Positron emission tomography scanning in the management of Hodgkin lymphoma patients: A single-institution experience

Abstract

Background. Positron emission tomography (PET-CT) has become a valuable implement in the management of Hodgkin lymphoma (HL). However, since PET-CT is a relatively new imaging method, its capabilities have not been fully explored. Objectives. The aim of the study was to evaluate the role of PET-CT at different points in HL management. Material and Methods. The medical documentation of 47 HL patients treated at the Comprehensive Cancer Center in Białystok, Poland, was analyzed retrospectively. The study group consisted of 15 men and 32 women, aged 18-59 years, in HL clinical stages II-IV, treated either with chemotherapy or sequential chemoradiotherapy. Results. In 65.2% of the patients who underwent post-chemotherapy PET-CT scanning before their qualification for adjuvant radiotherapy (RT), PET-CT was decisive in qualifying them for RT, by establishing whether or not metabolic partial remission (PR) had occurred. With regard to the achievement of partial or complete response (CR), computed tomography (CT) and PET-CT results correlated in 45.5% of the patients after the completion of chemotherapy, and in 18.7% after the completion of the entire treatment (chemotherapy or chemoradiotherapy). Among the patients from the advanced-stage group (stages III/IV stage and/or bulky HL), morphological PR in CT scans after two to three courses of chemotherapy was more often associated with a lack of metabolic CR in posttreatment PET-CT scanning (p = 0.022) than in other patients. Post-treatment PET-CT scanning was shown to be highly prognostic of a relapse-free follow-up (p < 0.0001) and superior to post-treatment CT imaging in relapse prediction (p < 0.0001). Conclusions. Compared to CT, PET-CT was more accurate in residual masses assessment. Notable ability of PET-CT in relapse-free follow-up prediction encourages to more common use of PET-CT in clinical practice. Further clinical research on the need for RT in patients with PR in CT parallel to CR in PET-CT is required.