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Imaging after 1 year may not be beneficial in HL survivors
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Follow-up CT imaging may be overused in pediatric Hodgkin’s lymphoma survivors, as a recent study has found that only a small percentage of relapses were detected by imaging that took place after the first year post-therapy.
Survivors frequently undergo routine imaging for up to 5 years after completing therapy. However, it is unclear if this increased surveillance is of any benefit to the patient. With this study, researchers wrote that they hoped to “identify an opportunity to reduce both unnecessary medical expense and radiation exposure by decreasing the number of imaging studies being routinely performed on patients with Hodgkin’s lymphoma.”
The Pediatric Oncology Group 9425 trial retrospectively reviewed the data of 216 patients aged 21 years or younger with Hodgkin’s lymphoma. Researchers examined the records to determine the methods for detecting relapse. At follow-up, 35 patients (16%) had an event occurrence, but only 25 of these events were related to the Hodgkin’s lymphoma.
Sixty-four percent of these patients experienced relapse within the first year after therapy. Of them, 76% had their relapse discovered based on symptoms, laboratory or physical examination findings. Eight percent had their relapse discovered using imaging within the first year post-therapy. Only four patients (16%) had their relapse discovered using imaging after 1 year post-therapy.
The researchers acknowledged that since the time of the treatment of these patients, MRI has effectively replaced CT as the modality for surveillance imaging. Despite that, they still recommended that “a comprehensive outcome analysis is needed to determine whether surveillance imaging of any kind is a cost-effective means of monitoring a disease for which late, clinically occult relapses are unusual and for which OS rates remain high.”
Reference:
- Voss SD. J Clin Oncol. 2012;doi:10.1200/JCO.2011.40.7841.
Perspective
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Joseph R. Bertino, MD
These data, and data from follow-up studies of diffuse large cell lymphoma patients after chemotherapy, would indicate that fewer scans should be done. Because most of these patients who relapse do so within the first year, careful follow-up and PET scans at 6 and 12 months make sense.
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