Gandikota Neetha, Hartridge-Lambert Sidonie, Migliacci Jocelyn C, Yahalom Joachim, Portlock Carol S, Schöder Heiko
Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Cancer. 2015 Jun 15;121(12):1985-92. doi: 10.1002/cncr.29277. Epub 2015 Mar 4.
This study evaluated the need for surveillance imaging in early-stage classic Hodgkin lymphoma (cHL) after planned combined-modality therapy (CMT).
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.
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.
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.
本研究评估了计划性综合治疗（CMT）后早期经典型霍奇金淋巴瘤（cHL）患者进行监测成像的必要性。
纳入接受CMT的原发性早期cHL患者。在初始分期、化疗期间或化疗后以及随访至少2年期间进行正电子发射断层扫描（PET）/计算机断层扫描（CT）、CT或两者检查。回顾影像学研究和病历以确定是否以及何时发生复发。还从随访成像中计算辐射剂量和成本。
该研究纳入78例患者，中位随访时间为46个月；85%的患者为II期疾病（32%为大包块疾病）。77次中期PET扫描中有4次为阳性；这些患者在24至80个月的随访期间均未复发。在总共466次随访影像学研究后（91%为CT，9%为PET/CT），未检测到cHL复发。监测成像发现11项异常结果：9项为假阳性，2项为第二原发性恶性肿瘤。每位患者随访成像的平均累积剂量为107 mSv，这转化为估计的终生额外癌症风险为0.5%；根据医疗保险报销估算的总成本为296,817美元。
对于接受多柔比星、博来霉素、长春花碱和达卡巴嗪联合放疗治疗的早期cHL患者，可以安全地省略CT或PET/CT监测成像，因为复发风险极低。这一观察结果也适用于大包块疾病患者。取消监测成像还将降低这些主要为年轻患者的医疗费用和累积辐射剂量。
