Deauville score: the Phoenix rising from ashes

Excerpt

The biggest success for medical imaging arrives when the findings therein provided have clinical usefulness and directly impact patients’ management and outcome. Similar aims should always lead the work of imagers and particularly ours in nuclear medicine. Hence, the significant results obtained from important clinical trials proving the relevance of positron emission tomography (PET)-guided treatment in patients, such as HD18 or AHL2011 in advanced-stage Hodgkin’s lymphoma [1, 2] appear exceptional and “world breaking”, although they should be the natural modus operandi in molecular imaging research. Based on linear concepts and “simple” reading with Deauville score [3], the results of these trials prove what is known as the current paradigm of response in Hodgkin’s lymphoma (Fig. 1): after two cycles of chemotherapy, metabolic response on PET is already able to predict the outcome of the patient and can be used to adapt therapeutic intensity accordingly [4]. This concept took time before being endorsed by the medical community. It now finds arguments in the extensive literature published in the last decade and pioneered by nuclear medicine physicians and medical oncologists working together. The current paradigm is based on several premises: 1) imaging response is assessed based on metabolism and not only on morphology; 2) international criteria for response help discriminate the different pathophysiological meanings of residual uptake; 3) the best moment to assess response is defined in order to change efficiently the therapeutic strategy [5, 6]. Yet, the evidence for this paradigm of response now appears clearly demonstrated for first-line treatment and in Hodgkin’s lymphoma. Does it fit as a reference model for other lines, or even in case of immune-modulatory regimens?

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