Radiotherapy Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
Department of Oncology, University of Torino, Torino, Italy.
Int J Radiat Oncol Biol Phys. 2015 Aug 1;92(5):1077-1083. doi: 10.1016/j.ijrobp.2015.04.021. Epub 2015 Apr 17.
This multicenter retrospective study was designed to evaluate the prognostic role of interim fluorodeoxyglucose-labeled positron emission tomography (i-FDG-PET) in a cohort of patients affected with early-stage Hodgkin lymphoma (HL) treated initially with adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy followed by radiation therapy, and to assess the role of chemotherapy continuation plus radiation therapy for i-FDG-PET-positive patients.
Data from 257 patients were retrieved from 4 hematology and radiation oncology departments. Inclusion criteria were stage I to IIAB HL, "intention-to-treat" AVBD plus radiation therapy, and FDG-PET at diagnosis and after the first 2 ABVD cycles. All i-FDG-PET scans underwent blinded local review by using the Deauville 5-point scoring system; patients were stratified as negative or positive using 2 Deauville score cutoff values, ≥3 or ≥4.
Median follow-up time was 56 months (range: 9-163 months); 5-year overall survival (OS) and disease-specific survival (DSS) for the whole cohort were 97.5% and 98.3%, respectively. Five-year progression-free survival (PFS) was 95.6%. After i-FDG-PET revision, 43 of 257 patients (16.7%) had a positive i-FDG-PET (Deauville scores: 3-5). Five-year PFS rates for i-FDG-PET-negative and i-FDG-PET-positive patients were 98.1% and 83.7%, respectively, if using a Deauville score cutoff of 3, and 97.7% and 78.6%, respectively, if using a cutoff of 4 (P=.0001). Five-year OS for i-FDG-PET-negative and i-FDG-PET-positive patients was 98.5% and 93.0%, respectively, if using a cutoff of 3, and 98.6% and 89.3%, respectively, if using a cutoff of 4 (P=.029 and P=.002). At univariate regression analysis, i-FDG-PET positivity was associated with worse OS and PFS. At multivariate analysis, performed only for PFS, i-FDG-PET positivity confirmed its negative impact (P=.002).
i-FDG-PET is prognostic for PFS and OS in early-stage HL patients treated with combined modality therapy; the continuation of chemotherapy followed by radiation therapy is able to obtain durable, complete remission in most i-FDG-PET-positive patients.
本多中心回顾性研究旨在评估氟脱氧葡萄糖标记的正电子发射断层扫描（i-FDG-PET）在一组接受阿霉素、博来霉素、长春碱、达卡巴嗪（ABVD）化疗后接受放射治疗的早期霍奇金淋巴瘤（HL）患者中的预后作用，并评估对于 i-FDG-PET 阳性患者继续化疗加放疗的作用。
从 4 个血液学和放射肿瘤学部门检索了 257 名患者的数据。纳入标准为 I 期至 IIAB HL，“意向治疗”ABVD 加放射治疗，以及在诊断时和前 2 个 ABVD 周期后进行 FDG-PET。所有 i-FDG-PET 扫描均通过使用 Deauville 5 分评分系统进行盲法局部审查；使用 2 个 Deauville 评分截断值将患者分层为阴性或阳性，分别为≥3 或≥4。
中位随访时间为 56 个月（范围：9-163 个月）；全队列的 5 年总生存率（OS）和疾病特异性生存率（DSS）分别为 97.5%和 98.3%。5 年无进展生存率（PFS）为 95.6%。在 i-FDG-PET 修订后，257 名患者中有 43 名（16.7%）i-FDG-PET 阳性（Deauville 评分：3-5）。如果使用 Deauville 评分截断值为 3，则 i-FDG-PET 阴性和 i-FDG-PET 阳性患者的 5 年 PFS 率分别为 98.1%和 83.7%，如果使用截断值为 4，则分别为 97.7%和 78.6%（P=.0001）。如果使用截断值为 3，则 i-FDG-PET 阴性和 i-FDG-PET 阳性患者的 5 年 OS 率分别为 98.5%和 93.0%，如果使用截断值为 4，则分别为 98.6%和 89.3%（P=.029 和 P=.002）。单变量回归分析显示，i-FDG-PET 阳性与 OS 和 PFS 较差相关。多变量分析仅用于 PFS，i-FDG-PET 阳性证实了其负面影响（P=.002）。
i-FDG-PET 对接受联合治疗的早期 HL 患者的 PFS 和 OS 具有预后作用；在大多数 i-FDG-PET 阳性患者中，继续化疗加放疗可获得持久的完全缓解。
