Original articleACR Appropriateness Criteria Follow-up of Hodgkin Lymphoma
Section snippets
Introduction/Background
Routine follow-up evaluation of patients after treatment for Hodgkin lymphoma serves several functions. Detection of relapse is most important in the first 5 years after treatment. Beyond 5 years, the focus is on monitoring for late effects of therapy. The treatment of Hodgkin lymphoma has evolved greatly over the past few decades; toxicity continues to decrease and the already high cure rate is improving. With diminishing use of alkylating agents and radiation therapy, the profile of late
Summary
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The main focus of follow-up is recurrent disease in the first 5 years, as the majority of relapses occur in this time period. However, the focus shifts to late side effects beyond this time period.
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In general, a majority of recurrences can be detected initially by history and physical examination rather than by routine imaging studies or blood tests such as erythrocyte sedimentation rate, complete blood count, and chemistry panel.
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Routine surveillance CT scans can detect a proportion of recurrent
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Imaging Surveillance of Limited-stage Classic Hodgkin Lymphoma Patients After PET–CT-documented First Remission
2020, Clinical Lymphoma, Myeloma and LeukemiaCitation Excerpt :We did not find any differences in OS among the patients that had PET-CT imaging for surveillance during the 2 years after therapy compared with those that did not. All currently published guidelines agree that there is no role for PET-CT surveillance in patients with HL in remission after frontline therapy.8,13,25 For patients that undergo combined modality therapy, it is not clear whether PET-CT imaging should be repeated after RT is completed if a negative PET-CT scan was performed after systemic therapy.
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2017, Seminars in OncologyCitation Excerpt :American College of Radiology (ACR) Appropriateness Criteria (2014; Text Box 6) for post-treatment surveillance of Hodgkin lymphoma notes that a majority of recurrences can be detected clinically rather than through the use of imaging or blood tests, and that routine surveillance CT scans can detect an additional proportion of recurrences, though the value of this detection is unclear. PET-CT surveillance is not recommended because of low PPV, high false-positive rate, and high cost [47]. Current NCCN guidelines (Text Box 7) advise that it is acceptable to obtain CT imaging at 6, 12, and 24 months after completion of treatment, or as clinically indicated [48] Surveillance PET-CT is discouraged because of high rates of false-positive scans.
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2020, Prevention and Management of Acute and Late Toxicities in Radiation Oncology: Management of Toxicities in Radiation Oncology
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The ACR seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document.
Christopher R. Flowers, MD, MS, provides consulting for the Prescription Solutions Pharmacy and Therapeutics division. Consultation involves advice on FDA-regulated drugs only. None of the consultation overlaps with existing or planned ACR guidelines. Anas Younes, MD, has received an honoraria from: Novartis, Seattle Genetics, Millenium,Clegene, Curis, Sanofi, Pharmacyclics and Incyte; and research support from: Novartis, Johnson & Johnson, Seattle Genetics, Merck, Genentech, Infinity, and Gilead.