Results
Baseline
A total of 396 were enrolled onto the study and 382 underwent ERA (186
PET-CT and 196 CECT). Based on the modality used at ERA, patients were
divided into two groups (CECT and PET-CT). As shown in table 1, patients
in CECT group had a lower mean age, lower hemoglobin value, more bulky
disease and more B symptoms. Distribution in terms of early and advanced
disease was similar in both groups. Of all the CECTs done, 75.5% of ERA
were done at government hospitals, 5.1% at private and 19.4% at trust
hospitals. PET-CT was the preferred modality at private and trust (36%
+ 37.6%=73.6%) hospitals as compared to the government hospitals
(26.4%) (p<0.00001). This reflects that financial disparity,
availability of scanning modality and institutional preference plays an
imperative role in response evaluation.
Early response assessment
At ERA, more satisfactory response was observed in the PET-CT based
assessment (151/186, 81.2%) as compared to CECT (126/196, 64.3%) (p
value<0.001).
While analysing the significance of modality of scans at ERA, we also
looked at its impact on patients with non-bulky disease. These were the
patients who by the virtue of their disease did not merit RT unless
their response was suboptimal. For the PET-CT arm 96/114 non-bulky
patients achieved a satisfactory response (84.2%) as compared to 61/89
patients in the CECT arm (68.5%) with a p value=0.008. This showed
that, by intention to treat analysis, children who undergo PET-CT at
reassessment are significantly less likely to receive RT as compared to
those who undergo CECT. RT was given (significantly) more in CECT arm,
98/196 (50%) as compared to 72/186 (38.7%) PET-CT patients (p
value=0.017).