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Positron emission tomography/computed tomography assessment after immunochemotherapy and irradiation using the lugano classification criteria in the IELSG-26 study of primary mediastinal B-cell lymphoma

Positron emission tomography/computed tomography assessment after immunochemotherapy and irradiation using the lugano classification criteria in the IELSG-26 study of primary mediastinal B-cell lymphoma
Positron emission tomography/computed tomography assessment after immunochemotherapy and irradiation using the lugano classification criteria in the IELSG-26 study of primary mediastinal B-cell lymphoma

PURPOSE: To assess the predictive value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for disease recurrence after immunochemotherapy (R-CHT) and mediastinal irradiation (RT), using the recently published criteria of the Lugano classification to predict outcomes for patients with primary mediastinal large B-cell lymphoma.

METHODS AND MATERIALS: Among 125 patients prospectively enrolled in the IELSG-26 study, 88 were eligible for central review of PET/CT scans after completion of RT. Responses were evaluated using the 5-point Deauville scale at the end of induction R-CHT and after consolidation RT. According to the Lugano classification, a complete metabolic response (CMR) was defined by a Deauville score (DS) ≤3.

RESULTS: The CMR (DS1, -2, or -3) rate increased from 74% (65 patients) after R-CHT to 89% (78 patients) after consolidation RT. Among the 10 patients (11%) with persistently positive scans, the residual uptake after RT was slightly higher than the liver uptake in 6 patients (DS4; 7%) and markedly higher in 4 patients (DS5; 4%): these patients had a significantly poorer 5-year progression-free survival and overall survival. At a median follow-up of 60 months (range, 35-107 months), no patients with a CMR after RT have relapsed. Among the 10 patients who did not reach a CMR, 3 of the 4 patients (positive predictive value, 75%) with DS5 after RT had subsequent disease progression (within the RT volume in all cases) and died. All patients with DS4 had good outcomes without recurrence.

CONCLUSIONS: All the patients obtaining a CMR defined as DS ≤3 remained progression-free at 5 years, confirming the excellent negative predictive value of the Lugano classification criteria in primary mediastinal large B-cell lymphoma patients. The few patients with DS4 also had an excellent outcome, suggesting that they do not necessarily require additional therapy, because the residual (18)F-fluorodeoxyglucose uptake may not reflect persistent lymphoma.

Journal Article
0360-3016
42-49
Ceriani, Luca
5767bf0b-1df0-4479-90df-a3e0beb1c8b8
Martelli, Maurizio
32f72970-6db0-45ec-9246-6d074b504192
Gospodarowicz, Maria K
fe20c999-6bf3-4d40-9c8d-6aeb7d5094df
Ricardi, Umberto
faf727fc-7cd6-4ab0-8a76-b3f063de031b
Ferreri, Andrés J M
ce2b2989-3888-49b5-a623-5094175db3d7
Chiappella, Annalisa
1538be7f-badb-4fc0-b6c6-c65ba3a83d70
Stelitano, Caterina
d20ef370-c8f7-4b5c-8b76-22dda1ba2c15
Balzarotti, Monica
e63fea66-73b5-4332-bf18-ba9555b1c0ce
Cabrera, Maria E
14221c29-544b-4ce1-94e6-5dea6758bbdb
Cunningham, David
c40c8fe4-7eac-4b98-aaa5-b866da1e32ab
Guarini, Attilio
f7a050a4-815f-4e37-ba9c-81bf99c8de8b
Zinzani, Pier Luigi
c8a817bb-0f54-4bde-90b2-d3339ed8fff5
Giovanella, Luca
f701b100-a7b6-4b35-9bb1-464bcc28a66c
Johnson, Peter W M
3f6068ce-171e-4c2c-aca9-dc9b6a37413f
Zucca, Emanuele
40bd5950-d74e-4169-a2ea-0bfc1058058e
Ceriani, Luca
5767bf0b-1df0-4479-90df-a3e0beb1c8b8
Martelli, Maurizio
32f72970-6db0-45ec-9246-6d074b504192
Gospodarowicz, Maria K
fe20c999-6bf3-4d40-9c8d-6aeb7d5094df
Ricardi, Umberto
faf727fc-7cd6-4ab0-8a76-b3f063de031b
Ferreri, Andrés J M
ce2b2989-3888-49b5-a623-5094175db3d7
Chiappella, Annalisa
1538be7f-badb-4fc0-b6c6-c65ba3a83d70
Stelitano, Caterina
d20ef370-c8f7-4b5c-8b76-22dda1ba2c15
Balzarotti, Monica
e63fea66-73b5-4332-bf18-ba9555b1c0ce
Cabrera, Maria E
14221c29-544b-4ce1-94e6-5dea6758bbdb
Cunningham, David
c40c8fe4-7eac-4b98-aaa5-b866da1e32ab
Guarini, Attilio
f7a050a4-815f-4e37-ba9c-81bf99c8de8b
Zinzani, Pier Luigi
c8a817bb-0f54-4bde-90b2-d3339ed8fff5
Giovanella, Luca
f701b100-a7b6-4b35-9bb1-464bcc28a66c
Johnson, Peter W M
3f6068ce-171e-4c2c-aca9-dc9b6a37413f
Zucca, Emanuele
40bd5950-d74e-4169-a2ea-0bfc1058058e

Ceriani, Luca, Martelli, Maurizio, Gospodarowicz, Maria K, Ricardi, Umberto, Ferreri, Andrés J M, Chiappella, Annalisa, Stelitano, Caterina, Balzarotti, Monica, Cabrera, Maria E, Cunningham, David, Guarini, Attilio, Zinzani, Pier Luigi, Giovanella, Luca, Johnson, Peter W M and Zucca, Emanuele (2017) Positron emission tomography/computed tomography assessment after immunochemotherapy and irradiation using the lugano classification criteria in the IELSG-26 study of primary mediastinal B-cell lymphoma. International Journal of Radiation: Oncology, Biology, Physics, 97 (1), 42-49. (doi:10.1016/j.ijrobp.2016.09.031).

Record type: Article

Abstract

PURPOSE: To assess the predictive value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for disease recurrence after immunochemotherapy (R-CHT) and mediastinal irradiation (RT), using the recently published criteria of the Lugano classification to predict outcomes for patients with primary mediastinal large B-cell lymphoma.

METHODS AND MATERIALS: Among 125 patients prospectively enrolled in the IELSG-26 study, 88 were eligible for central review of PET/CT scans after completion of RT. Responses were evaluated using the 5-point Deauville scale at the end of induction R-CHT and after consolidation RT. According to the Lugano classification, a complete metabolic response (CMR) was defined by a Deauville score (DS) ≤3.

RESULTS: The CMR (DS1, -2, or -3) rate increased from 74% (65 patients) after R-CHT to 89% (78 patients) after consolidation RT. Among the 10 patients (11%) with persistently positive scans, the residual uptake after RT was slightly higher than the liver uptake in 6 patients (DS4; 7%) and markedly higher in 4 patients (DS5; 4%): these patients had a significantly poorer 5-year progression-free survival and overall survival. At a median follow-up of 60 months (range, 35-107 months), no patients with a CMR after RT have relapsed. Among the 10 patients who did not reach a CMR, 3 of the 4 patients (positive predictive value, 75%) with DS5 after RT had subsequent disease progression (within the RT volume in all cases) and died. All patients with DS4 had good outcomes without recurrence.

CONCLUSIONS: All the patients obtaining a CMR defined as DS ≤3 remained progression-free at 5 years, confirming the excellent negative predictive value of the Lugano classification criteria in primary mediastinal large B-cell lymphoma patients. The few patients with DS4 also had an excellent outcome, suggesting that they do not necessarily require additional therapy, because the residual (18)F-fluorodeoxyglucose uptake may not reflect persistent lymphoma.

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More information

Accepted/In Press date: 21 September 2016
Published date: 1 January 2017
Additional Information: Copyright © 2016 Elsevier Inc. All rights reserved.
Keywords: Journal Article

Identifiers

Local EPrints ID: 414116
URI: https://eprints.soton.ac.uk/id/eprint/414116
ISSN: 0360-3016
PURE UUID: 4cbf71f0-a97c-4cf9-b51e-97742fe242d1
ORCID for Peter W M Johnson: ORCID iD orcid.org/0000-0003-2306-4974

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Date deposited: 14 Sep 2017 16:32
Last modified: 14 Mar 2019 01:49

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Contributors

Author: Luca Ceriani
Author: Maurizio Martelli
Author: Maria K Gospodarowicz
Author: Umberto Ricardi
Author: Andrés J M Ferreri
Author: Annalisa Chiappella
Author: Caterina Stelitano
Author: Monica Balzarotti
Author: Maria E Cabrera
Author: David Cunningham
Author: Attilio Guarini
Author: Pier Luigi Zinzani
Author: Luca Giovanella
Author: Emanuele Zucca

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