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

Bradford S. Hoppe, Kathleen M. McCarten, Qinglin Pei, Sandy Kessel, Adina Alazraki, Joyce C. Mhlanga, Hollie A. Lai, Eric Eutsler, David C. Hodgson, Kenneth B. Roberts, Anne Marie Charpentier, Frank G. Keller, Stephan D. Voss, Yue Wu, Steve Y. Cho, Kara M. Kelly, Sharon M. Castellino

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: We investigated the effects of central review of the interim fluorodeoxyglucose−positron emission tomography/computed tomography (FDG-PET/CT) scan response (iPET) assessment on treatment allocation in the risk-based, response-adapted, Children's Oncology Group study AHOD1331 ( identifier: NCT02166463) for pediatric patients with high-risk Hodgkin lymphoma. Methods and Materials: 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, 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 rapid-responding lesions 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 using the Cohen κ statistic (κ > 0.80 was considered very good agreement and κ > 0.60-0.80, good agreement). Results: The concordance rate (514 of 573 [89.7%]) had a κ of 0.685 (95% CI, 0.610-0.759), consistent with good agreement. In terms of the direction of discordance, among the 126 patients who were considered iPET positive by institutional review, 38 (30.2%) were categorized as iPET negative by central review, preventing overtreatment with radiation therapy. Conversely, among the 447 patients who were considered iPET negative by institutional review, 21 patients (4.7%) were categorized as iPET positive by the central review and would have been undertreated without radiation therapy. Conclusions: Central review is integral to PET response−adapted clinical trials for children with Hodgkin lymphoma. Continued support of central imaging review and education about DS are needed.

Original languageEnglish
Pages (from-to)1025-1030
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number5
StatePublished - Aug 1 2023


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