Journal of Clinical Oncology, Vol 15, 1123-1130, Copyright © 1997 by American Society of Clinical Oncology
Detection of relapse in early-stage Hodgkin's disease: role of routine follow-up studies
MJ Torrey, JC Poen and RT Hoppe
Department of Radiation Oncology, Stanford University Medical Center, CA, USA. margaret.torrey@mcrad.med.nyu.edu
PURPOSE: To examine the costs and benefits of routine follow-up evaluation
in patients treated with radiation therapy for early-stage Hodgkin's
disease. PATIENTS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.
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