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PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study

PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study
PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study

International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged using clinical assessment, CT, and bone marrow biopsy (RATHL stage). PET-CT was performed at baseline (PET0) and after 2 chemotherapy cycles (PET2) in a response-adapted design. PET-CT was reported centrally by experts at 5 national core laboratories. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement among experts and between expert and local readers was measured. RATHL and PET0 stage were concordant in 938 (80%) patients. PET-CT upstaged 159 (14%) and downstaged 74 (6%) patients. Upstaging by extranodal disease in bone marrow (92), lung (11), or multiple sites (12) on PET-CT accounted for most discrepancies. Follow-up of discrepant findings confirmed the PET characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a κ (95% confidence interval) of 0.84 (0.76-0.91) was very good and between experts and local readers (300 scans) at 0.77 (0.68-0.86) was good. These results confirm PET-CT as the modern standard for staging HL and that response assessment using Deauville criteria is robust, enabling translation of RATHL results into clinical practice.

Antineoplastic Combined Chemotherapy Protocols, Biopsy, Bleomycin, Bone Marrow, Dacarbazine, Doxorubicin, Female, Fluorodeoxyglucose F18, Hodgkin Disease, Humans, Male, Neoplasm Staging, Positron-Emission Tomography, Radiopharmaceuticals, Vinblastine, Journal Article, Research Support, Non-U.S. Gov't
0006-4971
1531-1538
Barrington, Sally F.
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Kirkwood, Amy A.
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Franceschetto, Antonella
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Fulham, Michael J.
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Roberts, Thomas H.
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Almquist, Helén
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Brun, Eva
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Hjorthaug, Karin
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Viney, Zaid N.
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Pike, Lucy C.
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Federico, Massimo
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Luminari, Stefano
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Radford, John
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Trotman, Judith
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Fosså, Alexander
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Berkahn, Leanne
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Molin, Daniel
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D'Amore, Francesco
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Sinclair, Donald A.
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Smith, Paul
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O'Doherty, Michael J.
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Stevens, Lindsey
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Johnson, Peter W.
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Barrington, Sally F.
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Kirkwood, Amy A.
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Franceschetto, Antonella
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Fulham, Michael J.
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Roberts, Thomas H.
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Almquist, Helén
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Brun, Eva
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Hjorthaug, Karin
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Viney, Zaid N.
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Pike, Lucy C.
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Federico, Massimo
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Luminari, Stefano
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Radford, John
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Trotman, Judith
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Fosså, Alexander
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Berkahn, Leanne
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Molin, Daniel
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D'Amore, Francesco
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Sinclair, Donald A.
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Smith, Paul
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O'Doherty, Michael J.
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Stevens, Lindsey
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Johnson, Peter W.
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Barrington, Sally F., Kirkwood, Amy A., Franceschetto, Antonella, Fulham, Michael J., Roberts, Thomas H., Almquist, Helén, Brun, Eva, Hjorthaug, Karin, Viney, Zaid N., Pike, Lucy C., Federico, Massimo, Luminari, Stefano, Radford, John, Trotman, Judith, Fosså, Alexander, Berkahn, Leanne, Molin, Daniel, D'Amore, Francesco, Sinclair, Donald A., Smith, Paul, O'Doherty, Michael J., Stevens, Lindsey and Johnson, Peter W. (2016) PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study. Blood, 127 (12), 1531-1538. (doi:10.1182/blood-2015-11-679407).

Record type: Article

Abstract

International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged using clinical assessment, CT, and bone marrow biopsy (RATHL stage). PET-CT was performed at baseline (PET0) and after 2 chemotherapy cycles (PET2) in a response-adapted design. PET-CT was reported centrally by experts at 5 national core laboratories. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement among experts and between expert and local readers was measured. RATHL and PET0 stage were concordant in 938 (80%) patients. PET-CT upstaged 159 (14%) and downstaged 74 (6%) patients. Upstaging by extranodal disease in bone marrow (92), lung (11), or multiple sites (12) on PET-CT accounted for most discrepancies. Follow-up of discrepant findings confirmed the PET characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a κ (95% confidence interval) of 0.84 (0.76-0.91) was very good and between experts and local readers (300 scans) at 0.77 (0.68-0.86) was good. These results confirm PET-CT as the modern standard for staging HL and that response assessment using Deauville criteria is robust, enabling translation of RATHL results into clinical practice.

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RATHL PET responses.Blood - Version of Record
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Published date: 24 March 2016
Additional Information: © 2016 by The American Society of Hematology.
Keywords: Antineoplastic Combined Chemotherapy Protocols, Biopsy, Bleomycin, Bone Marrow, Dacarbazine, Doxorubicin, Female, Fluorodeoxyglucose F18, Hodgkin Disease, Humans, Male, Neoplasm Staging, Positron-Emission Tomography, Radiopharmaceuticals, Vinblastine, Journal Article, Research Support, Non-U.S. Gov't

Identifiers

Local EPrints ID: 413536
URI: https://eprints.soton.ac.uk/id/eprint/413536
ISSN: 0006-4971
PURE UUID: 4fdaca4f-af7b-44c6-96c6-d9592a47e40b
ORCID for Peter W. Johnson: ORCID iD orcid.org/0000-0003-2306-4974

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Date deposited: 25 Aug 2017 16:31
Last modified: 14 Mar 2019 01:49

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Contributors

Author: Sally F. Barrington
Author: Amy A. Kirkwood
Author: Antonella Franceschetto
Author: Michael J. Fulham
Author: Thomas H. Roberts
Author: Helén Almquist
Author: Eva Brun
Author: Karin Hjorthaug
Author: Zaid N. Viney
Author: Lucy C. Pike
Author: Massimo Federico
Author: Stefano Luminari
Author: John Radford
Author: Judith Trotman
Author: Alexander Fosså
Author: Leanne Berkahn
Author: Daniel Molin
Author: Francesco D'Amore
Author: Donald A. Sinclair
Author: Paul Smith
Author: Michael J. O'Doherty
Author: Lindsey Stevens

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