Is there a place for routine imaging for patients in complete remission from aggressive lymphoma?

Abstract

Routine imaging of patients with aggressive lymphoma in complete remission is standard practice in most of the United States. The timing (i.e. every 6 months or every year), the duration (i.e. usually for 3–5 years) and the type of image performed (i.e. CT scan, PET scan or both) vary among clinicians. However, these studies are often routinely performed by academic oncologists and private practitioners. In this issue of the Annals, Liedtke et al. describe 108 patients with relapsed aggressive non-Hodgkin's lymphoma who were treated with ifosfamide, carboplatin and etoposide (ICE) followed by an autologous hematopoietic stem cell transplant in responding patients [1]. Eighty per cent of the patients in the study had their relapse diagnosed as part of an evaluation for new symptoms or physical findings, and 20% of the patients had their diagnosis of relapse made because of findings from routine imaging. They found that patients whose relapse was discovered as a result of routine imaging were more likely to have low risk disease and had a slight, but not significant, increase in 5-year survival (i.e. 54% versus 43%). However, the proportion of detecting relapse based on routine versus non-routine imaging would have been better quantified if the study had included patients who did not develop relapse.