期刊
BLOOD
卷 127, 期 12, 页码 1531-1538出版社
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2015-11-679407
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资金
- Cancer Research UK [CRUK/07/033]
- Associazione Angela Serra for Cancer Research (Modena, Italy)
- Larvik Kreftforening, Norway
- Cancer Australia's Priority Driven Collaborative Cancer Research Scheme
- Cancer Research UK
- National Institute for Health Research in England
- Department of Health for Scotland [C19631/A16091]
- Department of Health for Wales [C19631/A16091]
- Department of Health for Northern Ireland [C19631/A16091]
- Cancer Research UK [9619, 16463, 15953] Funding Source: researchfish
International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged 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 laboratories. Local readers optionally scored PET2scans. The RATHL and PET-CT stages were compared. Agreement among 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 characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a k (95% confidence interval) 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.
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