We read with interest the recent article in Journal of Clinical Oncology by André et al,¹ which included 1,950 patients with early-stage favorable or unfavorable Hodgkin lymphoma who underwent interim fluorodeoxyglucose (FDG) positron emission tomography (PET) after two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Depending on the interim FDG-PET results, patients were randomly assigned to continuation of ABVD therapy with involved-field radiotherapy (IFRT); intensified therapy with escalated doses of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) and IFRT; or de-escalated therapy with ABVD monotherapy without IFRT. After two cycles of ABVD, interim FDG-PET was positive in 18.8% of patients (13.0% with a favorable and 22.4% with an unfavorable risk profile). Treatment de-escalation in interim FDG-PET–negative patients was considered infeasible because of the higher relapse rate in patients treated without IFRT in both the favorable and unfavorable Hodgkin lymphoma subgroups. Unfortunately, subgroup analyses in interim FDG-PET–positive patients was not performed “because of their presumed common poor prognosis.”^1(p1787) The 5-year progression-free survival (PFS) rate was 77.4% in interim FDG-PET–positive patients treated with standard treatment, with 36 of 192 (18.8%) patients developing disease relapse during follow-up, whereas the 5-year PFS rate was 90.6% in interim FDG-PET–positive patients treated with escalated treatment, with 13 of 169 (7.7%) patients developing disease relapse during follow-up, resulting in a risk difference of 11.1%. André et al¹ concluded that classic European Organisation for Research and Treatment of Cancer prognostic factors (eg, erythrocyte sedimentation rate, B symptoms, age, and bulky disease) lose clinical relevance in the era of FDG- PET–adapted therapy. They also concluded that interim FDG-PET allowed for early treatment adaptation, but only for treatment intensification in interim FDG-PET–positive patients, whereas a negative interim FDG-PET result was not considered appropriate for omission of IFRT.

中文翻译：

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临时氟代氧葡萄糖正电子发射断层扫描-适应性治疗不是改善早期霍奇金淋巴瘤结果的有效方法。

我们感兴趣地阅读了André等人在《临床肿瘤学杂志》上发表的最新文章，¹其中包括1,950例早期，早期或早期恶性霍奇金淋巴瘤患者，他们在接受了两个周期的阿霉素，博来霉素，长春碱和达卡巴嗪（ABVD）治疗后接受了中期氟脱氧葡萄糖（FDG）正电子发射断层显像（PET）。根据FDG-PET的中期结果，患者被随机分配继续进行ABVD治疗，并采用累及野放疗（IFRT）。逐步增加剂量的博来霉素，依托泊苷，阿霉素，环磷酰胺，长春新碱，丙卡巴肼和泼尼松（BEACOPP）和IFRT的强化治疗；或没有IFRT的ABVD单一疗法的降级治疗。在两个ABVD周期后，临时FDG-PET在18.8％的患者中呈阳性（13.0％的患者为良好，而22.4％的患者为不良风险）。暂时性FDG-PET阴性患者的治疗降级被认为是不可行的，因为在好和不利的霍奇金淋巴瘤亚组中，未经IFRT治疗的患者复发率更高。不幸的是，“由于他们假定的一般不良预后”，未对FDG-PET阳性的中期患者进行亚组分析。^1（p1787）在接受标准治疗的FDG-PET中期患者中，其5年无进展生存率（PFS）为77.4％，其中192名患者中有36名（18.8％）在随访期间出现疾病复发，而在逐步接受治疗的FDG-PET阳性中期患者中，其5年PFS率为90.6％，在169名患者中有13名（7.7％）在随访期间出现疾病复发，因此风险差异为11.1％。安德烈（André）等人¹结论是，经典的欧洲癌症研究和治疗预后因素组织（例如，红细胞沉降率，B症状，年龄和大块疾病）在采用FDG-PET的治疗时代失去了临床意义。他们还得出结论，临时性FDG-PET允许早期治疗适应，但仅适用于临时性FDG-PET阳性患者的强化治疗，而阴性的临时性FDG-PET结果不适合省略IFRT。