Torrey M J, Poen J C, Hoppe R T
Department of Radiation Oncology, Stanford University Medical Center, CA, USA.
J Clin Oncol. 1997 Mar;15(3):1123-30. doi: 10.1200/JCO.1997.15.3.1123.
To examine the costs and benefits of routine follow-up evaluation in patients treated with radiation therapy for early-stage Hodgkin's disease.
We retrospectively examined patterns of follow-up evaluation and methods of relapse detection among 709 patients with stage I and II Hodgkin's disease treated with primary radiotherapy between 1969 and 1994. We determined the probability of relapse detection for seven routine follow-up procedures, compared their relative costs, and determined the impact of each procedure on the likelihood of survival following salvage therapy.
Relapse has occurred in 157 patients (22%) at a median 1.9 years (range, 0 to 13 years) posttreatment. Relapse was suspected primarily by history (Hx) in 55% of patients, physical examination (PE) in 14%, chest x-ray (CXR) in 23%, and abdominal x-ray (KUB) in 7%. Only one relapse (1%) was identified by a routine laboratory study. The rate of relapse detection was highest for a combination of Hx and PE (78 of 10,000 examinations) followed by CXR (26 of 10,000 examinations). The projected charges (1995 dollars) per relapse detected by routine follow-up Hx and PE were $11,000 compared with $68,000 for CXR and $142,000 for KUB. The 10-year actuarial survival rate following salvage therapy was 65% overall, 65% for patients in whom relapse was detected by Hx or PE, and 69% for patients in whom relapse was detected by radiographs (P = not significant).
The majority of relapses occurred within 5 years of treatment and were identified by Hx and PE. CXR was useful during the first 3 years of follow-up evaluation. KUB, CBC, and laboratory studies accounted for nearly half of all follow-up charges and rarely led to the detection of relapse. Their routine use as a method of relapse detection is questionable. In general, the method of relapse detection did not have a significant impact on the likelihood of successful salvage therapy.
探讨早期霍奇金病患者接受放射治疗后进行常规随访评估的成本与效益。
我们回顾性研究了1969年至1994年间接受原发性放射治疗的709例Ⅰ期和Ⅱ期霍奇金病患者的随访评估模式及复发检测方法。我们确定了七种常规随访程序检测到复发的概率，比较了它们的相对成本，并确定了每种程序对挽救治疗后生存可能性的影响。
157例患者（22%）出现复发，中位复发时间为治疗后1.9年（范围0至13年）。55%的患者主要通过病史（Hx）怀疑复发，14%通过体格检查（PE），23%通过胸部X线（CXR），7%通过腹部X线（KUB）。仅1例复发（1%）通过常规实验室检查发现。Hx和PE联合检测到复发的比率最高（每10000次检查中有78例），其次是CXR（每10000次检查中有26例）。通过常规随访Hx和PE检测到每次复发的预计费用（1995年美元）为11000美元，而CXR为68000美元，KUB为142000美元。挽救治疗后的10年精算生存率总体为65%，通过Hx或PE检测到复发的患者为65%，通过X线片检测到复发的患者为69%（P = 无显著性差异）。
大多数复发发生在治疗后5年内，通过Hx和PE发现。CXR在随访评估的前3年有用。KUB、全血细胞计数（CBC）和实验室检查占所有随访费用的近一半，且很少能检测到复发。将它们作为复发检测方法常规使用存在疑问。总体而言，复发检测方法对挽救治疗成功的可能性没有显著影响。
