Image-aided estimate of tumor burden in Hodgkin's disease: Evidence of itsprimary prognostic importance

Purpose: To explore a more direct method for evaluating tumor burden (TB) i n Hodgkin's disease (HD) and to verify its prognostic importance. Patients and Methods: The volume of TB at diagnosis was directly and retros pectively measured in 121 HD patients through images of the lesions recorde d by computed tomographic (CT) scan of the thorax, abdomen, and pelvis for all deep sites of involvement and many superficial ones, and by ultrasonogr aphy (US) for the remaining superficial lesions. Results: The TB, which was obtained from the sum of the volumes of all the lesions measured on CT scans and US and normalized to body-surface area (re lative TB [rTBI]), showed a median value of 102.6 cm(3)/m(2) (range, 2.2 to 582.8). Ar multivariate analysis for prognostic value, rTB was the paramet er that statistically correlated best with time to treatment failure (P = 2 .2 x 10(-6)], followed by erythrocyte sedimentation rate (ESR) (P =.0003), and serum fibrinogen (P =.0112). The prognostic discrimination allowed by r TB alone proved to be clearly superior to that obtained with the score of t he international Prognostic Factor project. The P TB was found to be correl ated with many clinical staging parameters (bulky disease, number of involv ed lymph node regions, serum lactate dehydrogenase, ESR, hemoglobin, Karnof sky index), but its predictability from these variables was low (R-2 =.668) . Conclusion: Relative TB is emerging as a strong prognostic factor in HD, mo re powerful than and largely independent of those hitherto known and used. Further studies are needed to confirm these results and exploit their clini cal value, particularly the relationship among rTB, drug doses, and respons e. J Clin Oncol 19:1388-1394. (C) 2001 by American Society of Clinical Onco logy.