Pediatric Hodgkin lymphoma

Are we over-scanning our patients

N. Rathore, H. M. Eissa, J. F. Margolin, Hao 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 journalArticle

20 Citations (Scopus)

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 1 2012
Externally publishedYes

Fingerprint

Hodgkin Disease
Pediatrics
Radiation Dosage
Recurrence
Tomography
Ionizing Radiation
Thorax
Therapeutics
Second Primary Neoplasms
Diagnostic Imaging
Pelvis
Positron-Emission Tomography
Abdomen
Carcinogenesis
Neck
Radiation
Radiation Exposure
Neoplasms

Keywords

  • Hodgkin disease
  • Late effects
  • Radiology

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Rathore, N., Eissa, H. M., Margolin, J. F., Liu, H., Wu, M. F., Horton, T., ... Bollard, C. M. (2012). Pediatric Hodgkin lymphoma: Are we over-scanning our patients. Pediatric Hematology and Oncology, 29(5), 415-423. https://doi.org/10.3109/08880018.2012.684198

Pediatric Hodgkin lymphoma : Are we over-scanning our patients. / Rathore, N.; Eissa, H. M.; Margolin, J. F.; Liu, Hao; Wu, M. F.; Horton, T.; Kamdar, K.; Dreyer, Z.; Steuber, P.; Rabin, K. R.; Redell, M.; Allen, C. E.; McClain, K. L.; Guillerman, R. P.; Bollard, C. M.

In: Pediatric Hematology and Oncology, Vol. 29, No. 5, 01.08.2012, p. 415-423.

Research output: Contribution to journalArticle

Rathore, N, Eissa, HM, Margolin, JF, Liu, H, Wu, MF, Horton, T, Kamdar, K, Dreyer, Z, Steuber, P, Rabin, KR, Redell, M, Allen, CE, McClain, KL, Guillerman, RP & Bollard, CM 2012, 'Pediatric Hodgkin lymphoma: Are we over-scanning our patients', Pediatric Hematology and Oncology, vol. 29, no. 5, pp. 415-423. https://doi.org/10.3109/08880018.2012.684198
Rathore, N. ; Eissa, H. M. ; Margolin, J. F. ; Liu, Hao ; Wu, M. F. ; Horton, T. ; Kamdar, K. ; Dreyer, Z. ; Steuber, P. ; Rabin, K. R. ; Redell, M. ; Allen, C. E. ; McClain, K. L. ; Guillerman, R. P. ; Bollard, C. M. / Pediatric Hodgkin lymphoma : Are we over-scanning our patients. In: Pediatric Hematology and Oncology. 2012 ; Vol. 29, No. 5. pp. 415-423.
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