Prognostic importance of metabolic tumor parameters on initial  FDG-PET/CT in patients with isolated infradiaphragmatic Hodgkin’s lymphoma

Engin Alagoz; Kursat Okuyucu; Semra Ince; Gokhan Ozgur; Ozlem Ozmen; Alper Ozgur Karacalioglu; Mustafa Ozturk; Nuri Arslan

doi:10.2298/VSP160322087A

Engin Alagoz Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine; Etlik-Ankara, Turkey
Kursat Okuyucu Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine; Etlik-Ankara, Turkey
Semra Ince Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine; Etlik-Ankara, Turkey
Gokhan Ozgur Gulhane Military Medical Academy and School of Medicine, Department of Haematology, Etlik-Ankara, Turkey;
Ozlem Ozmen Training and Research Hospital, Ataturk Chest Diseases and Thoracic Surgery, Department of Nuclear Medicine, Kecioren, Ankara, Turkey
Alper Ozgur Karacalioglu Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine, Etlik-Ankara, Turkey
Mustafa Ozturk Gulhane Military Medical Academy and School of Medicine, Department of Medical Oncology, Etlik-Ankara, Turkey
Nuri Arslan Gulhane Military Medical Academy and School of Medicine, Department of Nuclear Medicine,Etlik-Ankara, Turkey

DOI: https://doi.org/10.2298/VSP160322087A

Keywords: hodgkin disease, lymph nodes, diaphragm, positron- emission tomography, fluordeoxyglucose f18, tomography, x-ray computed, prognosis,

Abstract

Background/Aim. Isolated infradiaphragmatic lymph node involvement is not common and makes up 5–13% of stage I-II Hodgkin’s lymphoma. Important subjects about prognostic factors and optimal treatment of isolated infradiaphragmatic Hodgkin’s lymphoma (II HL) have not been clearly defined. We aimed to evaluate the prognostic value of metabolic tumor indices on initial 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) through quantitative PET/CT parameters together with the classical predefined risk factors for patients with II HL. Methods. This retrospective cohort study conducted between 2004 and 2015 included 21 patients for whom FDG-PET/CT were requested for primary staging. Quantitative PET/CT parameters (maximum standardized uptake value – SUV max) average standardized uptake value – SUV mean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were used to estimate disease-free survival and overall survival. Results. Univariate Cox regression analysis was performed for all potential risk factors impacting metastasis/recurrence of the disease. Factors which had values of p < 0.2 after univariate analysis (sex, age, stage, bulky disease, SUV max, SUV mean, MTV, TLG) were processed with the multivariate model. Sex, TLG and bulky disease were found to be statistically significant risk factors for prognosis of outcome in patients with IIHL after multivariate analysis. Conclusion. The existence of bulky disease at the diagnosis and high TLG values on primary staging by FDG-PET/CT are potential risk factors for both disease-free survival and overall survival in Hodgkin’s lymphoma with isolated infradiaphragmatic lymph node involvement.

References

Song JY, Eberle FC, Xi L, Raffeld M, Rahma O, Wilson WH, et al. Coexisting and clonally identical classic hodgkin lymphoma and nodular lymphocyte predominant hodgkin lymphoma. Am J Surg Pathol 2011;35(5):767-72. PubMed PMID: 21490448

Swerdlow S, Campo E, Harris N, Jaffe E, Pileri S. WHO CLassifi-cation of Tumours of Haematopoietic and Lymphoid Tissues. 4th ed. Lyon: IARC; 2008.

Vassilakopoulos TP, Angelopoulou MK, Siakantaris MP, Konstantinou N, Symeonidis A, Karmiris T, et al. Pure infradiaphragmatic Hodgkin's lymphoma. Clinical features, prognostic factor and comparison with supradiaphragmatic disease. Haematologica 2006; 91(1): 32−9.

Johnson DW, Hoppe RT, Cox RS, Rosenberg SA, Kaplan HS. Hodgkin's disease limited to intrathoracic sites. Cancer 1983; 52(1): 8−13.

Iannitto E, Accurso V, Federico M, Vallisa D, Pieresca C, Gravina SF, et al. Hodgkin's disease presenting below the diaphragm. The experience of the Gruppo Italiano Studio Linfomi (GISL). Haematologica 1997;82(6):676-682.

Valette F, Querellou S, Oudoux A, Carlier T, Dupas B, Chatal JF, et al. Comparison of positron emission tomography and lym-phangiography in the diagnosis of infradiaphragmatic Hodg-kin's disease. Acta Radiol 2007; 48(1): 59−63.

Picardi M, Soricelli A, Grimaldi F, Nicolai E, Gallamini A, Pane F. Fused FDG-PET/contrast-enhanced CT detects occult sub-diaphragmatic involvement of Hodgkin's lymphoma thereby identifying patients requiring six cycles of anthracycline-containing chemotherapy and consolidation radiation of spleen. Ann Oncol 2011; 22(3): 671−80.

Mason MD, Law M, Ashley S, Nichols J, Brada M, Peckham MJ, et al. Infradiaphragmatic Hodgkin's disease. Eur J Cancer 1992; 28(11): 1851−2.

Specht L, Nissen NI. Hodgkin's disease stages I and II with infradiaphragmatic presentation: a rare and prognostically un-favourable combination. Eur J Haematol 1988; 40(5): 396−402.

Barton M, Boyages J, Crennan E, Davis S, Fisher RJ, Hook C, et al. Radiotherapy for early infradiaphragmatic Hodgkin's disease: The Australasian experience. Radiother Oncol 1996; 39(1): 1−7.

Mai DH, Peschel RE, Portlock C, Knowlton A, Farber L. Stage I and II subdiaphragmatic Hodgkin's disease. Cancer 1991; 68(7): 1476−81.

Mauch P, Greenberg H, Lewin A, Cassady JR, Weichselbaum R, Hellman S. Prognostic factors in patients with subdiaph-ragmatic Hodgkin's disease. Hematol Oncol 1983; 1(3): 205−14.

Liao Z, Ha CS, Fuller LM, Hagemeister FB, Cabanillas F, Tucker SL, et al. Subdiaphragmatic stage I & II Hodgkin's disease: Long-term follow-up and prognostic factors. Int J Radiat On-col Biol Phys 1998; 41(5): 1047−56.

Darabi K, Sieber M, Chaitowitz M, Braitman LE, Tester W, Diehl V. Infradiaphragmatic versus supradiaphragmatic Hodgkin lymphoma: A retrospective review of 1,114 patients. Leuk Lymphoma 2005; 46(12): 1715−20.

Cutuli B, Petit T, Hoffstetter S, Velten M, Dufour P, Giron C, et al. Treatment of subdiaphragmatic Hodgkin's disease: Long-term results and side effects. Oncol Rep 1998; 5(6): 1513−8.

Enrici RM, Osti MF, Anselmo AP, Banelli E, Cartoni C, Sbarbati S, et al. Hodgkin's disease stage I and II with exclusive sub-diaphragmatic presentation. The experience of the Depart-ments of Radiation Oncology and Hematology, University "La Sapienza", of Rome. Tumori 1996; 82(1): 48−52.

Kälkner KM, Enblad G, Gustavsson A, Starkhammar H, Branehög SH, Lenner P, et al. Infradiaphragmatic Hodgkin's disease: The Swedish National Care Programme experience. The Swedish Lymphoma Study Group. Eur J Haematol 1997; 59(1): 31−7.

Hull MC, Mendenhall NP, Colgan ME. Subdiaphragmatic Hodg-kin's disease: The University of Florida experience. Int J Radiat Oncol Biol Phys 2002; 52(1): 161−6.

Córdoba S, Romero J, de la Torre A, Valcárcel F, Magallón R, Regueiro CA, et al. Early stage infradiaphragmatic Hodgkin's disease: Results of radiotherapy and review of the literature. Radiother Oncol 2003; 67(3): 259−63.

Crnkovich MJ, Leopold K, Hoppe RT, Mauch PM. Stage I to IIB Hodgkin's disease: the combined experience at Stanford Uni-versity and the Joint Center for Radiation Therapy. J Clin On-col 1987; 5(7): 1041−9.

Partridge S, Timothy A, O'Doherty MJ, Hain SF, Rankin S, Mik-haeel G. 2-Fluorine-18-fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of Hodgkin's disease: Influence on patient management in a single institution. Ann Oncol 2000; 11(10): 1273−9.

Swerdlow AJ, Douglas AJ, Hudson VG, Hudson VB, MacLennan KA. Risk of second primary cancer after Hodgkin's disease in patients in the British National Lymphoma Investigation: Rela-tionships to host factors, histology and stage of Hodgkin's disease, and splenectomy. Br J Cancer 1993; 68(5): 1006−11.

Diehl V, Stein H, Hummel M, Zollinger R, Connors JM. Hodgkin's lymphoma: Biology and treatment strategies for primary, re-fractory, and relapsed disease. Hematology Am Soc Hematol Educ Program 2003: 225−47.

Kim TM, Paeng JC, Chun IK, Keam B, Jeon YK, Lee SH, et al. Total lesion glycolysis in positron emission tomography is a better predictor of outcome than the International Prognostic Index for patients with diffuse large B cell lymphoma. Cancer 2013; 119(6): 1195−202.

Gallicchio R, Mansueto G, Simeon V, Nardelli A, Guariglia R, Ca-pacchione D, et al. F-18 FDG PET/CT quantization parameters as predictors of outcome in patients with diffuse large B-cell lymphoma. Eur J Haematol 2014; 92(5): 382−9.

Ceriani L, Martelli M, Zinzani PL, Ferreri AJ, Botto B, Stelitano C, et al. Utility of baseline 18FDG PET/CT functional parame-ters in defining prognosis of primary mediastinal (thymic) large B-cell lymphoma. Blood 2015; 126(8): 950−6.

Song MK, Chung JS, Lee JJ, Jeong SY, Lee SM, Hong JS, et al. Me-tabolic tumor volume by positron emission tomogra-phy/computed tomography as a clinical parameter to deter-mine therapeutic modality for early stage Hodgkin's lympho-ma. Cancer Sci 2013; 104(12): 1656−61.