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J Am Coll Radiol. 2014 Nov;11(11):1026-1033.e3. doi: 10.1016/j.jacr.2014.07.038. Epub 2014 Sep 30.

ACR appropriateness criteria follow-up of Hodgkin lymphoma.

Author information

1
Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Electronic address: hac@uthscsa.edu.
2
Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
3
Stanford School of Medicine, Stanford Cancer Center, Stanford, California; American Society of Clinical Oncology, Alexandria, Virginia.
4
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
5
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York.
6
Dept of Hematology & Oncology, Emory University, Atlanta, Georgia; American Society of Clinical Oncology, Alexandria, Virginia.
7
University of Florida Proton Therapy Institute, Jacksonville, Florida.
8
Department of Radiation Oncology, University of Florida, Gainesville, Florida.
9
Dept. of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; American Society of Clinical Oncology, Alexandria, Virginia.
10
Dept. of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
11
Dept. of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
12
Dept. of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
13
University of Chicago, Chicago, Illinois; American Society of Hematology, Washington DC.
14
Dept. of Radiation Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland.
15
Dept. of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
16
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; American Society of Clinical Oncology, Alexandria, Virginia.

Abstract

The main objectives of follow-up studies after completion of treatment for Hodgkin lymphoma are detection of recurrence for salvage therapy and monitoring for sequelae of treatment. The focus of the follow-up shifts, with time after treatment, from detection of recurrence to long-term sequelae. A majority of recurrence is detected by history and physical examination. The yield for routine imaging studies and blood tests is low. Although routine surveillance CT scan can detect recurrence not detected by history and physical examination, its benefit in ultimate survival and cost-effectiveness is not well defined. Although PET scan is a useful tool in assessing response to treatment, its routine use for follow-up is not recommended. Long-term sequelae of treatment include secondary malignancy, cardiovascular disease, pneumonitis, reproductive dysfunction, and hypothyroidism. Follow-up strategies for these sequelae need to be individualized, as their risks in general depend on the dose and volume of radiation to these organs, chemotherapy, age at treatment, and predisposing factors for each sequela. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is either lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

KEYWORDS:

Appropriateness Criteria; Hodgkin lymphoma; follow up; recurrence; surveillance; treatment sequela

PMID:
25278496
DOI:
10.1016/j.jacr.2014.07.038
[Indexed for MEDLINE]

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