Prognostic role of baseline 18F-FDG PET/CT metabolic parameters in elderly HL: a two-center experience in 123 patients
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ORIGINAL ARTICLE
Prognostic role of baseline 18F-FDG PET/CT metabolic parameters in elderly HL: a two-center experience in 123 patients Domenico Albano 1 & Angelica Mazzoletti 1 & Marianna Spallino 2 & Cristina Muzi 3 & Vittorio Ruggiero Zilioli 3 & Chiara Pagani 4 & Alessandra Tucci 4 & Claudio Rossetti 2 & Raffaele Giubbini 1 & Francesco Bertagna 1 Received: 13 September 2019 / Accepted: 11 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Elderly Hodgkin lymphoma (HL) is an aggressive lymphoma subgroup with high 18F-FDG avidity at 18F-FDG-PET/CT but no shared criteria for PET/CT in treatment evaluation and prediction of outcome are available. The aim of our bicentric study was to investigate whether the metabolic baseline PET/CT parameters can predict treatment response and prognosis in elderly HL. We retrospectively included 123 patients who underwent baseline 18F-FDG-PET/CT and end of treatment PET/CT scans. The PET images were analyzed visually and semi-quantitatively by measuring the lesion to liver SUVmax ratio (L-L SUV R), lesion to blood-pool SUVmax ratio (L-BP SUV R), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Survival curves were plotted according to the Kaplan-Meier method. At a median follow-up of 40 months, the median PFS and OS were 29 and 37 months. L-BP SUV R, L-L SUV R, MTV, and TLG were significantly higher in patients with no complete response compared with complete response group at end of treatment. Moreover, these parameters were demonstrated to be independent prognostic factors for PFS together with tumor stage, while only L-L SUV R and L-BP SUV R for OS. End of treatment PET/CT results using Deauville criteria were significantly correlated with outcome survival. End of treatment PET/CT results (using Deauville criteria) and semiquantitative baseline PET/CT parameters were significantly correlated with response to treatment and long-term outcome. Keywords Hodgkin lymphoma . 18F-FDG PET/CT . Elderly . Prognosis
Introduction Hodgkin lymphoma (HL) typically affects young adults, but it has a bi-modal age distribution curve, with up to a quarter of cases diagnosed in patients aged more than 60 years old [1, 2]. The prognosis in elderly patients (aged over 65 years) is considerably poor especially in comparison with young HL patients, mainly related to the difficulties to tolerate aggressive chemotherapy regimen and the coexistence of comorbidities [3, 4].
* Domenico Albano [email protected] 1
Nuclear Medicine, University of Brescia and Spedali Civili, Brescia, Italy
2
Nuclear Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
3
Haematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
4
Division of Hematology, Spedali Civili, Brescia, Italy
The role of fluorine-18-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) in the evaluation of HL is already studied showing promising evidences in the staging, treatment response evaluation, and prognosis [5–8], but specific studies focusing on
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