Treatment of Hodgkin lymphoma (HL) has evolved with risk-stratified therapy based on PET-CT scan at multiple timepoints. In a resource constraint setting even a single PET-CT scan ($400) is inaccessible to many patients, who are re-assessed with only clinical examination, abdominal ultrasonogram and/or x-ray (C/U/X) ($10). To compare clinical outcomes in patients with HL who have had suboptimal imaging after completion of chemotherapy for HL, with those who had a CT or PET-CT, 283 patients were treated for HL from 2011 to 2015, and 268 patients completed six cycles of ABVD therapy with response assessment modality by CT/PET in 185 patients and by C/U/X in 83. There was no difference in the number of patients with advanced (64·1% vs. 61·1%; P = 0·650) or bulk disease (8·1% vs. 7·2%). A significantly higher number of patients in the CT/PET group received IFRT (25·4% vs. 7·7%; P = 0·0005). The three-year overall survival and progression-free survival of all treated patients (n = 283) was 83·5 ± 2·3% and 76·7 ± 2·6% respectively [median follow-up 36 months (range 2-93)]. At three years, the overall relapse-free survival (RFS) was 80·1 ± 2·5%, with RFS of 77 ± 3·2% vs. 85 ± 4·0% in the CT/PET group and C/U/X groups respectively (P = 0·349). There was no difference in RFS between the two groups either in early-stage disease (88·1 ± 4·6% vs. 91·8 ± 5·6%; P = 0·671) or late-stage disease (73·9 ± 4·8% vs. 81·3 ± 6·0%; P = 0·747). The only significant factor adversely affecting RFS was advanced disease (P = 0·004). Factors not affecting RFS were age (P = 0·763), sex (P = 0·925), bulk disease (P = 0·889) and imaging modality (P = 0·352). There was no difference in relapse rates between patients who had suboptimal imaging compared to those who had a PET/CT. It is possible to use these basic imaging modalities when resources are a constraint, with acceptable outcomes.

中文翻译：

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在资源有限的情况下，成像方式对霍奇金淋巴瘤临床结局的影响。

基于在多个时间点进行PET-CT扫描的风险分层疗法已发展为霍奇金淋巴瘤（HL）的治疗。在资源紧张的情况下，许多患者甚至无法进行一次PET-CT扫描（400美元），仅通过临床检查，腹部超声检查和/或X射线（C / U / X）（10美元）进行重新评估。为了比较在完成HL化疗后影像学表现欠佳的HL患者与接受CT或PET-CT的HL患者的临床结局，2011年至2015年共治疗283例HL患者，其中268例患者完成了六个ABVD周期185例患者采用CT / PET进行反应评估方式的治疗，83例采用C / U / X进行反应评估方式的治疗。晚期患者的数量没有差异（64·1％对61·1％； P = 0·650） ）或散装疾病（8·1％比7·2％）。CT / PET组中接受IFRT的患者明显更多（25·4％比7·7％； P = 0·0005）。所有接受治疗的患者（n = 283）的三年总体生存率和无进展生存率分别为83·5±2·3％和76·7±2·6％[中位随访36个月（范围2 – 93）]。三年后，总无复发生存率（RFS）为80·1±2·5％，RFS为77±3·2％，而CT / PET和C / U组为85±4·0％ / X组（P = 0·349）。两组的RFS在早期疾病（88·1±4·6％与91·8±5·6％； P = 0·671）或晚期疾病（73· 9±4·8％与81·3±6·0％； P = 0·747）。不利影响RFS的唯一重要因素是晚期疾病（P = 0·004）。不影响RFS的因素包括年龄（P = 0·763），性别（P = 0·925），大量疾病（P = 0·889）和影像学检查（P = 0·352）。影像学欠佳的患者与PET / CT的患者之间的复发率没有差异。当资源有限且结果可接受时，可以使用这些基本成像方式。