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Surveillance imaging of Hodgkin lymphoma patients in first remission
A clinical and economic analysis
Version of Record online: 13 MAY 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 16, pages 3835–3842, 15 August 2010
How to Cite
Lee, A. I., Zuckerman, D. S., Van den Abbeele, A. D., Aquino, S. L., Crowley, D., Toomey, C., Lacasce, A. S., Feng, Y., Neuberg, D. S. and Hochberg, E. P. (2010), Surveillance imaging of Hodgkin lymphoma patients in first remission. Cancer, 116: 3835–3842. doi: 10.1002/cncr.25240
- Issue online: 4 AUG 2010
- Version of Record online: 13 MAY 2010
- Manuscript Accepted: 18 NOV 2009
- Manuscript Revised: 26 OCT 2009
- Manuscript Received: 16 AUG 2009
- computed tomography scan;
- Hodgkin lymphoma;
- positron emission tomography scan;
- radiation exposure;
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.
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.
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.
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.