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Reclassifying patients with early-stage Hodgkin lymphoma based on functional radiographic markers at presentation
Mani Akhtari1,2, Sarah A Milgrom1, Chelsea C Pinnix1
1Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Insights
Three-dimensional measurements from PET-CT scans, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), can better risk-stratify Hodgkin lymphoma patients than traditional methods. These metrics aid in refining treatment strategies for early unfavorable HL.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Bulky disease in Hodgkin lymphoma (HL) impacts patient risk stratification and treatment.
- Traditional 1D measurements may not fully capture disease burden.
Purpose of the Study:
- To investigate if 3D PET-CT metrics (MTV, TLG) improve risk stratification in early-stage HL.
- To compare 3D metrics against traditional disease assessment.
Main Methods:
- Retrospective review of pretreatment PET-CT scans from 267 stage I-II HL patients (2003-2013).
- Disease delineation using manual contouring and subthresholding (SUV ≥2.5).
- Extraction of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from delineated volumes.
Main Results:
- MTV and TLG (MTVt, TLGt) strongly correlated with freedom from progression.
- 80th percentile cutoffs identified: MTVt=268, TLGt=1703.
- MTV and TLG enabled reclassification of early unfavorable HL patients into distinct risk groups.
Conclusions:
- MTV and TLG offer a more accurate assessment of tumor burden in early unfavorable HL.
- These 3D PET-CT metrics can assist in refining risk stratification and treatment planning.
Abstract:
The presence of bulky disease in Hodgkin lymphoma (HL), traditionally defined with a 1-dimensional measurement, can change a patient's risk grouping and thus the treatment approach. We hypothesized that 3-dimensional measurements of disease burden obtained from baseline 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), would more accurately risk-stratify patients. To test this hypothesis, we reviewed pretreatment PET-CT scans of patients with stage I-II HL treated at our institution between 2003 and 2013. Disease was delineated on prechemotherapy PET-CT scans by 2 methods: (1) manual contouring and (2) subthresholding of these contours to give the tumor volume with standardized uptake value ≥2.5. MTV and TLG were extracted from the threshold volumes (MTVt, TLGt) and from the manually contoured soft-tissue volumes. At a median follow-up of 4.96 years for the 267 patients evaluated, 27 patients were diagnosed with relapsed or refractory disease and 12 died. Both MTVt and TLGt were highly correlated with freedom from progression and were dichotomized with 80th percentile cutoff values of 268 and 1703, respectively. Consideration of MTV and TLG enabled restratification of early unfavorable HL patients as having low- and high-risk disease. We conclude that MTV and TLG provide a potential measure of tumor burden to aid in risk stratification of early unfavorable HL patients.