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El-Galaly TC, Mylam KJ, Bøgsted M, Brown P, Rossing M, Gang AO, Haglund A, Arboe B, Clausen MR, Jensen P, Pedersen M, Bukh A, Jensen BA, Poulsen CB, d'Amore F, Hutchings M. Role of routine imaging in detecting recurrent lymphoma: A review of 258 patients with relapsed aggressive non-Hodgkin and Hodgkin lymphoma. Am J Hematol 2014; 89:575-80. [PMID: 24493389 DOI: 10.1002/ajh.23688] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 01/29/2014] [Indexed: 11/10/2022]
Abstract
After first-line therapy, patients with Hodgkin lymphoma (HL) and aggressive non-HL are followed up closely for early signs of relapse. The current follow-up practice with frequent use of surveillance imaging is highly controversial and warrants a critical evaluation. Therefore, a retrospective multicenter study of relapsed HL and aggressive non-HL (nodal T-cell and diffuse large B-cell lymphomas) was conducted. All included patients had been diagnosed during the period 2002-2011 and relapsed after achieving complete remission on first-line therapy. Characteristics and outcome of imaging-detected relapses were compared with other relapses. A total of 258 patients with recurrent lymphoma were included in the study. Relapse investigations were initiated outside preplanned visits in 52% of the patients. Relapse detection could be attributed to patient-reported symptoms alone or in combination with abnormal blood tests or physical examination in 64% of the patients. Routine imaging prompted relapse investigations in 27% of the patients. The estimated number of routine scans per relapse was 91-255 depending on the lymphoma subtype. Patients with imaging-detected relapse had lower disease burden (P = 0.045) and reduced risk of death following relapse (hazard ratio = 0.62, P = 0.02 in multivariate analysis). Patient-reported symptoms are still the most common factor for detecting lymphoma relapse and the high number of scans per relapse calls for improved criteria for use of surveillance imaging. However, imaging-detected relapse was associated with lower disease burden and a possible survival advantage. The future role of routine surveillance imaging should be defined in a randomized trial.
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Affiliation(s)
- TC El-Galaly
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
- Department of Hematology; Aarhus University Hospital; Aarhus Denmark
| | - Karen Juul Mylam
- Department of Hematology; Odense University Hospital; Odense Denmark
| | - Martin Bøgsted
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
- Department of Mathematical Sciences; Aalborg University; Aalborg Denmark
| | - Peter Brown
- Department of Hematology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Maria Rossing
- Department of Hematology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Anne Ortved Gang
- Department of Hematology; Herlev; Copenhagen University Hospital; Herlev Denmark
| | - Anne Haglund
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
| | - Bente Arboe
- Department of Hematology; Roskilde Hospital; Roskilde Denmark
| | | | - Paw Jensen
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
| | - Michael Pedersen
- Department of Hematology; Herlev; Copenhagen University Hospital; Herlev Denmark
| | - Anne Bukh
- Department of Hematology; Aarhus University Hospital; Aarhus Denmark
| | - Bo Amdi Jensen
- Department of Hematology; Odense University Hospital; Odense Denmark
| | | | - Francesco d'Amore
- Department of Hematology; Aarhus University Hospital; Aarhus Denmark
| | - Martin Hutchings
- Department of Hematology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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Kostakoglu L, Cheson BD. Current role of FDG PET/CT in lymphoma. Eur J Nucl Med Mol Imaging 2014; 41:1004-27. [PMID: 24519556 DOI: 10.1007/s00259-013-2686-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 12/27/2013] [Indexed: 01/08/2023]
Abstract
The management approach in Hodgkin's (HL) and high-grade non-Hodgkin's lymphomas (NHL) has shifted towards reducing the toxicity and long-term adverse effects associated with treatment while maintaining favorable outcomes in low-risk patients. The success of an individualized treatment strategy depends largely on accurate diagnostic tests both at staging and during therapy. In this regard, positron emission tomography (PET) using fluorodeoxyglucose (FDG) with computed tomography (CT) has proved effective as a metabolic imaging tool with compelling evidence supporting its superiority over conventional modalities, particularly in staging and early evaluation of response. Eventually, this modality was integrated into the routine staging and restaging algorithm of lymphomas. This review will summarize the data on the proven and potential utility of PET/CT imaging for staging, response assessment, and restaging, describing current limitations of this imaging modality.
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Affiliation(s)
- Lale Kostakoglu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1141, New York, NY, 10029, USA,
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Lynch RC, Zelenetz AD, Armitage JO, Carson KR. Surveillance imaging for lymphoma: pros and cons. Am Soc Clin Oncol Educ Book 2014:e388-e395. [PMID: 24857129 DOI: 10.14694/edbook_am.2014.34.e388] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
There is no international consensus on the optimal frequency or duration of computed tomography or positron emission tomography scanning for surveillance in patients who achieve complete remission after initial therapy for lymphoma. Although some clinical practice guidelines suggest periodic imaging is reasonable, others suggest little or no benefit to this practice. From a theoretical perspective, the frequency and duration of surveillance imaging is largely dependent upon the lymphoma subtype. Aggressive lymphomas with a fast growth rate will require surveillance more frequently and for a shorter duration compared to the indolent lymphomas. Historically, relapse has been detected in a majority of patients based upon clinically evident signs and symptoms. Currently, no study has demonstrated an overall survival difference for patients with relapse detected by imaging as opposed to clinical evaluation, although one study did demonstrate a lower second-line International Prognostic Index in patients with relapse detected by surveillance imaging. Enthusiasm for this finding has been tempered by recent studies highlighting the potential long-term risk of secondary malignancies because of ionizing radiation exposure from diagnostic imaging. These factors along with the significant costs associated with diagnostic imaging have contributed to an ongoing debate regarding the relative costs, risks, and benefits of radiographic surveillance. Herein we present perspectives for and against routine surveillance imaging in an effort to facilitate a better understanding of the issues relevant to what is ultimately a clinical decision made by an oncologist and his or her patient.
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Affiliation(s)
- Ryan C Lynch
- From the: Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO; Lymphoma Division, Memorial Sloan Kettering Cancer Center, New York, NY; Division of Oncology, Department of Medicine, University of Nebraska; Division of Oncology, Department of Medicine, Washington University School of Medicine; and Division of Hematology/Oncology, St. Louis VA Medical Center, St. Louis, MO
| | - Andrew D Zelenetz
- From the: Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO; Lymphoma Division, Memorial Sloan Kettering Cancer Center, New York, NY; Division of Oncology, Department of Medicine, University of Nebraska; Division of Oncology, Department of Medicine, Washington University School of Medicine; and Division of Hematology/Oncology, St. Louis VA Medical Center, St. Louis, MO
| | - James O Armitage
- From the: Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO; Lymphoma Division, Memorial Sloan Kettering Cancer Center, New York, NY; Division of Oncology, Department of Medicine, University of Nebraska; Division of Oncology, Department of Medicine, Washington University School of Medicine; and Division of Hematology/Oncology, St. Louis VA Medical Center, St. Louis, MO
| | - Kenneth R Carson
- From the: Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO; Lymphoma Division, Memorial Sloan Kettering Cancer Center, New York, NY; Division of Oncology, Department of Medicine, University of Nebraska; Division of Oncology, Department of Medicine, Washington University School of Medicine; and Division of Hematology/Oncology, St. Louis VA Medical Center, St. Louis, MO
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Schnipper LE, Lyman GH, Blayney DW, Hoverman JR, Raghavan D, Wollins DS, Schilsky RL. American Society of Clinical Oncology 2013 Top Five List in Oncology. J Clin Oncol 2013; 31:4362-70. [DOI: 10.1200/jco.2013.53.3943] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Lowell E. Schnipper
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Gary H. Lyman
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Douglas W. Blayney
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - J. Russell Hoverman
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Derek Raghavan
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Dana S. Wollins
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
| | - Richard L. Schilsky
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Gary H. Lyman, Duke University and Duke Cancer Institute, Durham; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA; J. Russell Hoverman, Texas Oncology, Dallas, TX; and Dana S. Wollins and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA
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