Factors affecting intrapatient liver and mediastinal blood pool F-FDG standardized uptake value changes during ABVD chemotherapy in Hodgkin's lymphoma

Chiaravalloti, Agostino; Danieli, Roberta; Abbatiello, Paolo; Pietro, Barbara; Travascio, Laura; Cantonetti, Maria; Guazzaroni, Manlio; Orlacchio, Antonio; Simonetti, Giovanni; Schillaci, Orazio
June 2014
European Journal of Nuclear Medicine & Molecular Imaging;Jun2014, Vol. 41 Issue 6, p1123
Academic Journal
Purpose: The aim of our study was to assess the intrapatient variability of 2-deoxy-2-(F)-fluoro- D-glucose (F-FDG) uptake in the liver and in the mediastinum among patients with Hodgkin's lymphoma (HL) treated with doxorubicin (Adriamycin), bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy (CHT). Methods: The study included 68 patients (30 men, 38 women; mean age 32 ± 11 years) with biopsy-proven HL. According to Ann Arbor criteria, 6 were stage I, 34 were stage II, 12 were stage 3 and 16 were stage 4. All of them underwent a baseline (PET0) and an interim (PET2) F-FDG whole-body positron emission tomography (PET)/CT. All patients were treated after PET0 with two ABVD cycles for 2 months that ended 15 ± 5 days prior to the PET2 examination. All patients were further evaluated 15 ± 6 days after four additional ABVD cycles (PET6). None of the patients presented a serum glucose level higher than 107 mg/dl. The mean and maximum standardized uptake values (SUV) of the liver and mediastinum were calculated using the same standard protocol for PET0, PET2 and PET6, respectively. Data were examined by means of the Wilcoxon matched pairs test and linear regression analysis. Results: The main results of our study were an increased liver SUV in PET2 (1.76 ± 0.35) as compared with that of PET0 (1.57 ± 0.31; p < 0.0001) and PET6 (1.69 ± 0.28; p = 0.0407). The same results were obtained when considering liver SUV in PET2 (3.13 ± 0.67) as compared with that of PET0 (2.82 ± 0.64; p < 0.0001) and PET6 (2.96 ± 0.52; p = 0.0105). No significant differences were obtained when comparing mediastinum SUV and SUV in PET0, PET2 and PET6 ( p > 0.05). Another finding is a relationship in PET0 between liver SUV and SUV with the stage, which was lower in those patients with advanced disease ( r = 0.1456 and p = 0.0013 for SUV and r = 0.1277 and p = 0.0028 for SUV). Conclusion: The results of our study suggest that liver F-FDG uptake is variable in patients with HL during the CHT treatment and the disease course and should be considered carefully when used to define the response to therapy in the interim PET in HL.


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