@article{3119407,
    title = "Positron emission tomography after response to rituximab-CHOP in primary mediastinal large B-cell lymphoma: impact on outcomes and radiotherapy strategies",
    author = "Vassilakopoulos, T.P. and Papageorgiou, S.G. and Angelopoulou, M.K. and Chatziioannou, S. and Prassopoulos, V. and Karakatsanis, S. and Arapaki, M. and Mellios, Z. and Sachanas, S. and Kalpadakis, C. and Katodritou, E. and Leonidopoulou, T. and Kotsianidis, I. and Hatzimichael, E. and Kotsopoulou, M. and Dimou, M. and Variamis, E. and Boutsis, D. and Terpos, E. and Michali, E. and Karianakis, G. and Tsirkinidis, P. and Vadikolia, C. and Poziopoulos, C. and Pigaditou, A. and Vrakidou, E. and Siakantaris, M.P. and Kyrtsonis, M.-C. and Symeonidis, A. and Anargyrou, K. and Papaioannou, M. and Chatziharissi, E. and Vervessou, E. and Tsirogianni, M. and Palassopoulou, M. and Gainaru, G. and Mainta, C. and Tsirigotis, P. and Assimakopoulou, T. and Konstantinidou, P. and Papadaki, H. and Dimopoulos, M.-A. and Pappa, V. and Karmiris, T. and Roussou, P. and Datseris, I. and Panayiotidis, P. and Konstantopoulos, K. and Pangalis, G.A. and Rondogianni, P.",
    journal = "Annals of Hematology",
    year = "2021",
    volume = "100",
    number = "9",
    pages = "2279-2292",
    publisher = "Springer Science and Business Media Deutschland GmbH",
    issn = "0939-5555, 1432-0584",
    doi = "10.1007/s00277-021-04421-2",
    keywords = "cyclophosphamide plus doxorubicin plus prednisolone plus rituximab plus vincristine;  antineoplastic agent;  cyclophosphamide;  doxorubicin;  prednisone;  R-CHOP protocol;  rituximab;  vincristine, adolescent;  adult;  aged;  Article;  cancer prognosis;  cancer radiotherapy;  cancer recurrence;  female;  human;  large cell lymphoma;  major clinical study;  male;  mediastinum cancer;  positron emission tomography-computed tomography;  primary tumor;  radiation dose;  retrospective study;  treatment outcome;  diagnostic imaging;  diffuse large B cell lymphoma;  mediastinum tumor;  middle aged;  young adult, Adolescent;  Adult;  Aged;  Antineoplastic Combined Chemotherapy Protocols;  Cyclophosphamide;  Doxorubicin;  Female;  Humans;  Lymphoma, Large B-Cell, Diffuse;  Male;  Mediastinal Neoplasms;  Middle Aged;  Positron Emission Tomography Computed Tomography;  Prednisone;  Retrospective Studies;  Rituximab;  Treatment Outcome;  Vincristine;  Young Adult",
    abstract = "End-of-treatment (EoT) PET/CT is used as a guide to omit radiotherapy (RT) patients with primary mediastinal large B-cell lymphoma (PMBCL). We present the mature and extended results of a retrospective study evaluating the prognostic significance of EoT-PET/CT after adequate response to R-CHOP. Among 231 consecutive PMLBCL patients, 182 underwent EoT-PET/CT and were evaluated according to the Deauville 5-point scale (D5PS) criteria. Freedom from progression (FFP) was measured from the time of PET/CT examination. Among 182 patients, 72 (40%) had D5PS score 1 (D5PSS-1), 33 (18%) had 2, 28 (15%) had 3, 29 (16%) had 4, and 20 (11%) had 5. The 5-year FFP was 97, 94, 92, 82, and 44% for D5PSS-1, D5PSS-2, D5PSS-3, D5PSS-4, and D5PSS-5, respectively. Among 105 patients with unequivocally negative PET/CT (D5PSS-1/D5PSS-2), 49 (47%) received RT (median dose 3420 cGy) and 56 (53%) did not with relapses in 0/49 vs. 4/56 patients (2 mediastinum and 2 isolated CNS relapses).The 5-year FFP for those who received RT or not was 100% versus 96%, when isolated CNS relapses were censored (p = 0.159). Among D5PSS-3 patients (27/28 irradiated-median dose 3600 cGy), the 5-year FFP was 92%. The 5-year FFP for D5PSS-4 and D5PSS-5 was 82 and 44%; 44/49 patients received RT (median dose 4000 and 4400 cGy for D5PSS-4 and D5PSS-5). Our study supports the omission of RT in a sizeable fraction of PET/CT-negative patients and definitely discourages salvage chemotherapy and ASCT in patients with PMLBCL who conventionally respond to R-CHOP, solely based on PET/CT positivity in the absence of documented progressive or multifocal disease. The persistence of positive PET/CT with D5PSS < 5 after consolidative RT should not trigger the initiation of further salvage chemotherapy in the absence of conventionally defined PD. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature."
}