Hypodense volumes (HDV) in mediastinal masses can be visualized in a computed tomography scan in Hodgkin lymphoma. We analyzed staging CT scans of 1178 patients with mediastinal involvement from the EuroNet-PHL-C1 trial and explored correlations of HDV with patient characteristics, mediastinal tumor volume and progression-free survival. HDV occurred in 350 of 1178 patients (29.7%), typically in larger mediastinal volumes. There were different patterns in appearance with single lesions found in 243 patients (69.4%), multiple lesions in 107 patients (30.6%). Well delineated lesions were found in 248 cases (70.1%), diffuse lesions were seen in 102 cases (29.1%). Clinically, B symptoms occurred more often in patients with HDV (47.7% compared to 35.0% without HDV (p = 0.039)) and patients with HDV tended to be in higher risk groups. Inadequate overall early-18F-FDG-PET-response was strongly correlated with the occurrence of hypodense lesions (p < 0.001). Patients with total HDV > 40 ml (n = 80) had a 5 year PFS of 79.6% compared to 89.7% (p = 0.01) in patients with HDV < 40 ml or no HDV. This difference in PFS is not caused by treatment group alone. HDV is a common phenomenon in HL with mediastinal involvement.

• MeSH
• doba přežití bez progrese choroby MeSH
• dospělí MeSH
• fluorodeoxyglukosa F18 MeSH
• Hodgkinova nemoc * patologie   diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mediastinum patologie   diagnostické zobrazování   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nádory mediastina * patologie   diagnostické zobrazování   MeSH
• počítačová rentgenová tomografie MeSH
• pozitronová emisní tomografie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Disseminated pulmonary involvement in pediatric Hodgkin lymphoma (pHL) is indicative of Ann Arbor stage IV disease. During staging, it is necessary to assess for coexistence of non-malignant lung lesions due to infection representing background noise to avoid erroneously upstaging with therapy intensification. OBJECTIVE: This study attempts to describe new lung lesions detected on interim staging computed tomography (CT) scans after two cycles of vincristine, etoposide, prednisolone, doxorubicin in a prospective clinical trial. Based on the hypothesis that these new lung lesions are not part of the underlying malignancy but are epiphenomena, the aim is to analyze their size, number, and pattern to help distinguish true lung metastases from benign lung lesions on initial staging. MATERIALS AND METHODS: A retrospective analysis of the EuroNet-PHL-C1 trial re-evaluated the staging and interim lung CT scans of 1,300 pediatric patients with HL. Newly developed lung lesions during chemotherapy were classified according to the current Fleischner glossary of terms for thoracic imaging. Patients with new lung lesions found at early response assessment (ERA) were additionally assessed and compared to response seen in hilar and mediastinal lymph nodes. RESULTS: Of 1,300 patients at ERA, 119 (9.2%) had new pulmonary lesions not originally detectable at diagnosis. The phenomenon occurred regardless of initial lung involvement or whether a patient relapsed. In the latter group, new lung lesions on ERA regressed by the time of relapse staging. New lung lesions on ERA in patients without relapse were detected in 102 (7.8%) patients. Pulmonary nodules were recorded in 72 (5.5%) patients, the majority (97%) being<10 mm. Consolidations, ground-glass opacities, and parenchymal bands were less common. CONCLUSION: New nodules on interim staging are common, mostly measure less than 10 mm in diameter and usually require no further action because they are most likely non-malignant. Since it must be assumed that benign and malignant lung lesions coexist on initial staging, this benign background noise needs to be distinguished from lung metastases to avoid upstaging to stage IV disease. Raising the cut-off size for lung nodules to ≥ 10 mm might achieve the reduction of overtreatment but needs to be further evaluated with survival data. In contrast to the staging criteria of EuroNet-PHL-C1 and C2, our data suggest that the number of lesions present at initial staging may be less important.

• MeSH
• dítě MeSH
• doxorubicin terapeutické užití   MeSH
• etoposid terapeutické užití   aplikace a dávkování   MeSH
• Hodgkinova nemoc * diagnostické zobrazování   patologie   farmakoterapie   MeSH
• lidé MeSH
• mladiství MeSH
• nádory plic * diagnostické zobrazování   patologie   MeSH
• počítačová rentgenová tomografie * metody   MeSH
• předškolní dítě MeSH
• prevalence MeSH
• prospektivní studie MeSH
• protokoly antitumorózní kombinované chemoterapie terapeutické užití   MeSH
• retrospektivní studie MeSH
• staging nádorů * MeSH
• vinkristin terapeutické užití   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

18F-FDG PET/MRI might be the diagnostic method of choice for Hodgkin lymphoma patients, as it combines significant metabolic information from PET with excellent soft-tissue contrast from MRI and avoids radiation exposure from CT. However, a major issue is longer examination times than for PET/CT, especially for younger children needing anesthesia. Thus, a targeted selection of suitable whole-body MRI sequences is important to optimize the PET/MRI workflow. Methods: The initial PET/MRI scans of 84 EuroNet-PHL-C2 study patients from 13 international PET centers were evaluated. In each available MRI sequence, 5 PET-positive lymph nodes were assessed. If extranodal involvement occurred, 2 splenic lesions, 2 skeletal lesions, and 2 lung lesions were also assessed. A detection rate was calculated dividing the number of visible, anatomically assignable, and measurable lesions in the respective MRI sequence by the total number of lesions. Results: Relaxation time-weighted (T2w) transverse sequences with fat saturation (fs) yielded the best result, with detection rates of 95% for nodal lesions, 62% for splenic lesions, 94% for skeletal lesions, and 83% for lung lesions, followed by T2w transverse sequences without fs (86%, 49%, 16%, and 59%, respectively) and longitudinal relaxation time-weighted contrast-enhanced transverse sequences with fs (74%, 35%, 57%, and 55%, respectively). Conclusion: T2w transverse sequences with fs yielded the highest detection rates and are well suited for accurate whole-body PET/MRI in lymphoma patients. There is no evidence to recommend the use of contrast agents.

• MeSH
• celotělové zobrazování metody   MeSH
• difuzní magnetická rezonance metody   MeSH
• dítě MeSH
• fluorodeoxyglukosa F18 MeSH
• Hodgkinova nemoc * diagnostické zobrazování   patologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• nemoci kostí * MeSH
• PET/CT MeSH
• pozitronová emisní tomografie metody   MeSH
• průběh práce MeSH
• radiofarmaka MeSH
• staging nádorů MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Rebound thymic hyperplasia (RTH) is a common phenomenon caused by stress factors such as chemotherapy (CTX) or radiotherapy, with an incidence between 44% and 67.7% in pediatric lymphoma. Misinterpretation of RTH and thymic lymphoma relapse (LR) may lead to unnecessary diagnostic procedures including invasive biopsies or treatment intensification. The aim of this study was to identify parameters that differentiate between RTH and thymic LR in the anterior mediastinum. METHODS: After completion of CTX, we analyzed computed tomographies (CTs) and magnetic resonance images (MRIs) of 291 patients with classical Hodgkin lymphoma (CHL) and adequate imaging available from the European Network for Pediatric Hodgkin lymphoma C1 trial. In all patients with biopsy-proven LR, an additional fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT was assessed. Structure and morphologic configuration in addition to calcifications and presence of multiple masses in the thymic region and signs of extrathymic LR were evaluated. RESULTS: After CTX, a significant volume increase of new or growing masses in the thymic space occurred in 133 of 291 patients. Without biopsy, only 98 patients could be identified as RTH or LR. No single finding related to thymic regrowth allowed differentiation between RTH and LR. However, the vast majority of cases with thymic LR presented with additional increasing tumor masses (33/34). All RTH patients (64/64) presented with isolated thymic growth. CONCLUSION: Isolated thymic LR is very uncommon. CHL relapse should be suspected when increasing tumor masses are present in distant sites outside of the thymic area. Conversely, if regrowth of lymphoma in other sites can be excluded, isolated thymic mass after CTX likely represents RTH.

• MeSH
• dítě MeSH
• fluorodeoxyglukosa F18 terapeutické užití   MeSH
• Hodgkinova nemoc * diagnostické zobrazování   farmakoterapie   komplikace   MeSH
• hyperplazie thymu * diagnostické zobrazování   etiologie   MeSH
• lidé MeSH
• lokální recidiva nádoru diagnostické zobrazování   farmakoterapie   MeSH
• lymfom * farmakoterapie   MeSH
• nádory brzlíku * diagnostické zobrazování   farmakoterapie   komplikace   MeSH
• počítačová rentgenová tomografie MeSH
• pozitronová emisní tomografie metody   MeSH
• radiofarmaka MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• Hodgkinova nemoc * diagnostické zobrazování   terapie   MeSH
• lidé MeSH
• multimodální zobrazování metody   MeSH
• pozitronová emisní tomografie metody   MeSH
• protokoly protinádorové léčby MeSH
• staging nádorů metody   MeSH
• tomografie emisní počítačová metody   MeSH
• Check Tag
• lidé MeSH

In first-line treatment of Hodgkin lymphoma (HL), Deauville scores 1-3 define complete metabolic remission. Interim 18F-FDG PET is also used for relapse-treatment adaptation; however, PET response criteria are not validated for relapse treatment. Methods: We performed a pairwise comparative analysis of early response to first- and second-line treatments in 127 patients with classic HL who experienced relapse. The patients participated in the prospective, multicenter EuroNet-PHL-C1 study. Residual uptake was measured retrospectively using the qPET method, a validated semiautomatic quantitative extension of the Deauville score. Empiric cumulative distribution functions of the qPET values were used to systematically analyze the response to first- and second-line treatments. Results: Individual patients responded variably to first- and second-line treatments. However, the empiric cumulative distribution functions of the qPET values from all patients were nearly superimposable. Conclusion: The findings support that first- and second-line treatments in HL do not require different response criteria.

• MeSH
• dítě MeSH
• Hodgkinova nemoc diagnostické zobrazování   patologie   terapie   MeSH
• lidé MeSH
• mladiství MeSH
• pozitronová emisní tomografie * MeSH
• progrese nemoci * MeSH
• recidiva MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: In the EuroNet Pediatric Hodgkin Lymphoma (EuroNet-PHL) trials, decision on Waldeyer's ring (WR) involvement is usually based on clinical assessment, that is, physical examination and/or nasopharyngoscopy. However, clinical assessment only evaluates mucosal surface and is prone to interobserver variability. Modern cross-sectional imaging technology may provide valuable information beyond mucosal surface, which may lead to a more accurate WR staging. PATIENTS, MATERIALS, AND METHODS: The EuroNet-PHL-C1 trial recruited 2102 patients, of which 1752 underwent central review including reference reading of their cross-sectional imaging data. In 14 of 1752 patients, WR was considered involved according to clinical assessment. In these 14 patients, the WR was re-assessed by applying an imaging-based algorithm considering information from 18 F-fluorodeoxyglucose positron emission tomography, contrast-enhanced computed tomography, and/or magnetic resonance imaging. For verification purposes, the imaging-based algorithm was applied to 100 consecutive patients whose WR was inconspicuous on clinical assessment. RESULTS: The imaging-based algorithm confirmed WR involvement only in four of the 14 patients. Of the remaining 10 patients, four had retropharyngeal lymph node involvement and six an inconspicuous WR. Applying the imaging-based algorithm to 100 consecutive patients with physiological appearance of their WR on clinical assessment, absence of WR involvement could be confirmed in 99. However, suspicion of WR involvement was raised in one patient. CONCLUSIONS: The imaging-based algorithm was feasible and easily applicable at initial staging of young patients with Hodgkin lymphoma. It increased the accuracy of WR staging, which may contribute to a more individualized treatment in the future.

• MeSH
• dítě MeSH
• fluorodeoxyglukosa F18 analýza   MeSH
• Hodgkinova nemoc diagnostické zobrazování   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mladiství MeSH
• multimodální zobrazování MeSH
• počítačová rentgenová tomografie MeSH
• pozitronová emisní tomografie MeSH
• předškolní dítě MeSH
• staging nádorů MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

Úvod: V posledních letech se pozitronová emisní tomografie v kombinaci s výpočetní tomografií (PET/CT) změnila a zcela se zlepšily léčebné postupy u pacientů s Hodgkinovým lymfomem (HL). Hlavní myšlenkou několika studií je použití PET/CT a protokolů Mezinárodního prognostického skóre (International Prognostic Score – IPS) při identifikaci pacientů s vysokým rizikem a potenciálního časného relapsu/refrakterního onemocnění. Materiál a metody: Tato studie vychází z hodnocení PET/CT a léčebných strategií u pacientů z osmi hematologických center na Ukrajině. Pacientům ve věku 67 let nebo mladším, kteří byli zařazeni do studie, byl nově diagnostikován HL. Byla jim podávána léčba v režimu ABVD nebo BEACOPP-14/esc nebo "switched" režimech (ABVD + BEACOPP-esc/14, BEACOPP-esc/14 + ABVD). Primárními endpointy bylo stanovení korelace mezi nálezem na PET/CT v době diagnózy, odpovědí na léčbu a klinické výsledky (relaps/úmrtí) u pacienta s HL v časných nebo pokročilých stadiích. Mezi sekundární endpointy patřilo stanovení vztahu mezi IPS a nálezy z PET/CT. Výsledky: Ve studijní skupině bylo 106 pacientů. Celková míra odpovědí (overall response rate – ORR) byla 90,5 %. ORR u pacientů ve stadiu I–II byla 96,5 % (55/57) vs. 91 % (41/45) u pacientů ve stadiu III–IV. K progresi onemocnění došlo u 58,3 % (7/12) PET2+ pacientů a u 13,3 % (12/90) PET2− pacientů (p < 0,05). U pacientů PET2+ vs. PET2− nebyly zjištěny významné rozdíly mezi mírou přežitím bez příhody (EFS) a IPS (log-rank test; p = 0.4). Status PET3− byl zjištěn u 88,8 % (79/89) pacientů studijní skupiny a 1,2 % (10/89) mělo status PET3+ (p < 0.05). Pomocí Coxovy regrese jsme potvrdili významnou korelaci mezi EFS s PET3 podle Deauville stupnice (DS) a IPS. U pacientů s DS 1–2, DS 3 a DS 4–5 bylo jednoleté EFS 94,4 %, 100 % a 33 % (HR 0.56; 95% CI 1.07–2.8; p < 0,02). Naše multivariační analýza neprokázala statisticky významnou korelaci mezi PET2+ a PET3+ statusem a extranodálním postižením nebo velkou zátěží tumorem. Závěr: Výsledky využití PET/CT u pacienta s primárním HL ukázaly vysokou prognostickou hodnotu PET na konci léčby. Navíc jsme potvrdili prediktivní roli prognostického modelu IPS ve smyslu výsledku léčby v závislosti na PET statusu.

Introduction: In recent years, the positron emission tomography combined with computed tomography (PET/CT) has changed and the treatment approaches in Hodgkin's lymphoma (HL) patients have entirely improved. The main idea in several studies is the use of PET/CT and the International Prognostic Score (IPS) protocols in identifcation of patients within a high-risk group and potential early relapse/refractory disease. Materials and methods: This study was based on PET/CT evaluation and treatment strategies of patients from eight Centers of Hematology in Ukraine. The patients included were newly dia gnosed with HL and were aged 67 years or younger. They received a treatment with ABVD or BEACOPP-14/esc or “switched-regimens” (ABVD + BEACOPP-esc/14, BEACOPP- -esc/14 + ABVD). The primary endpoints were to assess a correlation between PET/CT findings at the time of dia gnosis, response to the therapy and clinical outcome (relapse/death) for patients with early and advanced stages of HL. The secondary endpoints were to evaluate the relationship between IPS and PET/CT findings. Results: The study group included 106 patients. The overall response rate (ORR) was 90.5%. The ORR for patients with stages I–II was 96.5% (55/57) vs. 91% (41/45) for stage III–IV patients. In total, the disease progression occurred in 58.3% (7/12) of PET2+ patients and in 13.3% (12/90) of PET2− patients (P < 0.05). No significant difference was found between the event free survival (EFS) rate and IPS for patients with PET2+ vs. PET2−, (log-rank test; P = 0.4). The PET3− status was found in 88.8% (79/89) of the study group patients and 1.2% (10/89) had a PET3+ status (P < 0.05). Using the Cox regression, we confirmed a significant correlation between EFS with PET3 Deauville scale (DS) and IPS. Patients with DS 1–2, DS 3 and DS 4–5 had a 1-year event-free survival of 94.4%, 100% and 33%, respectively (HR 0.56; 95% CI 1.07–2.8; P < 0.02). Our multivariable analysis showed no statistically significant correlation between PET2+ and PET3+ status and extranodal involvement or large tumor burden. Conclusion: The results of using PET/CT in patients with primary HL demonstrated a high prognostic value of PET at the end of the treatment. In addition, we confi rmed the predictive role of IPS prognostic model in the treatment outcome depending on PET status.

• MeSH
• analýza přežití MeSH
• Hodgkinova nemoc * diagnostické zobrazování   MeSH
• multicentrické studie jako téma MeSH
• PET/CT metody   MeSH
• prognóza MeSH
• prospektivní studie MeSH

• MeSH
• dospělí MeSH
• Hodgkinova nemoc diagnostické zobrazování   patologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mozek diagnostické zobrazování   patologie   MeSH
• nádory mozku diagnostické zobrazování   patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE: The enzyme O6-methylguanine-DNA methyltransferase (MGMT) is an important component of the DNA repair machinery. MGMT removes O6-methylguanine from the DNA by transferring the methyl group to a cysteine residue in its active site. Recently, we detected the single nucleotide polymorphism (SNP) rs12917 (C/T) in the MGMT sequence adjacent to the active site in Hodgkin lymphoma (HL) cell line KM-H2. We now investigated whether this SNP is also present in other HL cell lines and patient samples. Furthermore, we asked whether this SNP might have an impact on metabolic response in 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography ([18F]FDG-PET), and on overall treatment outcome based on follow-up intervals of at least 34 months. PROCEDURES: We determined the frequency of this MGMT polymorphism in 5 HL cell lines and in 29 pediatric HL (PHL) patients. The patient cohort included 17 female and 12 male patients aged between 4 and 18 years. After characterization of the sequence, we tested a possible association between rs12917 and age, gender, Ann Arbor stage, treatment group, metabolic response following two courses of OEPA (vincristine, etoposide, prednisone, and doxorubicin) chemotherapy, radiotherapy indication, and relapse status. RESULTS: We detected the minor T allele in four of five HL cell lines. 11/29 patients carried the minor T allele whereas 18/29 patients showed homozygosity for the major C allele. Interestingly, we observed significantly better metabolic response in PHL patients carrying the rs12917 C allele resulting in a lower frequency of radiotherapy indication. CONCLUSION: MGMT polymorphism rs12917 seems to affect chemotherapy response in PHL. The prognostic value of this polymorphism should be investigated in a larger patient cohort.

• MeSH
• dítě MeSH
• DNA modifikační methylasy genetika   MeSH
• enzymy opravy DNA genetika   MeSH
• fluorodeoxyglukosa F18 chemie   MeSH
• Hodgkinova nemoc diagnostické zobrazování   genetika   MeSH
• jednonukleotidový polymorfismus genetika   MeSH
• lidé MeSH
• mladiství MeSH
• nádorové buněčné linie MeSH
• nádorové supresorové proteiny genetika   MeSH
• pozitronová emisní tomografie * MeSH
• předškolní dítě MeSH
• sekvence nukleotidů MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH