FDG PET in response evaluation of bulky masses in paediatric Hodgkin’s lymphoma (HL) patients enrolled in the Italian AIEOP-LH2004 trial

  • Egesta LopciEmail author
  • Maurizio Mascarin
  • Arnoldo Piccardo
  • Angelo Castello
  • Caterina Elia
  • Luca Guerra
  • Eugenio Borsatti
  • Alessandra Sala
  • Alessandra Todesco
  • Pietro Zucchetta
  • Piero Farruggia
  • Angelina Cistaro
  • Salvatore Buffardi
  • Patrizia Bertolini
  • Maurizio Bianchi
  • Maria Luisa Moleti
  • Feisal Bunkheila
  • Paolo Indolfi
  • Franca Fagioli
  • Alberto Garaventa
  • Roberta Burnelli
  • AIEOP Hodgkin Lymphoma Study Group, Italy
Original Article



We present the results of an investigation of the role of FDG PET in response evaluation of bulky masses in paediatric patients with Hodgkin’s lymphoma (HL) enrolled in the Italian AIEOP-LH2004 trial.


We analysed data derived from 703 patients (388 male, 315 female; mean age 13 years) with HL and enrolled in 41 different Italian centres from March 2004 to September 2012, all treated with the AIEOP-LH2004 protocol. The cohort comprised 309 patients with a bulky mass, of whom 263 were evaluated with FDG PET at baseline and after four cycles of chemotherapy. Responses were determined according to combined functional and morphological criteria. Patients were followed up for a mean period of 43 months and for each child we calculated time-to-progression (TTP) and relapse rates considering clinical monitoring, and instrumental and histological data as the reference standard. Statistical analyses were performed for FDG PET and morphological responses with respect to TTP. Multivariate analysis was used to define independent predictive factors.


Overall, response evaluation revealed 238 PET-negative patients (90.5%) and 25 PET-positive patients (9.5%), with a significant difference in TTP between these groups (mean TTP: 32.67 months for negative scans, 23.8 months for positive scans; p < 0.0001, log-rank test). In the same cohort, computed tomography showed a complete response (CR) in 85 patients (32.3%), progressive disease (PD) in 6 patients (2.3%), and a partial response (PR) in 165 patients (62.7%), with a significant difference in TTP between patients with CR and patients with PD (31.1 months and 7.9 months, respectively; p < 0.001, log-rank test). Similarly, there was a significant difference in relapse rates between PET-positive and PET-negative patients (p = 0000). In patients with PR, there was also a significant difference in TTP between PET-positive and PET-negative patients (24.6 months and 34.9 months, respectively; p < 0.0001). In the multivariate analysis with correction for multiple testing, only the PET result was an independent predictive factor in both the entire cohort of patients and the subgroup showing PR on CT (p < 0.01).


After four cycles of chemotherapy, FDG PET response assessment in paediatric HL patients with a bulky mass is a good predictor of TTP and disease outcome. Moreover, in patients with a PR on CT, PET was able to differentiate those with a longer TTP. In paediatric HL patients with a bulky mass and in patients with a PR on CT, response on FDG PET was an independent predictive factor.


Hodgkin’s lymphoma FDG PET Paediatric Bulky masses Interim evaluation Response assessment 



AIEOP (Associazione Italiana di Ematologia e Oncologia Pediatrica) is acknowledged for its support of the current research. AIRC (Associazione Italiana per la Ricerca sul Cancro) is acknowledged for the fellowship support provided to Angelo Castello with the grant no. 18923.

Compliance with ethical standards

Ethical approval

All procedures performed in the AIEOP-LH 2004 protocol involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Egesta Lopci
    • 1
    Email author
  • Maurizio Mascarin
    • 2
  • Arnoldo Piccardo
    • 3
  • Angelo Castello
    • 1
  • Caterina Elia
    • 2
  • Luca Guerra
    • 4
  • Eugenio Borsatti
    • 5
  • Alessandra Sala
    • 6
  • Alessandra Todesco
    • 7
  • Pietro Zucchetta
    • 8
  • Piero Farruggia
    • 9
  • Angelina Cistaro
    • 10
  • Salvatore Buffardi
    • 11
  • Patrizia Bertolini
    • 12
  • Maurizio Bianchi
    • 13
  • Maria Luisa Moleti
    • 14
  • Feisal Bunkheila
    • 15
  • Paolo Indolfi
    • 16
  • Franca Fagioli
    • 13
  • Alberto Garaventa
    • 17
  • Roberta Burnelli
    • 18
  • AIEOP Hodgkin Lymphoma Study Group, Italy
  1. 1.Nuclear Medicine DepartmentHumanitas Clinical and Research HospitalRozzanoItaly
  2. 2.AYA and Pediatric RadiotherapyIRCCS Centro di Riferimento OncologicoAvianoItaly
  3. 3.Nuclear MedicineGalliera HospitalGenoaItaly
  4. 4.Nuclear MedicineHospital San GerardoMonzaItaly
  5. 5.Nuclear MedicineCentro di Riferimento OncologicoAvianoItaly
  6. 6.Pediatric DivisionHospital San GerardoMonzaItaly
  7. 7.Pediatric DivisionUniversity HospitalPadovaItaly
  8. 8.Nuclear Medicine DepartmentUniversity HospitalPadovaItaly
  9. 9.Pediatric DivisionOspedale dei BambiniPalermoItaly
  10. 10.Positron Emission Tomography Centre IRMET S.p.A. AffideaTurinItaly
  11. 11.Department of OncologyHospital Santobono-PausiliponNaplesItaly
  12. 12.Hematology and Pediatric OncologyAzienda OspedalieraParmaItaly
  13. 13.OncohematologyRegina Margherita HospitalTorinoItaly
  14. 14.Pediatric Oncohematology, Hospital Umberto IUniversity La SapienzaRomeItaly
  15. 15.RadiotherapyHospital San SalvatorePesaroItaly
  16. 16.Department of PediatricsII University HospitalNaplesItaly
  17. 17.Hematology and Pediatric OncologyGaslini HospitalGenoaItaly
  18. 18.Pediatric Onco-hematologic UnitUniversity Hospital S. AnnaFerraraItaly

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