The HD16 trial described by Fuchs et al¹ aimed to determine whether fluorodeoxyglucose positron emission tomography (FDG-PET) scans after 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) might help predict individual outcomes and guide treatment. Of the 1,007 patients included, FDG-PET after 2 cycles of ABVD revealed a Deauville score (DS) of 1 or 2 in 667 patients (66%), a DS of 3 in 218 (22%), a DS of 4 in 122 (12%), and a DS of 5 in 0 (0%). Using a conservative threshold, patients with a DS of 1 or 2 were randomly assigned to an additional 20 Gy of radiation therapy or no further treatment, whereas all patients with a DS of ≥ 3 were treated with an additional 20 Gy of radiation therapy. In the 328 patients with a DS of 1-2 treated with ABVD and radiation therapy, 15 (4.6%) had a tumor event, whereas in the 300 patients treated with ABVD only, 29 (9.7%) had a tumor event. In the 218 patients with a DS of 3 treated with ABVD and radiation therapy, 13 (6.0%) had a tumor event, whereas in the 122 patients with a DS of 4 treated with ABVD and radiation therapy, a tumor event occurred in 17 patients (13.9%). Of all 74 tumor events in all groups combined, 7 (9.5%) were classified as early progression occurring within 3 months of treatment, 17 (23.0%) as an early relapse within 1 year of treatment, and 50 (67.6%) as a late relapse occurring > 1 year after treatment. When only considering the patients treated with ABVD and radiation therapy, the 5-year progression-free survival (PFS) rate of patients with a DS of 1-2 (93.2%) was not very different from that of patients with a DS of ≥ 3 (88.4%). However, when a DS of ≥ 4 was used as the cutoff value, the predictive value improved. The 5-year PFS rate of patients with a DS ≤ 3 (93.1%) was significantly different from that of patients with a DS of ≥ 4 (80.9%). Fuchs et al¹ concluded that an FDG-PET with a DS of ≥ 4 indicates a high risk of treatment failure, and that radiation therapy in patients with low DS cannot be omitted without a clinically relevant loss of tumor control.

中文翻译：

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氟代氧葡萄糖正电子发射断层扫描无法在治疗期间和之后检测到可行的霍奇金淋巴瘤。

Fuchs等人¹描述的HD16试验目的是确定在阿霉素，博来霉素，长春碱和达卡巴嗪（ABVD）2个周期后进行氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）扫描是否有助于预测个体结局并指导治疗。在1,007名患者中，ABVD 2个周期后的FDG-PET显示667名患者（66％）中的Deauville评分（DS）为1或2，218名中的DS为3（22％），122名中的DS为4。 （12％），DS为5比0（0％）。使用保守的阈值，将DS为1或2的患者随机分配为额外的20 Gy放射治疗或不进行进一步治疗，而所有DS≥3的患者均接受额外的20 Gy放射治疗。在用ABVD和放射疗法治疗的DS值为1-2的328例患者中，有15例（4.6％）发生了肿瘤事件，而在仅用ABVD治疗的300例患者中，有29例（9。7％）发生了肿瘤事件。在接受ABVD和放射疗法治疗的DS值为3的218例患者中，有13位（6.0％）发生了肿瘤事件，而在接受ABVD和放射疗法治疗的DS值为4的122例患者中，有17位患者发生了肿瘤事件。 （13.9％）。在所有组的所有74例肿瘤事件中，有7例（9.5％）被分类为在治疗3个月内发生的早期进展，17例（23.0％）被分类为在1年内早期复发，而50例（67.6％）被分类为1级。治疗后> 1年发生晚期复发。仅考虑接受ABVD和放射治疗的患者时，DS≥1-2的患者（93.2％）的5年无进展生存率（PFS）与DS≥≥5的患者无太大差异。 3（88.4％）。但是，当DS≥4用作临界值时，预测值会提高。DS≤3（93.1％）的患者的5年PFS率与DS≥4（80.9％）的患者的5年PFS率显着不同。福克斯等¹得出结论，DS≥4的FDG-PET表示治疗失败的风险很高，并且在没有临床相关的肿瘤控制丧失的情况下，不能省略DS低的患者的放射治疗。