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Baseline total metabolic tumor volume (TMTV) application in Hodgkin lymphoma: a review article

Abstract

Introduction

Functional metabolic imaging with 18 F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT) is considered the gold standard for staging and response assessment in classical Hodgkin Lymphoma (cHL). Total metabolic tumor volume (TMTV) is a new functional and quantitative parameter extracted from the baseline PET/CT that has been reported as a strong predictor of outcome in HL. This review aims to describe the available methods used to perform TMTV calculation and discuss the reported published data and future direction about TMTV application in cHL.

Methods

A computerized search of PubMed was conducted to find relevant studies published regarding baseline TMTV in HL between 2010 and 2021. The following search terms were used: “{Hodgkin[title]} and {positron[title] or PET[title] or metabolic[title]) not “non-Hodgkin”[title]”. Twenty-six eligible studies were selected. We described and summarized the results in this review article.

Results

The optimal cut-off for predicting risk using TMTV depends on the selected TMTV segmentation method, population characteristics, and treatment. A high TMTV at baseline PET/CT was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cHL. High baseline TMTV was also a predictor of treatment failure after autologous stem cell transplant in relapsed and/or refractory cHL. In advanced-stage HL treated with eBEACOPP protocol, there was no statistically significant association between high TMTV value and reduction in PFS or OS. In the pediatric population studies, a high baseline TMTV was associated with worse outcomes.

Conclusion

There is no agreement about which is the best method for TMTV segmentation; however, regardless of the chosen method, it may predict prognosis with comparable precision. Risk stratification using PET/CT quantitative parameters in addition to baseline clinical parameters could be a future direction in PET/CT tailored strategy in cHL.

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Data availability

Data sharing does not apply to this article as no datasets were generated or analyzed during the current study.

Abbreviations

FDG:

18F-fluorodeoxyglucose

ABVD:

Adriamycin, bleomycin, vinblastine, and dacarbazine

ABVE-PC:

Doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide

AS:

Advanced stage

AHCT:

Autologous hematopoietic cell transplantation

BV:

Brentuximab–vedotin

cHL:

Classical Hodgkin lymphoma

CT:

Computed tomography

eBEACOPP:

Dose-escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone

DS:

Deauville scale

ES:

Early stage

EFS:

Event-free survival

F:

Favorable

FFP:

Freedom from progression

iPET:

Interim-PET

IPS:

International prognosis score

MRD:

Minimal residual disease

NPV:

Negative predictive value

OS:

Overall survival

PET:

Positron emission tomography

PFS:

Progression-free survival

PPV:

Positive predictive value

r/r :

Refractory and/or relapsed disease

ctDNA:

Tumor circulating DNA

TLG:

Total lesion glycolysis

TMTV:

Total metabolic tumor volume

U:

Unfavorable

VOI:

Volume of interest

SUV:

Standard uptake value

SD:

Standard deviation

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Feres, C.C.P., Nunes, R.F., Teixeira, L.L.C. et al. Baseline total metabolic tumor volume (TMTV) application in Hodgkin lymphoma: a review article. Clin Transl Imaging 10, 273–284 (2022). https://doi.org/10.1007/s40336-022-00481-0

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Keywords

  • FDG-PET
  • Total metabolic tumor volume
  • Hodgkin lymphoma