How to follow Hodgkin's after a documented remission is 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. NCCN recommends CT scans of chest and abdomen every 6 months for two years and says that "Surveillance PET should not be done routinely...management decisions should not be made on PET scan alone...".That is also ESMO recommendation of 2010.
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]
E T Dryver et al, Follow-up of patients with Hodgkin's disease following curative treatment: the routine CT scan is of little value British Journal of Cancer (2003) 89, 482–486.
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, 2011
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