Follow-up Protocol for Hodgkin's Disease
Dear OncoLink "Ask The Experts,"
I have Hodgkin's disease, stage 2, NS (nodular sclerosis) subtype. I have completed chemotherapy and radiation, but am not being scanned for about 7 weeks. I have only had one CT scan when I was first diagnosed, and worry that I should have had PET scans and bone marrow tests. What are the recommended follow up guidelines for Hodgkin's disease?
Babis (Charalambos) Andreadis, MD, Assistant Professor in Medicine in the Division of Hematology/Oncology at the Abramson Cancer Center and an Associate Scholar in the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania, responds:
Initial staging, response assessment, and follow-up in Hodgkin lymphoma are areas that are continuously evolving. Nevertheless, there are official practice guidelines supported by the National Cancer Center Network (NCCN) and available at their website (www.nccn.org). According to those guidelines, initial staging for Hodgkin's lymphoma should include a thorough history, physical, and laboratory evaluation, with a baseline CT scan, PET scan, and bone marrow biopsy. Additional tests that are optional, but that we perform routinely, include a baseline assessment of cardiac function with an echo or a MUGA, and assessment of pulmonary function with PFTs prior to the initiation of chemotherapy. During primary therapy with chemotherapy, with or without radiation therapy, the NCCN guidelines recommend restaging with any previously positive study (CT, PET) after 4 cycles of therapy, and again at completion of treatment.
Once the required response is achieved, i.e. a complete response (CR or Cru) with a negative PET scan, then close regular follow-up should be initiated. That includes a clinic visit every 2-4 months for the first 1-2 years, with CT scans performed every 3-6 months for the first 2-3 years and annually thereafter. Additional studies that are needed are annual mammograms in patients that receive chest radiation, starting at the age of 40 years or 8 years after treatment, whichever comes first.
Also, yearly thyroid function tests are done for patients that receive radiation to the neck. Most oncologists will follow patients for the first 5 years and subsequently transfer their care to the general physicians.