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Open Access Research

Interim-treatment quantitative PET parameters predict progression and death among patients with hodgkin's disease

Diane Tseng1, Leelanand P Rachakonda1, Zheng Su2, Ranjana Advani3, Sandra Horning3, Richard T Hoppe1, Andrew Quon4, Edward E Graves1, Billy W Loo1* and Phuoc T Tran56*

Author Affiliations

1 Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Dr., Stanford, CA 94305 USA

2 Department of Health Research and Policy, Biostatistics, Stanford University School of Medicine, 300 Pasteur Dr., Stanford, CA 94305 USA

3 Department of Medicine, Medical Oncology, Stanford University School of Medicine, 875 Blake Wilbur Dr., Stanford, CA, 94305 USA

4 Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr., Stanford, CA, 94305 USA

5 Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutes, 1550 Orleans St., CRB2, Baltimore, MD 21231 USA

6 Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutes, 1550 Orleans St., CRB2, Baltimore, MD 21231 USA

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Radiation Oncology 2012, 7:5  doi:10.1186/1748-717X-7-5

Published: 19 January 2012

Abstract

Purpose

We hypothesized that quantitative PET parameters may have predictive value beyond that of traditional clinical factors such as the International Prognostic Score (IPS) among Hodgkin's disease (HD) patients.

Methods

Thirty HD patients treated at presentation or relapse had staging and interim-treatment PET-CT scans. The majority of patients (53%) had stage III-IV disease and 67% had IPS ≥ 2. Interim-treatment scans were performed at a median of 55 days from the staging PET-CT. Chemotherapy regimens used: Stanford V (67%), ABVD (17%), VAMP (10%), or BEACOPP (7%). Hypermetabolic tumor regions were segmented semiautomatically and the metabolic tumor volume (MTV), mean standardized uptake value (SUVmean), maximum SUV (SUVmax) and integrated SUV (iSUV) were recorded. We analyzed whether IPS, absolute value PET parameters or the calculated ratio of interim- to pre-treatment PET parameters were associated with progression free survival (PFS) or overall survival (OS).

Results

Median follow-up of the study group was 50 months. Six of the 30 patients progressed clinically. Absolute value PET parameters from pre-treatment scans were not significant. Absolute value SUVmax from interim-treatment scans was associated with OS as determined by univariate analysis (p < 0.01). All four calculated PET parameters (interim/pre-treatment values) were associated with OS: MTVint/pre (p < 0.01), SUVmeanint/pre (p < 0.05), SUVmaxint/pre (p = 0.01), and iSUVint/pre (p < 0.01). Absolute value SUVmax from interim-treatment scans was associated with PFS (p = 0.01). Three calculated PET parameters (int/pre-treatment values) were associated with PFS: MTVint/pre (p = 0.01), SUVmaxint/pre (p = 0.02) and iSUVint/pre (p = 0.01). IPS was associated with PFS (p < 0.05) and OS (p < 0.01).

Conclusions

Calculated PET metrics may provide predictive information beyond that of traditional clinical factors and may identify patients at high risk of treatment failure early for treatment intensification.

Keywords:
Hodgkin's disease; PET; metabolic tumor volume; quantitative PET parameters; survival