PET and CAT for followup of Hodgkin’s – pro
How to follow Hodgkin’s after a documented remission has always been controversial. Historically, follow-up protocols were based on a report generated in 1999 by pathologists, radiologists and oncologists from the Cotswolds meeting in 1999. This report recommended that patients be assessed every 3 months during the first 2 years post-therapy, every 4 months during the third year, every 6 months during the fourth and fifth years, and annually thereafter. However, subsequent literature has continued to question the need for such frequent imaging. The uncertainty about the value of routine radiological investigations in the detection of relapse has increased after two studies showed that most relapses are detected as a result of patient-reported symptoms, not radiological investigations. Farther uncertainty was introduced by availability of PET scans. American College of Radiology recommends CT scans every 6 months for two years, then annually for 3 years but lists PET as “no consensus”. BC guidelines dont recommend any CT scanning. That is also ESMO recommendation of 2010. NCCN does not recommend PET. It has surveillance recommendations for imaging for chest x-ray or CT every 6-12 months for 2-5 years and abdominal/pelvic CT(category 2B) every 6-12 months for first 203 years. Surveillance PET should nto be done routinely due to risk of false positives. Management decisions should not be made on PET alone…” After 5 years it recommends annual chest imaging for patients at increased risk of lung cancer and annual breast screening 8-10 years after therapy or at age 40.
Ng AK, Constine LS, Deming RL, Wolkov HB, Hoppe RT, Abrams RA, Mendenhall NP, Morris DE, Yahalom J, Chauvenet A, Hudson MM, Winter JN, Mauch PM, Expert Panel on Radiation Oncology-Hodgkin’s Disease Work Group. Follow-up of Hodgkin’s Disease. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 6 p. [43 references]
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ESMO – http://annonc.oxfordjournals.org/content/21/suppl_5/v168.full
http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Lymphoma/HodgkinsDisease.htm
Maeda LS, Horning SJ, Iagaru AH, et al. Role of FDG-PET/CT surveillance for patients with classical Hodgkin’s disease in first complete response: the Stanford University experience [abstract]. Blood 2009;114:Abstract 1563.
Zinzani PL, Stefoni V, Tani M, et al. Role of [18F]fluorodeoxyglucose positron emission tomography scan in the follow-up of lymphoma. J Clin Oncol 2009;27:1781–1787.
nccn.org, Hodgkin, 2015