Phillips Tycel, Mercer Jessica
Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
Curr Treat Options Oncol. 2017 Feb;18(2):10. doi: 10.1007/s11864-017-0451-7.
Advancements in the treatment of lymphoma over the last few decades have allowed more patients to achieve a remission after the completion of therapy. Due to the improvement in response rates, methods to detect recurrence early and accurately during follow-up, especially in patients with potential curable aggressive lymphomas, are a key. Observation has always involved close clinical follow-up with the use of physical exams and routine labs, but rapid changes in technology have allowed CT scans, PET scans, and MRIs to become an integral part of managing patients with lymphoma. While the utility of scans in initial staging and immediately after completion of therapy is well established, the use of these imaging modalities for monitoring recurrence in lymphoma patients is still controversial. Patient advocacy groups and other regulatory committees have questioned the frequency and in some cases even the need for these tests in patients without evidence of active disease given the concern for radiation-associated health risks. Additionally, the extent to which this form of testing impacts the psyche of our patients is not completely known. Given the numerous questions raised about the benefits, safety, and cost-effectiveness of CT imaging, firm guidelines are needed at this time in standard practice and within our clinical trials to limit the use of surveillance imaging. Such efforts are expected to improve the utility of these scans in asymptomatic patients, reduce healthcare costs, and reduce patient exposure to radiation.
在过去几十年里，淋巴瘤治疗取得的进展使更多患者在完成治疗后实现缓解。由于缓解率有所提高，在随访期间早期准确检测复发的方法至关重要，尤其是对于潜在可治愈的侵袭性淋巴瘤患者。以往的观察一直包括通过体格检查和常规实验室检查进行密切的临床随访，但技术的快速发展使CT扫描、PET扫描和MRI成为淋巴瘤患者管理中不可或缺的一部分。虽然扫描在初始分期和治疗刚结束后时的效用已得到充分证实，但在淋巴瘤患者中使用这些成像方式监测复发仍存在争议。鉴于对辐射相关健康风险的担忧，患者权益倡导组织和其他监管委员会对在无疾病活动证据的患者中进行这些检查的频率提出质疑，在某些情况下甚至质疑其必要性。此外，这种检测形式对患者心理的影响程度尚不完全清楚。鉴于对CT成像的益处、安全性和成本效益提出了诸多问题，目前在标准实践和我们的临床试验中需要制定严格的指南，以限制监测成像的使用。这些努力有望提高这些扫描在无症状患者中的效用，降低医疗成本，并减少患者接受辐射的剂量。
