Total tumor burden in lymphoma - an evolving strong prognostic parameter

Area of Science:

• Oncology
• Nuclear Medicine
• Radiomics

Background:

• Total metabolic tumor volume (TMTV) is a novel parameter from baseline FDG-PET/CT for lymphoma prognosis.
• TMTV quantifies the metabolically active tumor burden and correlates strongly with overall tumor load.

Purpose of the Study:

• To evaluate TMTV as a prognosticator in various lymphoma subtypes before first-line therapy.
• To assess TMTV's ability to predict progression-free survival and overall survival.

Main Methods:

• TMTV measurement using PET imaging processed with various software and techniques.
• Analysis of TMTV in diffuse large B-cell lymphoma, Hodgkin lymphoma, Follicular Lymphoma, and Peripheral T-cell lymphoma.

Main Results:

• TMTV is a strong predictor of outcome in lymphoma, often outperforming clinical scores, molecular predictors, and interim PET results.
• TMTV combined with existing scores improves risk stratification, with defined cut-offs impacting patient outcomes.
• Harmonization of TMTV measurement techniques is underway.

Conclusions:

• TMTV is a valuable and straightforward tool for assessing tumor burden in lymphoma prognostication.
• TMTV has the potential to replace current surrogates of tumor burden in prognostic indexes and guide therapy decisions.
• Further clinical trials are warranted to confirm the predictive value of TMTV.