Revisiting the predictive role of 18F‐fluorodeoxyglucose positron emission tomography/computerized tomography on treatment outcome in early‐stage favorable Hodgkin lymphoma

Abstract

AbstractIn the present manuscript Gallamini et al. comment the results of three large, phase III, randomized clinical trials in early‐stage favorable Hodgkin Lymphoma (HL), aimed at exploring the non‐inferiority of ABVD chemotherapy alone compared to combined‐modality treatment with ABVD and Involved Field/Node Radiotherapy (INRT). The authors also report the preliminary results of risk‐stratification in the first 60 enrolled patients in the phase 2, prospective, international study RAFTING: RAdiotherapy Free Treatment IN Good‐prognosis early‐stage HL (National Trial Identifier 04866654). In this trial patients are stratified, before treatment onset, according to the risk of therapy failure in a single patient basis, taking into account non only the results of interim and End‐of‐Therapy PET, but also the value of new metrics extracted from the baseline PET/CT such as the Large Nodal Mass (LNM) and Total Metabolic Tumor Volume (TMTV). Treatment intensity, consisting in ABVD chemotherapy, INRT and Nivolumab maintenance, is modulated on the presence/absence of the above factors, in a personalized‐medicine approach. The most frequently detected factors driving treatment intensity were LNM and TMTV, while the results of interim and end‐of‐treatment PET were also determinant, albeit in a lower percentage of cases.