A new 3D imaging approach for patients with early-stage Hodgkin lymphoma (HL) was better at predicting survival outcomes than standard two-dimensional imaging, a study has found.
Also, early-stage unfavorable HL patients could be classified into low- and high-risk groups accurately by using the 3D data.
The study, titled “Re-classifying patients with early-stage Hodgkin lymphoma based on functional radiographic markers at presentation,” was published in the journal Blood.
The 3D imaging method tested in this research is called 18fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scan, a medical imaging method that captures 3D images of structures in the body, such as tumors, by detecting activity involving the use of nutrients.
In this study, PET-CT scans were used to measure metabolic tumor volume (MTV) and total lesion glycolysis (TLG), two measures to estimate the total amount of tumor material distributed throughout the body, called tumor burden.
The researchers reviewed the scans of patients with stage I-II HL conducted between 2003-2013.
They examined data from 267 patients whose ages ranged from 18 to 95, most of whom were around the age of 32. Of them, 27 patients were diagnosed with relapsed or refractory disease and 12 patients died.
HL patients are usually classified into three groups: early-stage favorable (ESF), early-stage unfavorable (ESU), and advanced. ESF HL includes stage I-II HL patients whose disease characteristics include one or more additional risk factors including high tumor burden.
Of them, 178 patients (67%) were classified as ESU. The study’s main finding was that these patients could be further classified as low- or high-risk based on their overall survival (OS, time until death from any cause) and freedom from progression (FFP, time until relapse or lack of response to treatment). The researchers consider this finding important because the new classifications for ESU patients could affect treatment options.
“Consideration of MTV and TLG enabled re-stratification of early-unfavorable HL patients as having low-risk and high-risk disease. We conclude that MTV and TLG provide a potential measure of tumor burden to aid in risk stratification of early unfavorable HL patients,” the researchers noted.
“In conclusion, our findings, from one of the largest single-institution HL databases in the modern era of PET-CT, have shown that MTV and TLG, two measures of functional imaging available from baseline PET-CT scans, can aid in predicting which patients with early-stage HL will have worse outcomes by adding measurements that were not previously available for categorizing patients with HL. Most importantly, we have shown that not all cases of ESU HL are the same. Future studies will be needed to confirm these findings, validate our cut-off thresholds for MTV and TLG, and assess the clinical relevance of more accurately risk-stratifying ESU HL patients,” they wrote.