治疗前 FDG-PET 总代谢肿瘤体积可预测儿童霍奇金淋巴瘤对诱导治疗的反应。
Pretherapeutic FDG-PET total metabolic tumor volume predicts response to induction therapy in pediatric Hodgkin's lymphoma.
机构信息
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, D-13353, Berlin, Germany.
Berlin Institute of Health, Department of Pediatric Oncology/Hematology, Berlin, Germany.
出版信息
BMC Cancer. 2018 May 3;18(1):521. doi: 10.1186/s12885-018-4432-4.
BACKGROUND
Standardized treatment in pediatric patients with Hodgkin's lymphoma (HL) follows risk stratification by tumor stage, erythrocyte sedimentation rate and tumor bulk. We aimed to identify quantitative parameters from pretherapeutic FDG-PET to assist prediction of response to induction chemotherapy.
METHODS
Retrospective analysis in 50 children with HL (f:18; m:32; median age, 14.8 [4-18] a) consecutively treated according to EuroNet-PHL-C1 (n = 42) or -C2 treatment protocol (n = 8). Total metabolic tumor volume (MTV) in pretherapeutic FDG-PET was defined using a semi-automated, background-adapted threshold. Metabolic (SUVmax, SUVmean, SUVpeak, total lesion glycolysis [MTV*SUVmean]) and heterogeneity parameters (asphericity [ASP], entropy, contrast, local homogeneity, energy, and cumulative SUV-volume histograms) were derived. Early response assessment (ERA) was performed after 2 cycles of induction chemotherapy according to treatment protocol and verified by reference rating. Prediction of inadequate response (IR) in ERA was based on ROC analysis separated by stage I/II (1 and 26 patients) and stage III/IV disease (7 and 16 patients) or treatment group/level (TG/TL) 1 to 3.
RESULTS
IR was seen in 28/50 patients (TG/TL 1, 6/12 patients; TG/TL 2, 10/17; TG/TL 3, 12/21). Among all PET parameters, MTV best predicted IR; ASP was the best heterogeneity parameter. AUC of MTV was 0.84 (95%-confidence interval, 0.69-0.99) in stage I/II and 0.86 (0.7-1.0) in stage III/IV. In patients of TG/TL 1, AUC of MTV was 0.92 (0.74-1.0); in TG/TL 2 0.71 (0.44-0.99), and in TG/TL 3 0.85 (0.69-1.0). Patients with high vs. low MTV had IR in 86 vs. 0% in TG/TL 1, 80 vs. 29% in TG/TL 2, and 90 vs. 27% in TG/TL 3 (cut-off, > 80 ml, > 160 ml, > 410 ml).
CONCLUSIONS
In this explorative study, high total MTV best predicted inadequate response to induction therapy in pediatric HL of all pretherapeutic FDG-PET parameters - in both low and high stages as well as the 3 different TG/TL.
TRIAL REGISTRATION
Ethics committee number: EA2/151/16 (retrospectively registered).
背景
儿童霍奇金淋巴瘤（HL）的标准化治疗遵循肿瘤分期、红细胞沉降率和肿瘤体积的风险分层。我们旨在确定治疗前 FDG-PET 中的定量参数，以辅助预测诱导化疗的反应。
方法
对 50 例连续接受 EuroNet-PHL-C1（n=42）或-C2 治疗方案（n=8）治疗的 HL 儿童（f：18；m：32；中位年龄 14.8[4-18]a）进行回顾性分析。使用半自动、背景适应的阈值定义治疗前 FDG-PET 中的总代谢肿瘤体积（MTV）。衍生出代谢（SUVmax、SUVmean、SUVpeak、总病灶糖酵解[MTV*SUVmean]）和异质性参数（各向异性度[ASP]、熵、对比度、局部均匀性、能量和累积 SUV-体积直方图）。根据治疗方案在 2 个周期诱导化疗后进行早期反应评估（ERA），并通过参考评分进行验证。根据疾病分期（I/II 期 1 和 26 例，III/IV 期 7 和 16 例）或治疗组/水平（TG/TL）1-3，通过 ROC 分析确定 ERA 中反应不足（IR）的预测。
结果
50 例患者中有 28 例（TG/TL 1，6/12 例；TG/TL 2，10/17 例；TG/TL 3，12/21 例）出现 IR。在所有 PET 参数中，MTV 可最佳预测 IR；ASP 是最佳异质性参数。MTV 的 AUC 在 I/II 期为 0.84（95%置信区间，0.69-0.99），在 III/IV 期为 0.86（0.7-1.0）。在 TG/TL 1 患者中，MTV 的 AUC 为 0.92（0.74-1.0）；在 TG/TL 2 中为 0.71（0.44-0.99），在 TG/TL 3 中为 0.85（0.69-1.0）。MTV 较高的患者在 TG/TL 1 中出现 IR 的比例为 86%，而 MTV 较低的患者为 0%；在 TG/TL 2 中分别为 80%和 29%；在 TG/TL 3 中分别为 90%和 27%（截止值：>80ml，>160ml，>410ml）。
结论
在这项探索性研究中，治疗前 FDG-PET 中的总 MTV 是预测儿科 HL 诱导治疗反应不足的最佳参数-在低期和高期以及 3 个不同的 TG/TL 中均如此。
临床试验注册
伦理委员会编号：EA2/151/16（回顾性注册）。
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