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Role of FDG-PET in the Implementation of Involved-Node Radiation Therapy for Hodgkin Lymphoma Patients

Théodore Girinsky MD, Anne Aupérin MD PhD, Vincent Ribrag MD, Manel Elleuch MD, Christophe Fermé MD, Guillaume Bonniaud PhD, Claude Ruelle, Jean-Louis Alberini MD, Aljosa Celebic, Véronique Edeli

Abstract

Purpose

This study examines the role of 18F-labeled fluorodeoxyglucose positron emission tomography (FDG-PET) in the implementation of involved-node radiation therapy (INRT) in patients treated for clinical stages (CS) I/II supradiaphragmatic Hodgkin lymphoma (HL).

Methods and Material

Patients with untreated CS I/II HL enrolled in the randomized EORTC/LYSA/FIL Intergroup H10 trial and participating in a real-time prospective quality assurance program were prospectively included in this study. Data were electronically obtained from 18 French cancer centers. All patients underwent APET-computed tomography (PET-CT) and a post-chemotherapy planning CT scanning. The pre-chemotherapy gross tumor volume (GTV) and the postchemotherapy clinical target volume (CTV) were first delineated on CT only by the radiation oncologist. The planning PET was then co-registered, and the delineated volumes were jointly analyzed by the radiation oncologist and the nuclear medicine physician. Lymph nodes undetected on CT but FDG-avid were recorded, and the previously determined GTV and CTV were modified according to FDG-PET results.

Results

From March 2007 to February 2010, 135 patients were included in the study. PET-CT identified at least 1 additional FDG-avid lymph node in 95 of 135 patients (70.4%; 95% confidence interval [CI]: 61.9%-77.9%) and 1 additional lymph node area in 55 of 135 patients (40.7%; 95% CI: 32.4%-49.5%). The mean increases in the GTV and CTV were 8.8% and 7.1%, respectively. The systematic addition of PET to CT led to a CTV increase in 60% of the patients.

Conclusions

Pre-chemotherapy FDG-PET leads to significantly better INRT delineation without necessarily increasing radiation volumes.

This work was supported by Association pour la Recherche sur le Cancer (3154). Preliminary results of this work were presented in abstract form at the 52nd Annual Meeting of the America Society of Hematology, Orlando, FL, December 4-7, 2010; Blood 2010; 116; abstract 2817; and at the Annual Congress of the European Association of Nuclear Medicine 2013, Lyon, France, October 19-23, 2013; oral presentation 448.

DOI: 10.1016/j.ijrobp.2014.04.026


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