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    PET-CT for staging & early response: results from 'Response Adapted Therapy in Advanced Hodgkin Lymphoma' (RATHL) (CRUK/07/033).

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    Authors
    Barrington, S
    Kirkwood, A
    Franceschetto, A
    Fulham, M
    Roberts, T
    Almquist, H
    Brun, E
    Hjorthaug, K
    Viney, Z
    Pike, L
    Federico, M
    Luminari, S
    Radford, John A
    Trotman, J
    Fosså, A
    Berkahn, L
    Molin, D
    D'Amore, F
    Sinclair, D
    Smith, P
    O'Doherty, M
    Stevens, L
    Johnson, P
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    Affiliation
    PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London
    Issue Date
    2016-01-08
    
    Metadata
    Show full item record
    Abstract
    International guidelines recommend PET-CT should replace CT in Hodgkin Lymphoma (HL). The aims of this study were to i) compare PET-CT with CT for staging and ii) measure agreement between expert and local readers, using a five-point scale (Deauville criteria), to adapt treatment in a clinical trial 'Response Adapted Therapy in Advanced Hodgkin Lymphoma' (RATHL) www.cancer.gov/clinicaltrials, reference NCT00678327. Patients were staged for the trial 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 labs. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement amongst 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 characterisation of lesions in the vast majority. Five patients were upstaged by marrow biopsy; 7 by contrast-enhanced CT in bowel and/or liver or spleen. PET2 agreement amongst experts (140 scans) with kappa (95% CI) 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.
    Citation
    PET-CT for staging & early response: results from 'Response Adapted Therapy in Advanced Hodgkin Lymphoma' (RATHL) (CRUK/07/033). 2016: Blood
    Journal
    Blood
    URI
    http://hdl.handle.net/10541/594592
    DOI
    10.1182/blood-2015-11-679407
    PubMed ID
    26747247
    Type
    Article
    Language
    en
    ISSN
    1528-0020
    ae974a485f413a2113503eed53cd6c53
    10.1182/blood-2015-11-679407
    Scopus Count
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    All Christie Publications

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