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Annals of Oncology Advance Access originally published online on January 21, 2008
Annals of Oncology 2008 19(5):951-957; doi:10.1093/annonc/mdm596
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

hematologic malignancies

Late computed tomography scan response improvement and gallium scintigraphy evaluation as on-treatment prognostic parameters to tailor treatment intensity in patients with Hodgkin's lymphoma. A prospective phase II study

A. Re1,*, S. Ferrari1, P. Frata2, C. Pizzocaro3, C. Crippa1, A. Tucci1, F. Facchetti4, L. Grazioli5, S.M. Magrini2 and G. Rossi1

1 U.O. Ematologia, Spedali Civili di Brescia, Brescia
2 Istituto del Radio, Università di Brescia, Brescia
3 Medicina Nucleare, Spedali Civili di Brescia, Brescia
4 Anatomia Patologica I, Università di Brescia, Brescia
5 Radiologia I, Spedali Civili di Brescia, Brescia, Italy

* Correspondence to: Dr A. Re, U.O. Ematologia, Spedali Civili di Brescia, Piazzale Spedali Civili no. 1, 25100 Brescia, Italy. Tel: +39-30-3995438; Fax: +39-30-3700852; E-mail: sandrore{at}aruba.it

Background: Tailoring treatment intensity is critical in Hodgkin's lymphoma (HL). Ongoing prognostic parameters may be an useful adjunct to pretreatment stratification. We used the kinetics of computed tomography (CT) scan response and residual gallium (Ga)-67 uptake to better stratify risk.

Materials and methods: Patients received 4–8 adriamycin, bleomycin, vinblastine and dacarbazine courses according to stage. Disease was reassessed evaluating late computed tomography scan response improvement (CTRI) and Ga-67 uptake. Patients received no further treatment, radiotherapy (RT) or additional chemotherapy + RT according to the presence of none (low risk), one (intermediate risk) and both parameters (high risk). Patients with bulky mediastinum received RT anyhow.

Results: Among 102 assessable patients, 35 showed late CTRI and 9 residual Ga-67 uptake. In 30 patients with bulky mediastinum, the 3-year progression-free survival (PFS) was significantly better when neither parameter was present (100% versus 69%; P = 0.02). In 72 patients without bulky mediastinum, treatment was tailored according to risk assignment. Relapses occurred in 5 of 47 low-risk and 3 of 21 intermediate-risk patients, with no differences between the two groups, and in 3 of 4 high-risk patients.

Conclusion: This study shows that two on-treatment parameters, late CTRI and residual Ga-67 uptake, can predict PFS in HL and identify patients in which RT can be spared without apparently affecting the outcome.

Key words: computed tomography scan, Ga-67 scintigraphy, Hodgkin's lymphoma, prognostic factors

Received for publication June 21, 2007. Revision received September 28, 2007. Accepted for publication December 14, 2007.


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