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Surveillance imaging of Hodgkin lymphoma patients in first remission
Author(s) -
Lee Alfred Ian,
Zuckerman Dan S.,
Van den Abbeele Annick D.,
Aquino Suzanne L.,
Crowley Diane,
Toomey Christiana,
Lacasce Ann S.,
Feng Yang,
Neuberg Donna S.,
Hochberg Ephraim P.
Publication year - 2010
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.25240
Subject(s) - medicine , concordance , lymphoma , radiology , positron emission tomography , radiography , radiation therapy , retrospective cohort study , nuclear medicine
BACKGROUND: The majority of patients with Hodgkin lymphoma (HL) achieve disease remission after primary therapy. To the best of the authors' knowledge, no consensus exists for postremission surveillance imaging. METHODS: Retrospectively analyzed were 192 adult patients with classic HL in first remission. Events were defined as recurrent HL or secondary malignancies. Primary outcome was positive predictive value (PPV) of surveillance positron emission tomography/computed tomography (PET/CT) and CT scans in event detection. Secondary outcomes were costs and radiation exposures of surveillance scans. RESULTS: Sixteen events (12 recurrent HL cases and 4 secondary malignancies) were detected during a median follow‐up of 31 months. The PPV of surveillance PET/CT was 22.9% compared with 28.6% for CT ( P = .73). Factors that were found to significantly improve the PPV of scans in detecting recurrent HL included PET and CT concordance, involvement of a prior disease site, or the occurrence of a radiographic abnormality within 12 months. There were too few events to determine whether event detection by PET/CT versus CT or the presence of symptoms at the time of event detection affected overall outcomes. The cost to detect a single event was approximately $100,000. Radiation exposure to detect a single event was 146.6 millisieverts per patient for each of 9 patients. CONCLUSIONS: For patients with HL in first disease remission, surveillance radiography appears to be expensive, with limited clinical impact. Surveillance CT is generally adequate. Cancer 2010. © 2010 American Cancer Society.