Surveillance CT: Limit to 12 Months Posttherapy in Pediatric Advanced Hodgkin Lymphoma
(ChemotherapyAdvisor) – Computed tomography (CT) imaging is overused for routine surveillance of children with advanced-stage Hodgkin lymphoma, a study in the Journal of Clinical Oncology online June 11 has reported.
The majority of the relapses occurred in patients “within the first year after therapy or were detected based on change in clinical status,” the investigators found. In addition, “detecting late relapse, whether by imaging or clinical change, did not affect overall survival.”
Children with Hodgkin lymphoma routinely undergo surveillance CT imaging for up to five years after therapy without clear benefit but with attendant cost and radiation exposure. Data from the multicenter Pediatric Oncology Group 9425 trial were retrospectively reviewed to determine whether imaging or clinical events prompted suspicion of disease recurrence.
At a median follow-up of 7.4 years, 25 of 216 patients (11.6%) had experienced a relapse, 23 of which were local. Median time to relapse was 7.6 months (range, 0.2 to 48.9 months).
Symptoms, laboratory, or physical examinations led to detection of 19 of the relapses (76%); 2 (8%) were detected by imaging within the first year after therapy. After the first year, only four patients (16%) had their recurrence detected exclusively by surveillance CT imaging. All six deaths occurred in children who experienced relapse within the first year after therapy. “No patient with a recurrence after one year off treatment has died, regardless of how the recurrence was detected,” they found.
Noting that approximately 1,080 CT scans were obtained to detect four asymptomatic late relapses, “we recommend reducing the routine use of CT surveillance imaging to the initial 12 months after therapy,” the investigators concluded.