Baseline total metabolic tumor volume (TMTV) application in Hodgkin lymphoma: a review article

• Published in: Clinical and translational imaging : reviews in nuclear medicine and molecular imaging 2022, Vol.10 (3), p.273-284
• Main Authors: Feres, Carolina Cristina Pellegrino, Nunes, Rafael Fernandes, Teixeira, Larissa Lane Cardoso, Arcuri, Leonardo Javier, Perini, Guilherme Fleury
• Format: Article
• Language: English
• Subjects: Computed tomography; Diagnostic Radiology; Image segmentation; Imaging; Interventional Radiology; Lymphatic and hematological system; Lymphoma; Medical and Radiation Physics; Medical prognosis; Medicine; Medicine & Public Health; Metabolism; Nuclear Medicine; Parameters; Positron emission; Radiology; Radiotherapy; Stem cells; Survival; Systematic Review; Tomography; Tumors
• ISSN: 2281-7565; 2281-5872; 2281-7565
• DOI: 10.1007/s40336-022-00481-0

Introduction Functional metabolic imaging with 18 F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT) is considered the gold standard for staging and response assessment in classical Hodgkin Lymphoma (cHL). Total metabolic tumor volume (TMTV) is a new functional and quantitative parameter extracted from the baseline PET/CT that has been reported as a strong predictor of outcome in HL. This review aims to describe the available methods used to perform TMTV calculation and discuss the reported published data and future direction about TMTV application in cHL. Methods A computerized search of PubMed was conducted to find relevant studies published regarding baseline TMTV in HL between 2010 and 2021. The following search terms were used: “{Hodgkin[title]} and {positron[title] or PET[title] or metabolic[title]) not “non-Hodgkin”[title]”. Twenty-six eligible studies were selected. We described and summarized the results in this review article. Results The optimal cut-off for predicting risk using TMTV depends on the selected TMTV segmentation method, population characteristics, and treatment. A high TMTV at baseline PET/CT was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cHL. High baseline TMTV was also a predictor of treatment failure after autologous stem cell transplant in relapsed and/or refractory cHL. In advanced-stage HL treated with eBEACOPP protocol, there was no statistically significant association between high TMTV value and reduction in PFS or OS. In the pediatric population studies, a high baseline TMTV was associated with worse outcomes. Conclusion There is no agreement about which is the best method for TMTV segmentation; however, regardless of the chosen method, it may predict prognosis with comparable precision. Risk stratification using PET/CT quantitative parameters in addition to baseline clinical parameters could be a future direction in PET/CT tailored strategy in cHL.