Hodgkin's lymphoma in remission after first-line therapy: which patients need FDG-PET/CT for follow-up?

doi:10.1093/annonc/mdp519

Annals of Oncology Advance Access published online on November 13, 2009
Annals of Oncology, doi:10.1093/annonc/mdp519

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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Hodgkin’s lymphoma in remission after first-line therapy: which patients need FDG–PET/CT for follow-up?

U. Petrausch¹^,, P. Samaras¹^,, P. Veit-Haibach², A. Tschopp³, J. D. Soyka², A. Knuth¹, T. F. Hany², A. Mischo¹, C. Renner¹^, and N. G. Schaefer¹^,2^,*^,

¹ Department of Oncology
² Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich
³ Institute of Social and Preventive Medicine, Biostatistics Unit, University of Zurich, Zurich, Switzerland

^* Correspondence to: Dr N. G. Schaefer, Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Rämistr. 100, 8091 Zürich, Switzerland. Tel: +41 44 255 1111; Fax: +41 44 255 4548; E-mail: Niklaus.Schaefer{at}usz.ch

Background: The purpose of the study was to evaluate the impactof 2-[fluorine-18]fluoro-2-deoxy-D-glucose–positron emissiontomography (FDG–PET)/computed tomography (CT) during follow-upof patients with Hodgkin’s lymphoma.

Patients and methods: Patients in complete remission or an unconfirmedcomplete remission after first-line therapy who received FDG–PET/CTduring their follow-up were analyzed retrospectively. Confirmatorybiopsy was mandatory in case of recurrence.

Results: Overall, 134 patients were analyzed. Forty-two (31.3%)patients had a recurrence. The positive predictive value ofFDG–PET/CT was 0.98. Single-factor analysis identifiedmorphological residual mass [P = 0.0005, hazard ratio (HR) 3.4,95% confidence interval (CI) 1.7–6.6] and symptoms (P< 0.0001, HR 4.9, 95% CI 2.4–9.9) as significant riskfactors for relapse. By multivariate analysis, morphologicalresidual mass was the only significant risk factor for earlyfollow-up (<24 months) (P = 0.0019, HR 7.6, 95% CI 2.1–27.3).Advanced stage (P = 0.0426, HR 3.6, 95% CI 1.1–12.3) andthe presence of symptoms (P = 0.0009, HR = 14.6, 95% CI 3.0–69.7)were found to be significant risk factors for later follow-up(>24 months).

Conclusions: Asymptomatic patients without morphological residuesand an early stage of disease do not need a routine FDG–PET/CTfor follow-up. Asymptomatic patients with morphological residuesshould receive routine follow-up FDG–PET/CT for the first24 months. Only patients with advanced initial stage do needa routine follow-up FDG–PET/CT beyond 24 months.

follow-up, Hodgkin's lymphoma, PET/CT

These authors contributed equally.

Received for publication October 8, 2009. Accepted for publication October 13, 2009.

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