Very low utility of surveillance imaging in early-stage classic Hodgkin lymphoma treated with a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation therapy Journal Article


Authors: Gandikota, N.; Hartridge-Lambert, S.; Migliacci, J. C.; Yahalom, J.; Portlock, C. S.; Schöder, H.
Article Title: Very low utility of surveillance imaging in early-stage classic Hodgkin lymphoma treated with a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation therapy
Abstract: BACKGROUND This study evaluated the need for surveillance imaging in early-stage classic Hodgkin lymphoma (cHL) after planned combined-modality therapy (CMT). METHODS Primary early-stage cHL patients who underwent CMT were included. Positron emission tomography (PET)/computed tomography (CT), CT, or both were performed at the initial staging, during or after chemotherapy, and for at least 2 years during follow-up. Imaging studies and medical records were reviewed to determine if and when relapse had occurred. Radiation doses and costs were also calculated from follow-up imaging. RESULTS The study included 78 patients with a median follow-up of 46 months; 85% of the patients had stage II disease (32% with bulky disease). Four of 77 interim PET scans were positive; none of these patients relapsed during follow-up, which ranged from 24 to 80 months. After a total of 466 follow-up imaging studies (91% with CT and 9% with PET/CT), no cHL relapse was detected. Eleven abnormal findings were noted on surveillance imaging: 9 were false-positives, and 2 were second primary malignancies. The average cumulative dose per patient from follow-up imaging was 107 mSv, which translated into an estimated lifetime excess cancer risk of 0.5%; the estimated total costs were $296,817 according to Medicare reimbursements. CONCLUSIONS Surveillance imaging with either CT or PET/CT can be omitted safely for early-stage cHL treated with a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation therapy because the risk of relapse is extremely low. This observation also applies to patients with bulky disease. The elimination of surveillance imaging will also reduce healthcare expenses and cumulative radiation doses in these predominantly young patients. Cancer 2015;121:1985-1992. © 2015 American Cancer Society.
Keywords: adult; treatment response; aged; major clinical study; cancer recurrence; doxorubicin; cancer combination chemotherapy; cancer risk; treatment planning; cancer radiotherapy; radiation dose; cancer staging; follow up; adenocarcinoma; dacarbazine; computer assisted tomography; retrospective study; kidney carcinoma; vinblastine; health care cost; t cell lymphoma; partial nephrectomy; radioactive iodine; fluorodeoxyglucose f 18; computer assisted emission tomography; bleomycin; thyroid cancer; false positive result; hodgkin lymphoma; classical hodgkin lymphoma; combined-modality therapy; early stage; surveillance imaging; positron emission tomography (pet) scan; very elderly; human; male; female; priority journal; article; pet-ct scanner; lower esophagus sphincter adenocarcinoma
Journal Title: Cancer
Volume: 121
Issue: 12
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2015-06-15
Start Page: 1985
End Page: 1992
Language: English
DOI: 10.1002/cncr.29277
PROVIDER: scopus
PUBMED: 25739719
PMCID: PMC4972450
DOI/URL:
Notes: Export Date: 2 July 2015 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Joachim Yahalom
    394 Yahalom
  2. Carol Portlock
    178 Portlock
  3. Heiko Schoder
    285 Schoder