Definitions of E-lesions in recent pediatric treatment protocols
| Protocol(s) . | Reference . | Definition of E-lesions . |
|---|---|---|
| EuroNet PHL C1 | 19 | Extralymphatic structures or organs that are infiltrated per continuum out of a lymphatic mass are termed E-lesion (eg, lung, intestine, and bones) and do not automatically qualify for stage IV. Exceptions: liver or bone marrow involvement always implies stage IV |
| Pleura and pericardium: pleura and/or pericardial involvement are generally considered E-lesions. Involvement of the pleura is assumed if: the lymphoma is contiguous with the pleura without fat lamella, the lymphoma invades the chest wall, or a pleural effusion occurs, which cannot be explained by a venous congestion. Pericardial involvement is assumed if: the lymphoma has a broad area of close contact toward the heart surface beyond the valve level (ventriculus area), or a pericardial effusion occurs | ||
| Lung: a disseminated lung involvement (implying stage IV) is assumed if there are >3 foci or an intrapulmonary focus has a diameter of >10 mm. E-lesion of the lung is restricted to 1 pulmonary lobe or perihilar extension with homolateral hilar lymphadenopathy | ||
| Spleen: exclusive splenic involvement without other lymphatic disease is classified as stage I. Mere enlargement of liver/spleen only is not considered as involvement. Focal changes in the liver/ spleen structure that are tumor suspicious in ultrasonography are considered involved, independent of the FDG-PET result | ||
| EuroNet PHL C2 | 20 | An E-lesion is a contiguous infiltration of a lymph node mass into extralymphatic structures or organs (eg, lung or bone). Disseminated organ involvement always implies stage IV. |
| Pleural effusion is not considered to be an E-lesion. Involvement of the pleura is assumed if an adjacent nodal lesion infiltrates the pleura or chest wall AND the infiltrate and/or the adjacent nodal lesion is PET positive. | ||
| Pericardial effusion is not considered to be an E-lesion. Pericardial involvement is assumed if an adjacent nodal lesion infiltrates the pericardium AND the infiltrate and/or the adjacent nodal lesion is PET positive. | ||
| Lung: disseminated lung involvement is assumed if there are >2 small foci between 2 mm and 10 mm within the whole lung, or there is at least 1 intrapulmonary focus with a diameter of ≥10 mm | ||
| COG AHOD0031 & AHOD1331 | Clinical trial∗ | Extralymphatic structures contiguous with sites of lymph node involvement are considered E-lesions (particularly lung). Pleural, pericardial, or chest wall infiltration by an adjacent nodal lesion, that is, PET positive would be considered an E-lesion. Liver and/or bone marrow involvement is not considered an E-lesion but rather considered stage IV. Pleural and pericardial effusions alone are not considered E-lesions. |
| Stage IE: localized involvement of a single extralymphatic organ or site | ||
| Stage IIE: localized contiguous involvement of a single extralymphatic organ or site and its regional lymph node(s) with involvement of ≥1 lymph node regions on the same side of the diaphragm | ||
| Stage IIIE: involvement of lymph node regions on both sides of the diaphragm accompanied by localized contiguous involvement of an extralymphatic organ or site | ||
| Stage IV: disseminated (multifocal) involvement of ≥1 extralymphatic organs or tissues, with or without associated lymph node involvement, or isolated extralymphatic organ involvement with distant (nonregional) nodal involvement |
| Protocol(s) . | Reference . | Definition of E-lesions . |
|---|---|---|
| EuroNet PHL C1 | 19 | Extralymphatic structures or organs that are infiltrated per continuum out of a lymphatic mass are termed E-lesion (eg, lung, intestine, and bones) and do not automatically qualify for stage IV. Exceptions: liver or bone marrow involvement always implies stage IV |
| Pleura and pericardium: pleura and/or pericardial involvement are generally considered E-lesions. Involvement of the pleura is assumed if: the lymphoma is contiguous with the pleura without fat lamella, the lymphoma invades the chest wall, or a pleural effusion occurs, which cannot be explained by a venous congestion. Pericardial involvement is assumed if: the lymphoma has a broad area of close contact toward the heart surface beyond the valve level (ventriculus area), or a pericardial effusion occurs | ||
| Lung: a disseminated lung involvement (implying stage IV) is assumed if there are >3 foci or an intrapulmonary focus has a diameter of >10 mm. E-lesion of the lung is restricted to 1 pulmonary lobe or perihilar extension with homolateral hilar lymphadenopathy | ||
| Spleen: exclusive splenic involvement without other lymphatic disease is classified as stage I. Mere enlargement of liver/spleen only is not considered as involvement. Focal changes in the liver/ spleen structure that are tumor suspicious in ultrasonography are considered involved, independent of the FDG-PET result | ||
| EuroNet PHL C2 | 20 | An E-lesion is a contiguous infiltration of a lymph node mass into extralymphatic structures or organs (eg, lung or bone). Disseminated organ involvement always implies stage IV. |
| Pleural effusion is not considered to be an E-lesion. Involvement of the pleura is assumed if an adjacent nodal lesion infiltrates the pleura or chest wall AND the infiltrate and/or the adjacent nodal lesion is PET positive. | ||
| Pericardial effusion is not considered to be an E-lesion. Pericardial involvement is assumed if an adjacent nodal lesion infiltrates the pericardium AND the infiltrate and/or the adjacent nodal lesion is PET positive. | ||
| Lung: disseminated lung involvement is assumed if there are >2 small foci between 2 mm and 10 mm within the whole lung, or there is at least 1 intrapulmonary focus with a diameter of ≥10 mm | ||
| COG AHOD0031 & AHOD1331 | Clinical trial∗ | Extralymphatic structures contiguous with sites of lymph node involvement are considered E-lesions (particularly lung). Pleural, pericardial, or chest wall infiltration by an adjacent nodal lesion, that is, PET positive would be considered an E-lesion. Liver and/or bone marrow involvement is not considered an E-lesion but rather considered stage IV. Pleural and pericardial effusions alone are not considered E-lesions. |
| Stage IE: localized involvement of a single extralymphatic organ or site | ||
| Stage IIE: localized contiguous involvement of a single extralymphatic organ or site and its regional lymph node(s) with involvement of ≥1 lymph node regions on the same side of the diaphragm | ||
| Stage IIIE: involvement of lymph node regions on both sides of the diaphragm accompanied by localized contiguous involvement of an extralymphatic organ or site | ||
| Stage IV: disseminated (multifocal) involvement of ≥1 extralymphatic organs or tissues, with or without associated lymph node involvement, or isolated extralymphatic organ involvement with distant (nonregional) nodal involvement |
COG, Children’s Oncology Group; FDG, fluorodeoxyglucose.
AHOD0031 clinicaltrials.gov identifier: NCT00025259; AHOD1331 clinicaltrials.gov identifier: NCT02166463. EuroNet-PHL-C1 clinicaltrials.gov identifier: NCT00433459. EuroNet-PHL-C2 clinicaltrial.gov identifier: NCT02684708.