PET-CT for staging & early response: results from 'Response Adapted Therapy in Advanced Hodgkin Lymphoma' (RATHL) (CRUK/07/033).
(2016) In Blood 127(12). p.1531-1538- Abstract
- International guidelines recommend PET-CT should replace CT in Hodgkin Lymphoma (HL). The aims of this study were to i) compare PET-CT with CT for staging and ii) measure agreement between expert and local readers, using a five-point scale (Deauville criteria), to adapt treatment in a clinical trial 'Response Adapted Therapy in Advanced Hodgkin Lymphoma' (RATHL) www.cancer.gov/clinicaltrials, reference NCT00678327. Patients were staged for the trial 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 labs. Local readers optionally scored PET2 scans. The... (More)
- International guidelines recommend PET-CT should replace CT in Hodgkin Lymphoma (HL). The aims of this study were to i) compare PET-CT with CT for staging and ii) measure agreement between expert and local readers, using a five-point scale (Deauville criteria), to adapt treatment in a clinical trial 'Response Adapted Therapy in Advanced Hodgkin Lymphoma' (RATHL) www.cancer.gov/clinicaltrials, reference NCT00678327. Patients were staged for the trial 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 labs. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement amongst 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 characterisation of lesions in the vast majority. Five patients were upstaged by marrow biopsy; 7 by contrast-enhanced CT in bowel and/or liver or spleen. PET2 agreement amongst experts (140 scans) with kappa (95% CI) 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. (Less)
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https://lup.lub.lu.se/record/8592550
- author
- organization
- publishing date
- 2016-03
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Blood
- volume
- 127
- issue
- 12
- pages
- 1531 - 1538
- publisher
- American Society of Hematology
- external identifiers
-
- pmid:26747247
- wos:000373505600007
- scopus:84962235427
- pmid:26747247
- ISSN
- 1528-0020
- DOI
- 10.1182/blood-2015-11-679407
- language
- English
- LU publication?
- yes
- id
- c59a5d62-0980-4441-854b-3771fa0a0bb7 (old id 8592550)
- alternative location
- http://www.ncbi.nlm.nih.gov/pubmed/26747247?dopt=Abstract
- date added to LUP
- 2016-04-04 07:27:10
- date last changed
- 2022-04-07 22:35:51
@article{c59a5d62-0980-4441-854b-3771fa0a0bb7, abstract = {{International guidelines recommend PET-CT should replace CT in Hodgkin Lymphoma (HL). The aims of this study were to i) compare PET-CT with CT for staging and ii) measure agreement between expert and local readers, using a five-point scale (Deauville criteria), to adapt treatment in a clinical trial 'Response Adapted Therapy in Advanced Hodgkin Lymphoma' (RATHL) www.cancer.gov/clinicaltrials, reference NCT00678327. Patients were staged for the trial 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 labs. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement amongst 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 characterisation of lesions in the vast majority. Five patients were upstaged by marrow biopsy; 7 by contrast-enhanced CT in bowel and/or liver or spleen. PET2 agreement amongst experts (140 scans) with kappa (95% CI) 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.}}, author = {{Barrington, Sally F and Kirkwood, Amy A and Franceschetto, Antonella and Fulham, Michael J and Roberts, Thomas H and Almquist, Helén and Brun, Eva and Hjorthaug, Karin and Viney, Zaid N and Pike, Lucy C and Federico, Massimo and Luminari, Stefano and Radford, John and Trotman, Judith and Fosså, Alexander and Berkahn, Leanne and Molin, Daniel and D'Amore, Francesco and Sinclair, Donald A and Smith, Paul and O'Doherty, Michael J and Stevens, Lindsey and Johnson, Peter W}}, issn = {{1528-0020}}, language = {{eng}}, number = {{12}}, pages = {{1531--1538}}, publisher = {{American Society of Hematology}}, series = {{Blood}}, title = {{PET-CT for staging & early response: results from 'Response Adapted Therapy in Advanced Hodgkin Lymphoma' (RATHL) (CRUK/07/033).}}, url = {{http://dx.doi.org/10.1182/blood-2015-11-679407}}, doi = {{10.1182/blood-2015-11-679407}}, volume = {{127}}, year = {{2016}}, }