge R, Schäfers M, Lindner O. Myocardial perfusion scintigraphy 2006 in Germany. Nuklearmedizin 2018. [DOI: 10.3413/nukmed-0158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SummaryAim: This second survey was to deliver further information on myocardial perfusion scintigraphy (MPS) in Germany in 2006. Method: 351 questionnaires were evaluated: 207 private practices (PP), 117 hospitals (HO), 27 from university hospitals (UH). Results: MPS of 106 331 patients were reported, 85% were investigated with 99mTc-perfusion tracers. 74% [2005=72%] were performed in PP, 17% [2005=15%] in HO and 9% [2005=13%] in UH. PP, which participated in 2005 and 2006, demonstrated an increase by 3,9% (HO 0%, UH –13,0%). The type of stress was pharmacological in 27% [2005=22%]; 54% adenosine (of these 29% with exercise), 37% dipyridamole (of these 56% with exercise), and 9% dobutamine. Gated SPECT was performed in 42% [2005=36%] of all restand in 39% [2005=32%] of all stress MPS. An attenuation correction was used by 69 [2005=78] institutions. 40% of all MPS were performed in patients suspected to have CAD. 24% of all institutions reported changes in the use of MPS by competing methods. Conclusion: There is a small increase of MPS between 2005 and 2006 despite competing methods. Gated SPECT has experienced more acceptance. Suspicion of CAD is an important indication of MPS. In order to tap the full potential of MPS a gated SPECT should be performed routinely.
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Nanni C, Cottereau AS, Lopci E, Bodet-Milin C, Coronado M, Pro B, Kim WS, Trotman J, Barrington S, Duhrsen U, Vander Borght T, Zamagni E, Kraeber-Bodéré F, Messiou C, Rahmouni A, Buvat I, Andre M, Hertzberg M, Oyen W, Casasnovas O, Luminari S, Garderet L, Montravers F, Kobe C, Kluge R, Versari A, Zucca E, Moreau P, Cheson B, Haioun C, Gallamini A, Meignan M. Report of the 6th International Workshop on PET in lymphoma. Leuk Lymphoma 2017; 58:2298-2303. [PMID: 28264597 DOI: 10.1080/10428194.2017.1298752] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/12/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
Abstract
Two hundred and ten nuclear medicine physicians, radiologists, and hematologists from 26 countries attended the 6th International Workshop on Positron Emission Tomography (PET) in Lymphoma and Myeloma held in Menton, France, in September 2016. The meeting was under the auspices of the European Lymphoma Institute (ELI), the European Association of Nuclear Medicine (EANM) the Lymphoma Study Association (LYSA), the Italian Foundation on Lymphoma (FIL) and the Carnot Institute for Lymphoma (CALYM). Forty scientific posters were presented. For the first time, specialists in the field of multiple myeloma (MM) were involved in the expert session. The aim was to establish from the experience of Italian and French studies new guidelines of FDG-PET/CT reporting for myeloma staging and restaging. The meeting dedicated an entire session to MM imaging followed by a session on the role of PET in Peripheral T cell Lymphoma. An entire session addressed the issues of Deauville scale particularly for end treatment assessment and the challenging consequences of immunomodulatory treatments on PET reporting. A specific session presented the potential role of baseline metabolic tumor measurement to predict outcome and identify different risk categories and the main results obtained in different lymphoma entities were described. Whether it could replace clinical staging has been extensively discussed. The more recent results obtained in the H10 trial have been presented and compared to the published data in early stage Hodgkin lymphoma. Finally, the ongoing studies using PET for guiding therapeutic strategies have been reported by the various lymphoma cooperative groups that participated to the meeting.
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Affiliation(s)
- Cristina Nanni
- a Nuclear Medicine and Hematology , University of Bologna , Bologna , Italy
| | | | - Egesta Lopci
- c Nuclear Medicine , Instituto Clinica Humanitas, IRCCS , Milano , Italy
| | | | - Monica Coronado
- e Nuclear Medicine , La Paz University Hospital , Madrid , Spain
| | - Barbara Pro
- f Hematology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Wong Seog Kim
- g Hematology , Samsung Medical Center , Seoul , Korea
| | - Judith Trotman
- h Hematology , Concord Hospital, University of Sydney , Sydney , Australia
| | - Sally Barrington
- i PET Center, Guy's and St Thomas' Hospital, King's College , London , UK
| | | | - Thierry Vander Borght
- k Nuclear Medicine and Haematology , Université catholique de Louvain, CHU UCL Namur , Namur , Belgium
| | - Elena Zamagni
- a Nuclear Medicine and Hematology , University of Bologna , Bologna , Italy
| | | | | | - Alain Rahmouni
- m Radiology, Lysa Imaging and Haematology , Hôpitaux Universitaires Henri Mondor , Créteil , France
| | - Irène Buvat
- n Unité d'Imagerie Moléculaire in Vivo , Orsay , France
| | - Marc Andre
- k Nuclear Medicine and Haematology , Université catholique de Louvain, CHU UCL Namur , Namur , Belgium
| | - Mark Hertzberg
- o Haematology , Prince of Wales Hospital and Community Health Services , Sydney , Australia
| | - Wim Oyen
- l The Royal Marsden Hospital , London, UK
| | | | - Stefano Luminari
- q Nuclear Medicine and Haematology , Arcispedale S. Maria Nuova, IRCCS , Reggio Emilia , Italy
| | | | | | - Carsten Kobe
- s Nuclear Medicine , University Hospital of Cologne , Cologne , Germany
| | - Regine Kluge
- t Nuclear Medicine , University Hospital , Leipzig , Germany
| | - Annibale Versari
- q Nuclear Medicine and Haematology , Arcispedale S. Maria Nuova, IRCCS , Reggio Emilia , Italy
| | - Emanuele Zucca
- u Haematology , Istituto Oncologico della Swizzera Italiana , Bellizona , Switzerland
| | - Philippe Moreau
- d Nuclear Medicine and Haematology , CHU Nantes , Nantes , France
| | - Bruce Cheson
- v Haematology , Lombardi Comprehensive Cancer Center , Washington , DC , USA
| | - Corinne Haioun
- m Radiology, Lysa Imaging and Haematology , Hôpitaux Universitaires Henri Mondor , Créteil , France
| | - Andrea Gallamini
- w Research, Innovation and Statistics Department, A. Lacassagne Cancer Center , Nice , France
| | - Michel Meignan
- m Radiology, Lysa Imaging and Haematology , Hôpitaux Universitaires Henri Mondor , Créteil , France
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Kluge R, Barrington S, Kurch L, Hasenclever D. Reply to: Laffon and Marthan "FDG PET for therapy monitoring in Hodgkin's and non-Hodgkin's lymphomas: qPET versus rPET". Eur J Nucl Med Mol Imaging 2017; 44:2331-2332. [PMID: 28939986 DOI: 10.1007/s00259-017-3826-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/31/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstrasse 18, 04103, Leipzig, Germany.
| | - Sally Barrington
- PET Imaging Centre, King's College London and Guy's, King's Health Partners, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstrasse 18, 04103, Leipzig, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstrasse 16-18, 04107, Leipzig, Germany
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Abstract
PET using 18F-FDG for treatment monitoring in patients with lymphoma is one of the most well-developed clinical applications. PET/CT is nowadays used during treatment to assess chemosensitivity, with response-adapted therapy given according to 'interim' PET in clinical practice to adults and children with Hodgkin lymphoma. PET is also used to assess remission from disease and to predict prognosis in the pretransplant setting. Mature data have been reported for the common subtypes of aggressive B-cell lymphomas, with more recent data also supporting the use of PET for response assessment in T-cell lymphomas. The Deauville five-point scale incorporating the Deauville criteria (DC) is recommended for response assessment in international guidelines. FDG uptake is graded in relation to the reference regions of normal mediastinum and liver. The DC have been validated in most lymphoma subtypes. The DC permit the threshold for adequate or inadequate response to be adapted according to the clinical context or research question. It is important for PET readers to understand how the DC have been applied in response-adapted trials for correct interpretation and discussion with the multidisciplinary team. Quantitative methods to perform PET in standardized ways have also been developed which may further improve response assessment including a quantitative extension to the DC (qPET). This may have advantages in providing a continuous scale to refine the threshold for adequate/inadequate response in specific clinical situations or treatment optimization in trials. qPET is also less observer-dependent and limits the problem of optical misinterpretation due to the influence of background activity.
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Affiliation(s)
- Sally F Barrington
- PET Imaging Centre, King's College London and Guy's, King's Health Partners, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, 0410, Leipzig, Germany
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Flerlage JE, Kelly KM, Beishuizen A, Cho S, De Alarcon PA, Dieckmann U, Drachtman RA, Hoppe BS, Howard SC, Kaste SC, Kluge R, Kurch L, Landman-Parker J, Lewis J, Link MP, McCarten K, Punnett A, Stoevesandt D, Voss SD, Wallace WH, Mauz-Körholz C, Metzger ML. Staging Evaluation and Response Criteria Harmonization (SEARCH) for Childhood, Adolescent and Young Adult Hodgkin Lymphoma (CAYAHL): Methodology statement. Pediatr Blood Cancer 2017; 64. [PMID: 28097818 DOI: 10.1002/pbc.26421] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/25/2016] [Indexed: 01/05/2023]
Abstract
International harmonization of staging evaluation and response criteria is needed for childhood, adolescence, and young adulthood Hodgkin lymphoma. Two Hodgkin lymphoma protocols from cooperative trials in Europe and North America were compared for areas in need of harmonization, and an evidence-based approach is currently underway to harmonize staging and response evaluations with a goal to enhance comparisons, expedite identification of effective therapies, and aid in the approval process for new agents by regulatory agencies.
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Affiliation(s)
- Jamie E Flerlage
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kara M Kelly
- Roswell Park Cancer Institute, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Auke Beishuizen
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Steve Cho
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Ute Dieckmann
- Klinik für Strahlenheilkunde, Universitätsklinik Freiburg, Freiburg, Germany
| | - Richard A Drachtman
- Division of Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Bradford S Hoppe
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Scott C Howard
- University of Memphis School of Health Studies, Memphis, Tennessee
| | - Sue C Kaste
- Department of Diagnostic Imaging, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Judith Landman-Parker
- Department of Paediatric Haematology & Oncology, Hôpital Trousseau AP-HP & Université Pierre et Marie Curie, Paris, France
| | - Jocelyn Lewis
- Division of Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Michael P Link
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Kathleen McCarten
- Rhode Island Hospital/Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Angela Punnett
- Division of Haematology/Oncology, Department of Paediatrics, SickKids Hospital and University of Toronto, Toronto, Canada
| | | | - Stephan D Voss
- Department of Radiology, Boston Children's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Christine Mauz-Körholz
- Department of Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Gießen, Gießen, Germany.,Medical Faculty, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Monika L Metzger
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Abstract
Hodgkin's lymphoma is one of the most curable pediatric cancers with long-term survival rates exceeding 90% following intensive treatment. Collaborative group studies worldwide aim on reduction or elimination of radiotherapy to avoid potentially life-limiting late effects especially second cancers and cardiovascular diseases. Large prospective trials have integrated early response FDG-PET scans to identify adequate responders to chemotherapy in whom radiotherapy may safely be omitted. The criteria for interpretation of early response PET have changed during the past years and will be further refined based on trial results. FDG-PET is also systematically used to assess initial disease involvement of pediatric Hodgkin's lymphoma and could replace bone marrow biopsy. This article summarizes the role of FDG-PET in staging and response assessment focusing on large pediatric trials, the criteria for PET interpretation and pitfalls.
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Affiliation(s)
- Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany.
| | - L Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Thomas Georgi
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Monika Metzger
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
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Wichmann G, Krüger A, Boehm A, Kolb M, Hofer M, Fischer M, Müller S, Purz S, Stumpp P, Sabri O, Dietz A, Kluge R. Induction chemotherapy followed by radiotherapy for larynx preservation in advanced laryngeal and hypopharyngeal cancer: Outcome prediction after one cycle induction chemotherapy by a score based on clinical evaluation, computed tomography-based volumetry and 18F-FDG-PET/CT. Eur J Cancer 2016; 72:144-155. [PMID: 28033526 DOI: 10.1016/j.ejca.2016.11.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/30/2016] [Accepted: 11/20/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Long-term laryngectomy-free (LFS), tumour-specific (TSS) and overall survival (OS) is achieved by non-surgical larynx preservation (LP) only in a proportion of patients with locally advanced laryngeal or hypopharyngeal cancer. A score facilitating decision-making after 1 cycle induction chemotherapy (IC-1) may improve LFS and TSS. METHODS Early response to IC-1 with TPF ± cetuximab was assessed in 52 patients using endoscopic tumour staging for selecting total laryngectomy for non-responders with endoscopic tumour surface shrinkage <30% versus induction chemotherapy plus radiotherapy (IC + RT) for responders. Computed tomography (CT)-based volumetry was used to assess volumes of primary tumour, neck nodes and their sum; maximum and mean standardised uptake value (SUVmax, SUVmean) were measured by 18F-FDG-PET/CT. Baseline and residual values after IC-1 were calculated and correlated with LFS, TSS and OS. RESULTS After IC-1, 39/52 patients (75%) were early responders. Early response predicted complete response to IC + RT (p = 8.48 × 10-9). Early laryngectomised non-responders and responders with endoscopic tumour surface shrinkage > 70% had best OS. Significant independent predictors for LFS in responders are number of CT-staged suspect positive neck nodes (N+), residual primary tumour volume, residual total tumour volume and the ratio of residual SUVmax and SUVmean (resSUVmax/resSUVmean). Our LFS-score combines >2N+, residual primary tumour volume > 20%, residual total tumour volume > 5.6 mL and resSUVmax/resSUVmean > 1.51 weighted by their hazard ratio (12, 6, 5 and 4); LFS-score ≤ 16 predicts increased LFS, OS and TSS (p < 0.05). CONCLUSION LFS-score ≤ 16 identifies in responders to IC-1 the patients with maximum benefit of non-surgical LP achieving long-term LFS. Even more importantly, a LFS-score > 16 defines patients unsuitable for LP applying the TPF/TP IC + RT protocol.
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Affiliation(s)
- Gunnar Wichmann
- Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Germany.
| | - Anne Krüger
- Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Germany
| | - Andreas Boehm
- Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Germany
| | - Marlen Kolb
- Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Germany
| | - Mathias Hofer
- Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Germany
| | - Milos Fischer
- Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Germany
| | - Stefan Müller
- Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Germany
| | - Sandra Purz
- Department of Nuclear Medicine, University of Leipzig, Germany
| | - Patrick Stumpp
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Germany
| | - Andreas Dietz
- Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Germany
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Mozet C, Kuhnt T, Sattler B, Remmele J, Thome U, Stepan H, Kluge R, Dietz A, Knoedler M. [Head and Neck Cancer in Pregnancy - Recommendations for Diagnosis and Therapy With Case Report]. Laryngorhinootologie 2016; 95:674-683. [PMID: 27764854 DOI: 10.1055/s-0042-114987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: The diagnosis of cancer in pregnancy is rare, but might become more relevant even for head and neck cancer patients due to a shift of age of primipara towards the last third of reproductive years. Unsureness exists about the risk and benefit of diagnostic and therapeutic cancer modalities for the unborn and established recommendations are still missing. But, according to recent data, even multimodal therapeutic approaches (e. g. surgery, radiation, chemotherapy) seem possible in face of pregnancy and should be traded against the risk of prematurity. Material and Methods: Our findings are discussed on the basis of a case report of a pregnant woman with advanced carcinoma of the outer ear canal and therapy options are formulated. Results: Sufficient performed diagnostic modalities do not reach imperilling uterus dosages. A growing number of case reports und studies did not detect any developmental disadvantage of children of prenatal exposed mothers by radiation or chemotherapy, whereas long-term impairments of premature infants are proven. Conclusion: In cancer in pregnancy, an immediate start of well-established therapy modalities like surgery and/or cisplatin-based chemoradiation seems to be possible without unjustifiable risks for the unborn.
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Affiliation(s)
- C Mozet
- ENT, Schwarzwald-Baar-Klinikum Villingen-Schwenningen, Villingen-Schwenningen
| | - T Kuhnt
- Bildgebung und Strahlenmedizin, Universitätsklinikum Leipzig, Leipzig
| | - B Sattler
- Medizinphysik, Klinik und Poliklinik für Nuklearmedizin Leipzig, Leipzig
| | - J Remmele
- Klinik für Strahlentherapie und Radioonklogie, Universitatsklinikum Leipzig, Leipzig
| | - U Thome
- Neonatologie, Universität Leipzig, Leipzig
| | - H Stepan
- Geburtsmedizin, Universitatsklinikum Leipzig, Leipzig
| | - R Kluge
- Nuklearmedizin, Universitatsklinikum Leipzig, Leipzig
| | - A Dietz
- Plastische Operationen, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universität Leipzig, Leipzig
| | - M Knoedler
- Krebszentrm (UCCL),Universitatsklinikum Leipzig, Leipzig
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Kluge R, Chavdarova L, Hoffmann M, Kobe C, Malkowski B, Montravers F, Kurch L, Georgi T, Dietlein M, Wallace WH, Karlen J, Fernández-Teijeiro A, Cepelova M, Wilson L, Bergstraesser E, Sabri O, Mauz-Körholz C, Körholz D, Hasenclever D. Inter-Reader Reliability of Early FDG-PET/CT Response Assessment Using the Deauville Scale after 2 Cycles of Intensive Chemotherapy (OEPA) in Hodgkin's Lymphoma. PLoS One 2016; 11:e0149072. [PMID: 26963909 PMCID: PMC4786307 DOI: 10.1371/journal.pone.0149072] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/11/2016] [Indexed: 02/07/2023] Open
Abstract
Purpose The five point Deauville (D) scale is widely used to assess interim PET metabolic response to chemotherapy in Hodgkin lymphoma (HL) patients. An International Validation Study reported good concordance among reviewers in ABVD treated advanced stage HL patients for the binary discrimination between score D1,2,3 and score D4,5. Inter-reader reliability of the whole scale is not well characterised. Methods Five international expert readers scored 100 interim PET/CT scans from paediatric HL patients. Scans were acquired in 51 European hospitals after two courses of OEPA chemotherapy (according to the EuroNet-PHL-C1 study). Images were interpreted in direct comparison with staging PET/CTs. Results The probability that two random readers concord on the five point D score of a random case is only 42% (global kappa = 0.24). Aggregating to a three point scale D1,2 vs. D3 vs. D4,5 improves concordance to 60% (kappa = 0.34). Concordance if one of two readers assigns a given score is 70% for score D1,2 only 36% for score D3 and 64% for D4,5. Concordance for the binary decisions D1,2 vs. D3,4,5 is 67% and 86% for D1,2,3 vs D4,5 (kappa = 0.36 resp. 0.56). If one reader assigns D1,2,3 concordance probability is 92%, but only 64% if D4,5 is called. Discrepancies occur mainly in mediastinum, neck and skeleton. Conclusion Inter-reader reliability of the five point D-scale is poor in this interobserver analysis of paediatric patients who underwent OEPA. Inter-reader variability is maximal in cases assigned to D2 or D3. The binary distinction D1,2,3 versus D4,5 is the most reliable criterion for clinical decision making.
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Affiliation(s)
- Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Lidia Chavdarova
- Clinic of Nuclear Medicine, National Hospital for Active Treatment in Oncology, Sofia, Bulgaria
| | - Martha Hoffmann
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Carsten Kobe
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bogdan Malkowski
- Dept. of PET and Molecular Imaging, Nicolaus Copernicus University, Collegium MedicumBydgoszcz, Poland
| | - Françoise Montravers
- Department of Nuclear Medicine, Hopital Tenon, Assistance Publique Hôpitaux de Paris, Faculté de médecine Pierre et Marie Curie, Paris, France
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Thomas Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - W. Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonas Karlen
- Karolinska University Hospital, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden
| | - Ana Fernández-Teijeiro
- Pediatric Oncology Unit, Hospitales Universitarios Virgen Macarena y Virgen del Rocio, Sevilla, Spain
| | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol and 2nd Medical Faculty of Charles University, Prague, Czech Republic
| | - Lorrain Wilson
- Department of Nuclear Medicine, Blackrock Clinic, Dublin, Ireland
| | - Eva Bergstraesser
- Department of Paediatric Oncology, University Children’s Hospital Zurich, Switzerland
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - Dieter Körholz
- Department of Pediatric Oncology, University of Halle, Halle/Saale, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
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Brandmaier P, Purz S, Bremicker K, Höckel M, Barthel H, Kluge R, Kahn T, Sabri O, Stumpp P. Simultaneous [18F]FDG-PET/MRI: Correlation of Apparent Diffusion Coefficient (ADC) and Standardized Uptake Value (SUV) in Primary and Recurrent Cervical Cancer. PLoS One 2015; 10:e0141684. [PMID: 26551527 PMCID: PMC4638340 DOI: 10.1371/journal.pone.0141684] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/12/2015] [Indexed: 01/18/2023] Open
Abstract
Objectives Previous non–simultaneous PET/MR studies have shown heterogeneous results about the correlation between standardized uptake values (SUVs) and apparent diffusion coefficients (ADCs). The aim of this study was to investigate correlations in patients with primary and recurrent tumors using a simultaneous PET/MRI system which could lead to a better understanding of tumor biology and might play a role in early response assessment. Methods We included 31 patients with histologically confirmed primary (n = 14) or recurrent cervical cancer (n = 17) who underwent simultaneous whole-body 18F-FDG-PET/MRI comprising DWI. Image analysis was performed by a radiologist and a nuclear physician who identified tumor margins and quantified ADC and SUV. Pearson correlations were calculated to investigate the association between ADC and SUV. Results 92 lesions were detected. We found a significant inverse correlation between SUVmax and ADCmin (r = -0.532, p = 0.05) in primary tumors as well as in primary metastases (r = -0.362, p = 0.05) and between SUVmean and ADCmin (r = -0.403, p = 0.03). In recurrent local tumors we found correlations for SUVmax and ADCmin (r = -0.747, p = 0.002) and SUVmean and ADCmin (r = -0.773, p = 0.001). Associations for recurrent metastases were not significant (p>0.05). Conclusions Our study demonstrates the feasibility of fast and reliable measurement of SUV and ADC with simultaneous PET/MRI. In patients with cervical cancer we found significant inverse correlations for SUV and ADC which could play a major role for further tumor characterization and therapy decisions.
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Affiliation(s)
- P. Brandmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - S. Purz
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - K. Bremicker
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - M. Höckel
- Department of Gynecology and Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - H. Barthel
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - R. Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - T. Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - O. Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - P. Stumpp
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
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Mauz-Körholz C, Lange T, Hasenclever D, Burkhardt B, Feller A, Dörffel W, Kluge R, Vordermark D, Körholz D. Pediatric Nodular Lymphocyte-predominant Hodgkin Lymphoma: Treatment Recommendations of the GPOH-HD Study Group. Klin Padiatr 2015; 227:314-21. [DOI: 10.1055/s-0035-1559664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Mauz-Körholz
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle/ Wittenberg, Halle/ Saale, Germany
| | - T. Lange
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle/ Wittenberg, Halle/ Saale, Germany
| | - D. Hasenclever
- Institut für Medizinische Informatik, Statistik & Epidemiologie (IMISE), Universität Leipzig, Leipzig, Germany
| | - B. Burkhardt
- Clinic for Pediatric Hematology and Oncology, University Hospital Münster, Münster, Germany
| | - A. Feller
- Institute for Pathology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - W. Dörffel
- Clinic for Pediatric and Youth Medicine, Helios Hospital Berlin-Buch, Berlin, Germany
| | - R. Kluge
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - D. Vordermark
- Clinic and Policlinic for Radiation Therapy, University Hospital Halle (Saale), Halle (Saale), Germany
| | - D. Körholz
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle/ Wittenberg, Halle/ Saale, Germany
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50
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Kramell A, Porbeck F, Kluge R, Wiesner A, Csuk R. A fast and reliable detection of indigo in historic and prehistoric textile samples. J Mass Spectrom 2015; 50:ii. [PMID: 28338255 DOI: 10.1002/jms.3493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Across all cultures and over all time periods, as early as the third millennium BC, indigo, a very intense blue vat dye, has been used to dye textiles. Even today, indigo is regarded as one of the most popular blue colorants in items such as blue jeans. While synthetic indigo is used to color textiles today, throughout history, a variety of plants have provided indigo. In this special feature article, René Csuk and co-authors propose to use atmospheric solids analysis probe mass spectrometry (ASAP-MS) to very rapidly and reliably identify indigo colorants tiny amounts in ancient historic fabrics without any sample preparation. The ionization in ASAP experiments is effected by Penning ionization or by the transfer of protons originating from protonated clusters of water. Dr. René Csuk is Professor of organic bioorganic chemistry at the Martin-Luther Universität Halle-Wittenberg (Halle, Germany). His main research interests are in organic and medicinal chemistry, chemical biology and phytochemistry. Graphical Abstract: Historical samples can be investigated conveniently using ASAP®-MS experiments. ASAP®-MS allowed for rapid direct sampling without any preparation of the sample prior to its measurements, and reliable results were generated in less than 1 minute. As demonstrated for indigoid-type dyes, the efficacy of ASAP®-MS analysis is independent of the type of fiber, the age of the sample, the workmanship, and the state of preservation.
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