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CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0045-1805091
Original Article

Can 18F-FDG PET/CT Metabolic Tumor Volume Contribute to Better Prognostication in Pediatric Hodgkin's Lymphoma?

Authors

  • Sangeetha Ramdas

    1   Pediatric Hematology-Oncology, Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India

  • Saumya Sara Sunny

    2   Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India

  • Hema Nalapalu Srinivasan

    1   Pediatric Hematology-Oncology, Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India

  • Rikki Rorima John

    1   Pediatric Hematology-Oncology, Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India

  • Rajeev Zachariah Kompithra

    3   Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India

  • Mahasampath Gowri

    4   Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

  • Leenu Lizbeth Joseph

    1   Pediatric Hematology-Oncology, Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India

  • Julie Hepzibah

    2   Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India

  • Leni Grace Mathew

    1   Pediatric Hematology-Oncology, Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India

Funding This study was funded by the Christian Medical College, Fluid Research Grant.
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Abstract

Introduction

Studies in adults have shown that metabolic tumor volume (MTV) in fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) is a strong predictor of event-free survival (EFS) and overall survival (OS) in Hodgkin's lymphoma, often outperforming clinical scores and molecular predictors. However, there very few studies on pediatric Hodgkin's lymphoma (PHL), with conflicting results.

Objectives

This retrospective study was conducted to evaluate the feasibility of MTV assessment in PHL and to assess its prognostic role, given the paucity of data from the developing world and the technical expertise required.

Materials and Methods

Children with PHL, treated per EuroNet-PHL-C1 interim guidelines/C2 protocol at our center from 2017 to 2020 who had baseline and interim PET (iPET) scan done at our institution were included. MTV was measured in tumor areas with standardized uptake value (SUVmax) ≥2.5. MTV and SUVmax were compared at diagnosis and after two chemotherapy courses.

Results

Sixty-one children (male:female = 1.5:1; mean age: 10.10 years) were recruited and categorized into four stages (SI: 11; SII: 15; SIII: 21; and SIV: 14) and three treatment groups (TG1: 16; TG2: 11; and TG3: 34). Based on iPET, 47 and 14 children were adequate and inadequate responders, respectively. At a median follow-up period of 54 months, the OS was 96.7% and the EFS was 85.2%. The median SUVmax and MTV were both found to increase with advancing disease stage with a positive correlation (r = 0.41; p = 0.002). The difference in the median MTV was statistically significant for SII versus SIII (p = 0.004) but not for the median SUVmax (p = 0.13). Similarly, the difference in the median MTV was statistically significant for TG2 versus TG3 (p = 0.001) but not for the median SUVmax (p = 0.06). The median MTV in baseline PET/CT with Deauville score–based treatment response groups for adequate and inadequate responders was 98.35 (37.93–298.2) mL and 145 (84.43–463.5) mL, respectively (p = 0.31), and for those with events versus no events, the median MTV was 304 (30.45–452.7) mL and 105.35 (37.9–309.2) mL, respectively (p = 0.82).

Conclusion

Baseline PET/CT MTV showed better correlation than SUVmax in delineating stage and treatment groups. However, MTV in isolation was not sensitive or specific enough in prognosticating treatment response or EFS (relapse or death) in this study setting. The addition of significant clinico-biochemical parameters with MTV for future studies could enhance prognostication.

Keywords

18F-FDG PET/CT - event-free survival - metabolic tumor volume - overall survival - pediatric Hodgkin's lymphoma - prognostication - standardized uptake value

Authors' Contributions

S.R. and S.S.S. contributed to the design of the study, literature search, clinical studies, data acquisition and analysis, and manuscript preparation. H.N.S. contributed to the concepts, literature search, clinical studies, data analysis, and manuscript editing. R.R.J. contributed to the concepts, design, literature search, clinical studies, data analysis, manuscript editing, and manuscript review. R.Z.K. contributed to the design, literature search, clinical studies, data analysis, and manuscript editing. M.G. contributed to the design, data analysis, statistical analysis, and manuscript editing. L.L.J. contributed to the concepts, design, literature search, clinical studies, data analysis, statistical analysis, and manuscript review. J.H. contributed to the concepts, design, literature search, clinical studies, statistical analysis, and manuscript review. L.G.M. contributed to the concepts, design, definition of intellectual content, literature search, clinical studies, statistical analysis, and manuscript review, and served as a guarantor.


The authors wish to state that the manuscript has been read and approved by all the authors, that the requirements for authorship have been met, and that each author believes that the manuscript represents honest work.


Patient Consent

Individual patient consent was not required for this retrospective study, as approved by the Institutional Review Board (IRB) of the institution (IRB Min No. 14743/6.7.22).




Publication History

Article published online:
10 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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