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Blood. 2016 Mar 24;127(12):1531-8. doi: 10.1182/blood-2015-11-679407. Epub 2016 Jan 8.

PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study.

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PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom;
Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom;
Department of Nuclear Medicine, University of Modena and Reggio Emilia, Modena, Italy;
Department of Molecular Imaging (PET-CT), Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia;
Department of Medical Imaging and Physiology and.
Department of Oncology and Radiation Physics, Skane University Hospital, Lund University, Lund, Sweden;
Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark;
Department of Radiology, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom;
Oncology Unit, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy;
The University of Manchester and the Christie NHS Foundation Trust, Manchester, United Kingdom;
Sydney Medical School, University of Sydney, Sydney, Australia; Concord, Repatriation General Hospital, Sydney, Australia;
Department of Oncology, Norwegian Radium Hospital, Oslo, Norway;
Haematology, Auckland City Hospital, Auckland, New Zealand;
Department of Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden;
Haematology, Aarhus University, Aarhus, Denmark; and.
Cancer Research UK Centre, University of Southampton, Southampton, United Kingdom.


International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged 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 laboratories. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement among 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 characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a κ (95% confidence interval) 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.

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