DOI: 10.1007/s00259-018-4155-4Pages: 1-10

FDG PET in response evaluation of bulky masses in paediatric Hodgkin’s lymphoma (HL) patients enrolled in the Italian AIEOP-LH2004 trial

1. Humanitas Clinical and Research Hospital, Nuclear Medicine Department

2. IRCCS Centro di Riferimento Oncologico, AYA and Pediatric Radiotherapy

3. Galliera Hospital, Nuclear Medicine

4. Hospital San Gerardo, Nuclear Medicine

5. Centro di Riferimento Oncologico, Nuclear Medicine

6. Hospital San Gerardo, Pediatric Division

7. University Hospital, Pediatric Division

8. University Hospital, Nuclear Medicine Department

9. Ospedale dei Bambini, Pediatric Division

10. Positron Emission Tomography Centre IRMET S.p.A. Affidea

11. Hospital Santobono-Pausilipon, Department of Oncology

12. Azienda Ospedaliera, Hematology and Pediatric Oncology

13. Regina Margherita Hospital, Oncohematology

14. University La Sapienza, Pediatric Oncohematology, Hospital Umberto I

15. Hospital San Salvatore, Radiotherapy

16. II University Hospital, Department of Pediatrics

17. Gaslini Hospital, Hematology and Pediatric Oncology

18. University Hospital S. Anna, Pediatric Onco-hematologic Unit

Correspondence to:
Egesta Lopci
Tel: +39 02 82247542
Email: egesta.lopci@gmail.com

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Abstract

Purpose

We present the results of an investigation of the role of FDG PET in response evaluation of bulky masses in paediatric patients with Hodgkin’s lymphoma (HL) enrolled in the Italian AIEOP-LH2004 trial.

Methods

We analysed data derived from 703 patients (388 male, 315 female; mean age 13 years) with HL and enrolled in 41 different Italian centres from March 2004 to September 2012, all treated with the AIEOP-LH2004 protocol. The cohort comprised 309 patients with a bulky mass, of whom 263 were evaluated with FDG PET at baseline and after four cycles of chemotherapy. Responses were determined according to combined functional and morphological criteria. Patients were followed up for a mean period of 43 months and for each child we calculated time-to-progression (TTP) and relapse rates considering clinical monitoring, and instrumental and histological data as the reference standard. Statistical analyses were performed for FDG PET and morphological responses with respect to TTP. Multivariate analysis was used to define independent predictive factors.

Results

Overall, response evaluation revealed 238 PET-negative patients (90.5%) and 25 PET-positive patients (9.5%), with a significant difference in TTP between these groups (mean TTP: 32.67 months for negative scans, 23.8 months for positive scans; p < 0.0001, log-rank test). In the same cohort, computed tomography showed a complete response (CR) in 85 patients (32.3%), progressive disease (PD) in 6 patients (2.3%), and a partial response (PR) in 165 patients (62.7%), with a significant difference in TTP between patients with CR and patients with PD (31.1 months and 7.9 months, respectively; p < 0.001, log-rank test). Similarly, there was a significant difference in relapse rates between PET-positive and PET-negative patients (p = 0000). In patients with PR, there was also a significant difference in TTP between PET-positive and PET-negative patients (24.6 months and 34.9 months, respectively; p < 0.0001). In the multivariate analysis with correction for multiple testing, only the PET result was an independent predictive factor in both the entire cohort of patients and the subgroup showing PR on CT (p < 0.01).

Conclusion

After four cycles of chemotherapy, FDG PET response assessment in paediatric HL patients with a bulky mass is a good predictor of TTP and disease outcome. Moreover, in patients with a PR on CT, PET was able to differentiate those with a longer TTP. In paediatric HL patients with a bulky mass and in patients with a PR on CT, response on FDG PET was an independent predictive factor.

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  • Accepted: Sep 4, 2018
  • Online: Sep 15, 2018

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