Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
J Clin Oncol. 2014 Jun 10;32(17):1776-81. doi: 10.1200/JCO.2013.53.2507. Epub 2014 May 5.
Positron emission tomography (PET) after chemotherapy can guide consolidating radiotherapy in advanced-stage Hodgkin lymphoma (HL). This analysis aims to improve outcome prediction by integrating additional criteria derived by computed tomography (CT).
The analysis set consisted of 739 patients with residues≥2.5 cm after chemotherapy from a total of 2,126 patients treated in the HD15 trial (HD15 for advanced stage Hodgkin's disease: Quality assurance protocol for reduction of toxicity and the prognostic relevance of fluorodeoxyglucose-positron-emission tomography [FDG-PET] in the first-line treatment of advanced-stage Hodgkin's disease) performed by the German Hodgkin Study Group. A central panel performed image analysis and interpretation of CT scans before and after chemotherapy as well as PET scans after chemotherapy. Prognosis was evaluated by using progression-free survival (PFS); groups were compared with the log-rank test. Potential prognostic factors were investigated by using receiver operating characteristic analysis and logistic regression.
In all, 548 (74%) of 739 patients had PET-negative residues after chemotherapy; these patients did not receive additional radiotherapy and showed a 4-year PFS of 91.5%. The 191 PET-positive patients (26%) receiving additional radiotherapy had a 4-year PFS of 86.1% (P=.022). CT alone did not allow further separation of patients in partial remission by risk of recurrence (P=.9). In the subgroup of the 54 PET-positive patients with a relative reduction of less than 40%, the risk of progression or relapse within the first year was 23.1% compared with 5.3% for patients with a larger reduction (difference, 17.9%; 95% CI, 5.8% to 30%).
Patients with HL who have PET-positive residual disease after chemotherapy and poor tumor shrinkage are at high risk of progression or relapse.
化疗后正电子发射断层扫描（PET）可指导晚期霍奇金淋巴瘤（HL）的巩固性放疗。本分析旨在通过整合计算机断层扫描（CT）得出的其他标准来提高预后预测能力。
分析集包括来自德国霍奇金研究组（German Hodgkin Study Group）开展的 HD15 试验（HD15 治疗晚期霍奇金病：降低毒性的质量保证方案以及氟脱氧葡萄糖正电子发射断层扫描[FDG-PET]在晚期霍奇金病一线治疗中的预后相关性）的 2126 例患者中，739 例化疗后残留病灶≥2.5cm 的患者。一个中央小组对化疗前后的 CT 扫描和化疗后的 PET 扫描进行了图像分析和解释。采用无进展生存期（PFS）评估预后；使用对数秩检验比较各组。使用受试者工作特征（ROC）分析和逻辑回归分析调查潜在的预后因素。
化疗后，739 例患者中共有 548 例（74%）PET 阴性残留病灶；这些患者未接受额外放疗，4 年 PFS 为 91.5%。191 例 PET 阳性（26%）接受额外放疗的患者 4 年 PFS 为 86.1%（P=.022）。单独使用 CT 并不能根据复发风险进一步区分部分缓解的患者（P=.9）。在 54 例 PET 阳性患者中，PET 阳性且肿瘤缩小程度小于 40%的亚组患者，在第 1 年内进展或复发的风险为 23.1%，而肿瘤缩小程度较大的患者的风险为 5.3%（差异为 17.9%；95%CI，5.8%至 30%）。
化疗后 PET 阳性残留病灶且肿瘤缩小程度较差的 HL 患者进展或复发风险较高。
