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Thursday, April 24, 2014
Hodgkin`s Follow PET After Complete Remission
My wife had Classical Hodgkin’s Lymphoma, Stage 4A, with a large mass in her mediastinum. After 6 courses of ABVD Chemotherapy, she achieved complete clinical remission 3 years ago. What is the standard follow-up procedure or frequency for PET scans given her history?
We had PET scans done at the completion of chemotherapy, then at 6 month intervals until 2 years out, which was one year ago. Now our oncologist wants another complete PET as do we, but the insurance company is resisting. Because she exhibited no symptoms with the initial disease and because there will always be an area of necrosis in the mediastinum, the only way to see if there is active cancer is with a PET. Thank you for considering our question.
It is not necessarily routine to follow with PET scans. The NCCN (National Comprehensive Cancer Network) guidelines for follow-up of patients with Hodgkin's disease after treatment suggest CT scans every 6-12 months during the years 2-5 after treatment. NCCN recommends lab work, history and physical exam every 3-6 months in years 3-5 after treatment. There is a comment in the guidelines that PET should not be done routinely because of the possibility of false positives. However, if you and your oncologist feel that because of your wife's particular presentation or response to treatment that PET would be helpful, I would suggest a second opinion. If two physicians make the same recommendation, the insurer is more likely to go along.
Paula Silverman, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University