Pediatric Hodgkin lymphoma: Are we over-scanning our patients

N. Rathore, H. M. Eissa, J. F. Margolin, H. Liu, M. F. Wu, T. Horton, K. Kamdar, Z. Dreyer, P. Steuber, K. R. Rabin, M. Redell, C. E. Allen, K. L. McClain, R. P. Guillerman, C. M. Bollard

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Despite the favorable outcome of most pediatric patients with Hodgkin lymphoma (HL), there is rising concern about risks of carcinogenesis from both diagnostic and therapeutic radiation exposure for patients treated on study protocols. Although previous studies have investigated radiation exposure during treatment, radiation from post-treatment surveillance imaging may also increase the likelihood of secondary malignancies. All diagnostic imaging examinations involving ionizing radiation exposure performed for surveillance following completion of therapy were recorded for 99 consecutive pediatric patients diagnosed with HL from 2000 to 2010. Cumulative radiation dosage from these examinations and the frequency of relapse detection by these examinations were recorded. In the first 2 years following completion of therapy, patients in remission received a median of 11 examinations (range 026). Only 13 of 99 patients relapsed, 11 within 5 months of treatment completion. No relapse was detected by 1- or 2-view chest radiographs (n=38 and 296, respectively), abdomen/pelvis computed tomography (CT) scans (n=211), or positron emission tomography (PET) scans alone (n=11). However, 10/391 (2.6) of chest CT scans, 4/364 (1.1) of neck CT scans, and 3/47 (6.4) of PET/CT scans detected relapsed disease. Thus, only 17 scans (1.3) detected relapse in a total of 1358 scans. Mean radiation dosages were 31.97 mSv for Stage 1, 37.76 mSv for Stage 2, 48.08 mSv for Stage 3, and 51.35 mSv for Stage 4 HL. Approximately 1 of surveillance imaging examinations identified relapsed disease. Given the very low rate of relapse detection by surveillance imaging stipulated by current protocols for pediatric HL patients, the financial burden of the tests themselves, the high cure rate, and risks of second malignancy from ionizing radiation exposure, modification of the surveillance strategy is recommended.

Original languageEnglish (US)
Pages (from-to)415-423
Number of pages9
JournalPediatric hematology and oncology
Volume29
Issue number5
DOIs
StatePublished - Aug 2012
Externally publishedYes

Bibliographical note

Funding Information:
Received 9 January 2012; accepted 7 April 2012. This work was supported by Cancer Center Support Grant P30CA125123. Address correspondence to Catherine M. Bollard, MD, Center for Cell and Gene Therapy, Baylor College of Medicine, 6621 Fannin Street, MC 3-3320, Houston, TX 77030, USA. E-mail: cmbollar@txch.org

Keywords

  • Hodgkin disease
  • Late effects
  • Radiology

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