Background: Staging of lung disease in Hodgkin lymphoma (HL) has been a longstanding and controversial challenge. In 1984, a survey of 14 experts was published in the Journal of Clinical Oncology. Four case vignettes were distributed, and experts designated each vignette as either Stage IIE or Stage IV disease. Results were very divided for 2 of the 4 case vignettes, and the conclusion was a call for clear guidance and group consensus for staging of lung lesions. Despite updates to the HL staging systems at both the Cotswold (1989) and Lugano (2014) meetings, there remains today, nearly 30 years later, a perceived lack of uniformity in the approach to the staging of lung lesions even among experts in the field. The approach to each of these issues not only varies across consortium groups but among individuals within the same consortium groups. When reviewing the most recent frontline HL trials from St. Jude-Stanford-Dana Farber, EuroNet PHL, and the Children’s Oncology Group, lung lesions were defined differently for each. This creates difficulty in comparing outcomes across trials and highlights the need for consensus and uniformity.
Methods: The SEARCH for CAYAHL (Staging, Evaluation and Response Criteria Harmonization for Childhood, Adolescent, and Young Adult HL) group recreated a similar survey using 7 case vignettes and distributed it to 26 internationally recognized experts in pediatric HL to establish how current world experts are staging lung lesions (see Figure 1). Of the 21 survey respondents (81% response rate), 7 were radiologists or nuclear medicine radiologists, and 14 were pediatric oncologists. While there was near consensus for some of the cases, several remained very divided, namely around the role of PET avidity in lung lesions, the number and location of lung lesions, and the concept of contiguous disease.
Conclusions: After reviewing the results of our survey, the SEARCH group acknowledges the controversy and inconsistency with which we are currently staging lung disease around the globe. We are now actively working to establish clear criteria, based on available data, and expert consensus through Delphi survey methods, and plan to have this completed in the fall of 2022.