Joo-Seop Chung1, Moo-Gon Song2, Do-Young Kim1, Ho-Jin Shin1, Seong-Jang Kim1, Young-Don Joo3
1Pusan National University Hospital,2Hanmaeum Changwon Hospital,3Busan ON Hospital
There are several studies that metabolic tumor volume (MTV) by positron emission tomography/computed tomography (PET/CT) is an important prognostic parameter in patients with non-Hodgkin's lymphoma. However, it is unknown whether doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) alone in early stage Hodgkin's lymphoma would lead to similar disease control as combined modality therapy (CMT) using MTV by PET/CT. We investigated whether MTV by PET/CT is a clinical parameter predicting survival in patients with early stage HL by long term follow-up (median 64.5 months). One hundred and sixty five patients with early stage Hodgkin's lymphoma who underwent PET/CT at diagnosis were enrolled. The MTV was delineated on PET/CT by the area ≥ SUVmax, 2.5 (standardized uptake value [SUV]). Ninety-six patients received six cycles of ABVD only. The other 69 patients received CMT (involved-field radiotherapy after 4–6 cycles of ABVD). The calculated MTV cut-off value was 196 cm3 and the estimated area under the MTV ROC curve was 0.856. Clinical outcomes were compared according to several prognostic factors (i.e. age ≥ 50 years, male, performance status ≥ 2, stage II, B symptoms, ≥ 4 involved sites, extranodal site, large mediastinal mass, CMT, elevated erythrocyte sedimentation rate and high MTV). Older age (progression-free survival [PFS], P = 0.003; overall survival [OS], P = 0.010), B symptoms (PFS, P = 0.007; OS, P = 0.046) and high MTV (PFS, P = 0.008; OS, P = 0.009) were significant independent prognostic factors. Survival of two high MTV groups treated with ABVD only and CMT were lower than the low MTV groups (PFS, P < 0.018; OS, P < 0.048). ABVD alone was sufficient to control disease in those with low MTV status. However, survival was poor in those with high MTV status, even though the CMT was treated. The MTV can be helpful for deciding the therapeutic modality in patients with early stage Hodgkin's lymphoma.