1. Director Department of Pediatric Hematology & Oncology Delhi, INDIA.
Can use of PET scan reduce the burden of treatment for children with Hodgkin lymphoma
Dr Gauri Kapoor MD, PhD
Director Department of Pediatric Hematology & Oncology Delhi, INDIA.

2. Can use of PET scan reduce the burden of treatment for children with Hodgkin lymphoma
Dr Gauri Kapoor MD, PhD, Director Department of Pediatric Hematology & Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, INDIA.
Background/ Objective
Current treatment paradigms can cure most children with Hodgkin lymphoma, even in the developing world. In India, ABVD remains the most preferred chemotherapy regimen.
This is due to its good tolerability despite its known cardiac and pulmonary late effects.
PET scans are expensive and have become available only in recent years.
This study was planned to evaluate if the additional cost of PET scan can be justified by reduction in burden of therapy.
No PET scan
N=110
PET scan
N=30
Age
8(2-18)
12(4-18)
Sex
102:8
27:3
B symptoms 42 16
Bulky 22 03
Risk group
50:60
11:19
ABVD cycles (< 5)
16(14%)
08(27%)
IFRT
37(34%)
05(17%)
EFS
95/110 (86)
23/30(77) OS
100/110 (91)
27/30(90)
Design/Methods
Medical records of 148 children <18 yrs of age, treated between 1998 and 2013 were reviewed. In the pre PET scan era, most patients received six cycles of ABVD with involved field radiotherapy being reserved for bulky or residual disease. Burden of treatment was assessed by number of cycles of chemotherapy and use of radiotherapy.
Results
Median age of the 140 evaluable patients was 9 years (range 2-18 years), 11(7.8%) were girls and mixed cellularity was the commonest histology 71(51%). B symptoms, bulky disease and advanced stage was observed in 24(17%), 58(41%), and 79/140 patients respectively.
PET scans were available for 30/140 patients whose demographic and disease characteristics were similar to the remaining cohort.
The number of patients receiving fewer (<6) chemotherapy cycles (11/30, 36%; 21/110, 20%,p0.04) and no radiotherapy (26/30,87%; 73/110, 67%, p0.02) were more often in the PET scan subset.
The 5 year overall and event free survival of the subset with and without PET scan was 90% and 77% versus 91% and 86% respectively and median follow up was 65 months.
Conclusion
Results of this analysis suggest that better response assessment with PET scan may lead to reduction of burden of therapy while maintaining excellent survival.
This should encourage pediatric oncologists in developing countries who often tend to over treat due to fear of abandonment at relapse

3. Background/ Objective
Current treatment paradigms can cure most children with Hodgkin lymphoma, even in the developing world. In India, ABVD remains the most preferred chemotherapy regimen.
This is due to its good tolerability despite its known cardiac and pulmonary late effects.
PET scans are expensive and have become available only in recent years.
This study was planned to evaluate if the additional cost of PET scan can be justified by reduction in burden of therapy.

4. Design/Methods
Medical records of 148 children <18 yrs of age, treated between 1998 and 2013 were reviewed. In the pre PET scan era, most patients received six cycles of ABVD with involved field radiotherapy being reserved for bulky or residual disease. Burden of treatment was assessed by number of cycles of chemotherapy and use of radiotherapy.

5. Results
Median age of the 140 evaluable patients was 9 years (range 2-18 years), 11(7.8%) were girls and mixed cellularity was the commonest histology 71(51%). B symptoms, bulky disease and advanced stage was observed in 24(17%), 58(41%), and 79/140 patients respectively.
PET scans were available for 30/140 patients whose demographic and disease characteristics were similar to the remaining cohort.
The number of patients receiving fewer (<6) chemotherapy cycles (11/30, 36%; 21/110, 20%,p0.04) and no radiotherapy (26/30,87%; 73/110, 67%, p0.02) were more often in the PET scan subset.
The 5 year overall and event free survival of the subset with and without PET scan was 90% and 77% versus 91% and 86% respectively and median follow up was 65 months.

6. Results No PET scan N=110 PET scan N=30 Age 8(2-18) 12(4-18) Sex 102:8
27:3
B symptoms 42 16
Bulky 22 03
Risk group
50:60
11:19
ABVD cycles (< 5)
16(14%)
08(27%)
IFRT
37(34%)
05(17%)
EFS
95/110 (86)
23/30(77) OS
100/110 (91)
27/30(90)

10. Conclusion
Results of this analysis suggest that better response assessment with PET scan may lead to reduction of burden of therapy while maintaining excellent survival.
This should encourage pediatric oncologists in developing countries who often tend to over treat due to fear of abandonment at relapse