Management of Hodgkin Lymphoma - Episode 6
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PET imaging has emerged as an important tool for the management of Hodgkin lymphoma. In general, Craig H. Moskowitz, MD, explains, CT scans are beneficial for determining the size of the lesion while PET scans help ascertain the activity. PET scans are more sensitive to disease outside of the lymph nodes, Moskowitz notes. As a result, utilizing this technique often results in the discovery of metastases, indicating more advanced disease.
PET imaging has the most utility during staging and to determine if a patient is in remission, Moskowitz suggests. However, opinions on measuring response using interim PET scanning varies, particularly since an alternative therapy has not been proven to be more effective.
Given the high rate of false positives with PET imaging, results should be confirmed by biopsy following the completion of therapy, Lauren C. Pinter-Brown, MD, notes. However, in the interim of a treatment course, Paul A. Hamlin, MD, adds, it is still unclear whether PET scan alone is sufficiently prognostic to warrant a change in therapy or if the false positive rates are too high.
Following treatment, if a patient is in remission, the NCCN recommends that follow-up scans be performed every 6 to 12 months for the first two years, Hamlin explains. However, concerns exist over the lifetime exposure to radiation as it relates to this type of serial imaging. As a result, Moskowitz performs minimal scans on patients with early stage disease who achieve remissions, since cure rates are high.
Outside of scans, Jonathan W. Friedberg, MD, notes that many relapses are clinically detected. He adds that even if scans are being performed, the patients will likely indicate a return in symptoms or the presence of a lump.