Importance of Central Imaging Review in a Pediatric Hodgkin Lymphoma Trial Using Positron Emission Tomography Response Adapted Radiation Therapy

Hoppe BS, McCarten KM, Pei Q, Kessel S, Alazraki A, Mhlanga JC, Lai HA, Eutsler E, Hodgson DC, Roberts KB, Charpentier AM, Keller FG, Voss SD, Wu Y, Cho SY, Kelly KM, Castellino SM. Importance of Central Imaging Review in a Pediatric Hodgkin Lymphoma Trial Using Positron Emission Tomography Response Adapted Radiation Therapy. Int J Radiat Oncol Biol Phys. 2023 Aug 1;116(5):1025-1030. doi: 10.1016/j.ijrobp.2023.02.020. Epub 2023 Mar 2. PubMed PMID: 36868525; PubMed Central PMCID: PMC10363760.

We investigated the impact of central review of the interim fluorodeoxyglucose−positron emission tomography/computed tomography (FDG-PET/CT) scan response (iPET) assessment on treatment allocation on the risk-based, response-adapted, Children’s Oncology Group study AHOD1331 (ClinicalTrials.gov: NCT02166463) for pediatric patients with high-risk Hodgkin lymphoma. Per protocol, after 2 cycles of systemic therapy, patients underwent iPET, with visual response assessment by 5-point Deauville score (DS) at their treating institution and a real-time central review, with the latter considered the reference standard. An area of disease with a DS of 1 to 3 was considered a rapid-responding lesion (RRL), whereas a DS of 4 to 5 was considered a slow-responding lesion (SRL). Patients with 1 or more SRLs were considered iPET positive, whereas patients with only RRLs were considered iPET negative. We conducted a predefined exploratory evaluation of concordance in iPET response assessment between institutional and central reviews of 573 patients. The concordance rate was evaluated by using the Cohen kappa statistic (κ; a κ >0.80 was considered very good agreement; >0.60–0.80, good agreement).