Early-stage Hodgkin lymphoma outcomes after combined modality therapy according to the post-chemotherapy 5-point score: can residual pet-positive disease be cured with radiotherapy alone?

Abstract

Early-stage classical Hodgkin lymphoma (HL) patients are evaluated by an end-of-chemotherapy positron emission tomography-computed tomography (eoc-PET-CT) after doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) and before radiation therapy (RT). We determined freedom from progression (FFP) in patients treated with ABVD and RT according to the eoc-PET-CT 5-point score (5PS). Secondarily, we assessed whether patients with a positive eoc-PET-CT (5PS of 4-5) can be cured with RT alone. The cohort comprised 174 patients treated for stage I-II HL with ABVD and RT alone. ABVD was given with a median of four cycles and RT with a median dose of 30·6 Gy. Five-year FFP was 97%. Five-year FFP was 100% (0 relapses/98 patients) for patients with a 5PS of 1-2, 97% (2/65) for a 5PS of 3, 83% (1/8) for a 5PS of 4, and 67% (1/3) for a 5PS of 5 (P < 0·001). Patients with positive eoc-PET-CT scans who were selected for salvage RT alone had experienced a very good partial response to ABVD. Risk factors for recurrence in this subgroup included a small reduction in tumour size and a 'bounce' in ≥1 PET-CT parameter (reduction then rise from interim to final scan). Thus, a positive eoc-PET-CT is associated with inferior FFP; however, appropriately selected patients can be cured with RT alone.

Keywords: 5-point score; Hodgkin lymphoma; radiation therapy; radiotherapy; salvage.

Figure 1

Freedom from progression as a function of the eoc-PET-CT Deauville 5-point score (5PS) for patients selected for treatment with ABVD and RT (n = 174). Log-rank P < 0.001.

Figure 2

Relative change in PET-CT parameters during the course of chemotherapy for the select group of eoc-PET-positive patients who received salvage RT alone. The graphs demonstrate positron emission tomography-computed tomography (PET-CT) measurements for patients with pre-chemotherapy (1), interim (2), and post-chemotherapy (3) scans (n = 9). The 2 patients with subsequent relapse (red and green) experienced a “bounce” in ≥1 final PET or CT parameter, defined as a reduction in the value from the pre-chemotherapy to the interim scan followed by an increase in the value from the interim to the end-of-chemotherapy-PET-CT scan. A) Relative change in maximum standardized uptake value (SUV_max) B) Relative change in metabolic tumour volume (MTV) C) Relative change in total lesion glycolysis (TLG) D) Relative change in soft tissue volume (STV)

Figure 2

Relative change in PET-CT parameters during the course of chemotherapy for the select group of eoc-PET-positive patients who received salvage RT alone. The graphs demonstrate positron emission tomography-computed tomography (PET-CT) measurements for patients with pre-chemotherapy (1), interim (2), and post-chemotherapy (3) scans (n = 9). The 2 patients with subsequent relapse (red and green) experienced a “bounce” in ≥1 final PET or CT parameter, defined as a reduction in the value from the pre-chemotherapy to the interim scan followed by an increase in the value from the interim to the end-of-chemotherapy-PET-CT scan. A) Relative change in maximum standardized uptake value (SUV_max) B) Relative change in metabolic tumour volume (MTV) C) Relative change in total lesion glycolysis (TLG) D) Relative change in soft tissue volume (STV)

Figure 2

Relative change in PET-CT parameters during the course of chemotherapy for the select group of eoc-PET-positive patients who received salvage RT alone. The graphs demonstrate positron emission tomography-computed tomography (PET-CT) measurements for patients with pre-chemotherapy (1), interim (2), and post-chemotherapy (3) scans (n = 9). The 2 patients with subsequent relapse (red and green) experienced a “bounce” in ≥1 final PET or CT parameter, defined as a reduction in the value from the pre-chemotherapy to the interim scan followed by an increase in the value from the interim to the end-of-chemotherapy-PET-CT scan. A) Relative change in maximum standardized uptake value (SUV_max) B) Relative change in metabolic tumour volume (MTV) C) Relative change in total lesion glycolysis (TLG) D) Relative change in soft tissue volume (STV)

Figure 2

Relative change in PET-CT parameters during the course of chemotherapy for the select group of eoc-PET-positive patients who received salvage RT alone. The graphs demonstrate positron emission tomography-computed tomography (PET-CT) measurements for patients with pre-chemotherapy (1), interim (2), and post-chemotherapy (3) scans (n = 9). The 2 patients with subsequent relapse (red and green) experienced a “bounce” in ≥1 final PET or CT parameter, defined as a reduction in the value from the pre-chemotherapy to the interim scan followed by an increase in the value from the interim to the end-of-chemotherapy-PET-CT scan. A) Relative change in maximum standardized uptake value (SUV_max) B) Relative change in metabolic tumour volume (MTV) C) Relative change in total lesion glycolysis (TLG) D) Relative change in soft tissue volume (STV)