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Response Assessment by PET CT as compared to CECT in childhood Hodgkin Lymphoma can reduce the need for radiotherapy in low and middle income countries
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  • Manas Kalra,
  • Sameer Bakhshi,
  • M. Singh,
  • Rachna Seth,
  • Nishant Verma,
  • Sandeep Jain,
  • V. Radhakrishnan,
  • Piali Mandal,
  • Amita Mahajan,
  • Ramandeep Arora,
  • Veronique Dinand,
  • Gauri Kapoor,
  • M. Sajid,
  • Rakesh Kumar,
  • * Taluja,
  • Saumyaranjan mallick,
  • Jagdish Chandra
Manas Kalra
Sir Ganga Ram Hospital

Corresponding Author:[email protected]

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Sameer Bakhshi
All India Institute of Medical Sciences Department of Medical Oncology
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M. Singh
Mahavir Cancer Sansthan and Research Centre
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Rachna Seth
All India Institute of Medical Sciences
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Nishant Verma
King George's Medical University Department of Pediatrics
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Sandeep Jain
Rajiv Gandhi Cancer Institute Pediatric Oncology New Delhi India
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V. Radhakrishnan
Cancer Institute Women's India Association
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Piali Mandal
Kalawati Saran Children's Hospital
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Amita Mahajan
Indraprastha Apollo Hospital
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Ramandeep Arora
Max Super Speciality Hospital Saket
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Veronique Dinand
Bai Jerbai Wadia Hospital for Children
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Gauri Kapoor
Rajiv Gandhi Cancer Institute Pediatric Oncology New Delhi India
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M. Sajid
Mahavir Cancer Sansthan and Research Centre
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Rakesh Kumar
All India Institute of Medical Sciences
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* Taluja
Cankids Kidscan New Delhi India
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Saumyaranjan mallick
All India Institute of Medical Sciences
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Jagdish Chandra
Kalawati Saran Children's Hospital
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Abstract

Introduction: The InPOG-HL-15-01, a multi-centric prospective study used a risk-stratified and response-based approach with a doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) backbone to treat children with newly diagnosed Hodgkin Lymphoma (HL) and reduce the use of radiation therapy (RT). Children/adolescents with bulky disease or inadequate response at early response assessment (ERA) after 2 cycles of chemotherapy were assigned to receive RT. For ERA, positron emission tomography computed tomography (PET-CT) was recommended but not mandatory in view of limited access. This study aimed to compare the impact of using contrast enhanced computed tomography (CECT) vs PET-CT on treatment decisions and outcomes. Methodology: 396 patients were enrolled and 382 had an ERA at the assigned time point. Results: At ERA, satisfactory response was documented in 277/382 (72.5%) participants and this was significantly higher in PET-CT (151/186, 81.2%) as compared to CECT (126/196, 64.3%) respectively (p value<0.001). Amongst the 203 patients with non-bulky disease (wherein the indication for RT was entirely dependent on ERA), 96/114 (84.2%) and 61/89 (68.5%) patients achieved a satisfactory response according to the PET-CT and CECT (p value=0.008) respectively and hence a lesser proportion of patients in the PET-CT arm received RT. Despite a lower usage of RT the 5 year overall survival (OS) of both groups- ERA based on CECT (91.8%) vs PET-CT (94.1%) was comparable (p value=0.391) and so was the 5 year event free survival (EFS) (86.7 vs 85.5%, p value=0.724). Conclusion: Use of PET-CT as the modality for ERA is more likely to indicate a satisfactory response as compared to CECT and thereby decreases the need for RT in response-based treatment algorithm for HL afflicted children. The reduction in the application of RT did not impact the overall outcome and plausibly would lower the risk of delayed toxic effects.
01 Aug 2022Submission Checks Completed
01 Aug 2022Assigned to Editor
01 Aug 2022Submitted to Pediatric Blood & Cancer
05 Aug 2022Reviewer(s) Assigned
30 Aug 2022Review(s) Completed, Editorial Evaluation Pending
06 Sep 2022Editorial Decision: Revise Minor
22 Sep 20221st Revision Received
22 Sep 2022Submission Checks Completed
22 Sep 2022Assigned to Editor
23 Sep 2022Reviewer(s) Assigned
15 Oct 2022Review(s) Completed, Editorial Evaluation Pending
19 Oct 2022Editorial Decision: Accept