# Deauville score and PET-adapted therapy

Source: https://onco.cc/terms/deauville/  
OnCo record `deauville` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A 1-to-5 scale for how brightly a lymphoma lights up on a PET scan, compared with the liver and the middle of the chest. Scores of 1-3 after two cycles mean the treatment is working and allow it to be shortened; 4-5 means intensify.

## Summary

The Deauville five-point scale (1 no uptake; 2 ≤ mediastinum; 3 ≤ liver; 4 moderately above liver; 5 markedly above or new lesions) underpins the Lugano response criteria for lymphoma. Interim PET after two cycles is used to omit bleomycin or radiotherapy in Hodgkin lymphoma (RATHL, HD16/HD17), to escalate to BEACOPP in non-responders, and to shorten R-CHOP in early-stage DLBCL (FLYER). PET-adapted de-escalation is spreading to HER2-positive breast cancer (PHERGain, omitting chemotherapy in PET responders). A complete metabolic response is the PET equivalent of complete remission.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: Deauville; Deauville score; interim PET; end-of-treatment PET; PET-adapted; PET-guided; PET-negative; PET-positive; PET-directed; Lugano classification; Lugano; metabolic response; complete metabolic response

## Notes

- What the scale cannot do. A score of 3, uptake above the mediastinum but at or below the liver, is deliberately ambiguous: in a de-escalation trial it is usually treated as a good response and in an escalation trial as an inadequate one, so the same scan leads to opposite decisions depending on the protocol, and a patient told their score is 3 has been told less than they think. Inflammation, infection, granulomatous disease, brown fat and recent growth-factor support all take up the tracer. Indolent lymphomas are variably avid, so the scale is least useful where disease is most likely to be left behind. The Lugano classification, which incorporated PET-CT formally into staging for avid lymphomas, also removed the routine staging bone marrow biopsy for Hodgkin lymphoma and most diffuse large B-cell lymphoma (Cheson 2014, Barrington 2014).

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Deauville_Criteria
- Cheson et al., Lugano classification: recommendations for initial evaluation, staging and response assessment of Hodgkin and non-Hodgkin lymphoma (Journal of Clinical Oncology 2014): https://doi.org/10.1200/JCO.2013.54.8800
- Cheson et al., J Clin Oncol 2014: the Lugano classification for staging and response assessment in Hodgkin and non-Hodgkin lymphoma: https://doi.org/10.1200/JCO.2013.54.8800
- Barrington et al., J Clin Oncol 2014: the Imaging Working Group consensus on PET-CT in lymphoma and the five-point scale: https://doi.org/10.1200/JCO.2013.53.5229

## Connected records

- terms: [ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)](https://onco.cc/terms/abvd-beacopp/), [Complete response (CR) and partial response (PR)](https://onco.cc/terms/complete-response-term/), [De-escalation, escalation and response-adapted therapy](https://onco.cc/terms/de-escalation/), [Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed](https://onco.cc/terms/lymphoma-decision-beacopp-or-abvd/), [FLIPI, FLIPI2 and POD24 (follicular lymphoma risk)](https://onco.cc/terms/flipi/), [Mediastinum](https://onco.cc/terms/mediastinum/), [R-CHOP (lymphoma chemoimmunotherapy)](https://onco.cc/terms/r-chop/), [Radiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapy](https://onco.cc/terms/lymphoma-tx-radiotherapy/), [The Hodgkin microenvironment: when the cancer cell is the minority](https://onco.cc/terms/lymphoma-bio-hodgkin-microenvironment/), [The surveillance schedule, and the evidence that routine scans do not find relapse first](https://onco.cc/terms/lymphoma-living-scanxiety-and-surveillance/), [Transformation: when a slow lymphoma turns into a fast one](https://onco.cc/terms/lymphoma-bio-transformation/)
- cancers: [Advanced-stage classical Hodgkin lymphoma (stage III to IV)](https://onco.cc/cancers/advanced-stage-classical-hodgkin-lymphoma/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Primary mediastinal (thymic) large B-cell lymphoma](https://onco.cc/cancers/primary-mediastinal-b-cell-lymphoma/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/), [Richter transformation of chronic lymphocytic leukaemia](https://onco.cc/cancers/richter-transformation-cll/)
- fronts: [Imaging](https://onco.cc/fronts/imaging/)
- technologies: [FDG PET](https://onco.cc/technologies/fdg-pet/), [PET-adapted (response-adapted) therapy](https://onco.cc/technologies/pet-adapted-therapy/), [PET/CT](https://onco.cc/technologies/pet-ct/), [Quantitative imaging biomarkers (RECIST, PERCIST, SUV, ADC)](https://onco.cc/technologies/quantitative-imaging-biomarkers/)
- key papers: [Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification](https://onco.cc/key-papers/paper-cheson-j-clin-oncol/)
- drugs: [Fludeoxyglucose F-18 (FDG)](https://onco.cc/drugs/fludeoxyglucose-f18/)

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