PET-CT for staging & early response: results from 'Response Adapted Therapy in Advanced Hodgkin Lymphoma' (RATHL) (CRUK/07/033).
Radford, John A
AffiliationPET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London
MetadataShow full item record
AbstractInternational 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.
CitationPET-CT for staging & early response: results from 'Response Adapted Therapy in Advanced Hodgkin Lymphoma' (RATHL) (CRUK/07/033). 2016: Blood
- Factors affecting intrapatient liver and mediastinal blood pool ¹⁸F-FDG standardized uptake value changes during ABVD chemotherapy in Hodgkin's lymphoma.
- Authors: Chiaravalloti A, Danieli R, Abbatiello P, Di Pietro B, Travascio L, Cantonetti M, Guazzaroni M, Orlacchio A, Simonetti G, Schillaci O
- Issue date: 2014 Jun
- International validation study for interim PET in ABVD-treated, advanced-stage hodgkin lymphoma: interpretation criteria and concordance rate among reviewers.
- Authors: Biggi A, Gallamini A, Chauvie S, Hutchings M, Kostakoglu L, Gregianin M, Meignan M, Malkowski B, Hofman MS, Barrington SF
- Issue date: 2013 May
- PET-CT: reliable cornerstone for Hodgkin lymphoma treatment?
- Authors: Zijlstra JM
- Issue date: 2016 Mar 24
- In vivo treatment sensitivity testing with positron emission tomography/computed tomography after one cycle of chemotherapy for Hodgkin lymphoma.
- Authors: Hutchings M, Kostakoglu L, Zaucha JM, Malkowski B, Biggi A, Danielewicz I, Loft A, Specht L, Lamonica D, Czuczman MS, Nanni C, Zinzani PL, Diehl L, Stern R, Coleman M
- Issue date: 2014 Sep 1
- Chemotherapy Response Assessment by FDG-PET-CT in Early-stage Classical Hodgkin Lymphoma: Moving Beyond the Five-Point Deauville Score.
- Authors: Milgrom SA, Dong W, Akhtari M, Smith GL, Pinnix CC, Mawlawi O, Rohren E, Garg N, Chuang H, Yehia ZA, Reddy JP, Gunther JR, Khoury JD, Suki T, Osborne EM, Oki Y, Fanale M, Dabaja BS
- Issue date: 2017 Feb 1