ABSTRACT
UNLABELLED: The aim was to analyze the degree of agreement between the central review panel and the local PET interpretation within the HD15 trial and its impact on subsequent treatment and progression free survival. PATIENTS, METHODS: The analysis set consisted of 739 patients with residues ≥ 2.5 cm after 6 or 8 cycles of BEACOPPesc from the HD15 trial performed by the German Hodgkin Study Group. The recommendation for or against further radiotherapy was based on the central [(18)F]FDG-PET interpretation. Central PET interpretation was compared to the local PET interpretation and concordance was measured using Cohen's Kappa coefficient. Prognostic impact of the analysis of concordance between local and central PET interpretations was evaluated using progression free survival (PFS); groups were compared with the log rank test. RESULTS: The central panel rated 548 of 739 patients (74%) as PET negative. Of these, 513 were also rated as PET negative in the local PET interpretation. PET positivity was seen by central reviewers in the remaining 191 patients (26%), in concordance with local reviewers in 155 cases. Even though substantial agreement was found (Cohen's Kappa 0.81), the interpretation of the central PET review panel led to a different therapeutic recommendation in 71/739 (10%) patients. PFS was equally high in groups in which the therapeutic regime had been changed on the basis of the central panel decision. CONCLUSION: High concordance is found between local and central reviewers with regard to PET interpretation in residual tissue after intense chemotherapy. The existence of the central PET review panel allows the identification of additional patients as PET negative so that radiotherapy can be safely omitted (35 of 548 patients = 4.7%).
Subject(s)
Advisory Committees/statistics & numerical data , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hodgkin Disease/diagnostic imaging , Hodgkin Disease/drug therapy , Image Interpretation, Computer-Assisted/methods , Positron-Emission Tomography/statistics & numerical data , Drug Monitoring , Europe/epidemiology , Hodgkin Disease/epidemiology , Humans , Observer Variation , Prevalence , Reproducibility of Results , Risk Assessment , Sensitivity and Specificity , Treatment OutcomeABSTRACT
PURPOSE: The risk factor "large mediastinal tumor mass" is an internationally accepted unfavorable prognostic factor in the staging of Hodgkin's lymphoma (HL). The definition of this risk factor varies considerably between large cooperative study groups. The purpose of the present analysis was to determine to which degree data obtained from chest radiograph (CRX) give the same results as those from CT scans (CT). METHODS: A total of 145 de novo HL patients in early unfavorable and advanced stages were included in this study. A total of 94 patients had a large mediastinal tumor mass according to the guidelines of the German Hodgkin Study Group (GHSG), while 51 had mediastinal lymph node involvement only. The size of mediastinal involvement and the thoracic diameter were measured on CRX and CT. Agreement between CRX and CT was determined by sensitivity and specificity analysis as well as descriptive statistics and correlations. RESULTS: The correlation of the diameters on CRX with those of CT was 0.95 for the tumor size and 0.77 for the thoracic diameter. The diagnostic decision-large mediastinal mass or not-correlated with 0.81 between CRX and CT and was identical in 90.3% of cases. The sensitivity was 0.87 and the specificity 0.96 for CRX, which is considered the current standard. CONCLUSION: The results show that there is a high agreement between the measurements of CRX and CT. Diagnosis of a large mediastinal mass disagreed in 10% of patients. Since the correct diagnosis of this risk factor is decisive for the adequate multimodal treatment choice, CRX should not be omitted.
Subject(s)
Hodgkin Disease/diagnostic imaging , Hodgkin Disease/radiotherapy , Mediastinal Neoplasms/diagnostic imaging , Mediastinal Neoplasms/radiotherapy , Mediastinum/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Adult , Chemotherapy, Adjuvant , Combined Modality Therapy , Female , Hodgkin Disease/drug therapy , Hodgkin Disease/pathology , Humans , Lymphatic Metastasis/diagnostic imaging , Lymphatic Metastasis/pathology , Lymphatic Metastasis/radiotherapy , Male , Mediastinal Neoplasms/drug therapy , Mediastinal Neoplasms/pathology , Middle Aged , Neoplasm Staging , Prognosis , Sensitivity and Specificity , Young AdultSubject(s)
Medicine , Germany , History, Ancient , History, Early Modern 1451-1600 , History, Medieval , History, Modern 1601-ABSTRACT
The therapeutic effect of n-dipropylacetate (DPA) is described in 20 patients with cerebral or spinal spasticity. Improvement was ween in 8 out of 11 patients with cerebral spasticity, 3 out of 5 patients with spinal spasticity and 3 out of 4 cases who had sustained perinatal damage. Satisfactory clinical amelioration and improvement in the EEG was observed in myoclonia, particularly of the Unverricht-Lundborg type.
