DETECTION OF RELAPSE IN EARLY-STAGE HODGKINS-DISEASE - ROLE OF ROUTINE FOLLOW-UP-STUDIES

Purpose: To examine the costs and benefits of routine follow-up evalua tion in patients treated with radiation therapy for early-stage Hodgki n's disease. Patients and Methods: We retrospectively examined pattern of follow-up evaluation and methods of relapse detection among 709 pa tients with stage I and II Hodgkin's disease treated with primary radi otherapy between 1969 and 1994. We determined the probability of relap se detection for seven routine follow-up procedures, compared their re lative costs, and determined the impact of each procedure on the likel ihood of survival following salvage therapy. Results: Relapse has occu rred in 157 patients (22%) at a median 1.9 years (range, 0 to 13 years ) posttreatment. Relapse was suspected primarily by history (Hx) in 55 % of patients, physical examination (PE) in 14%, chest x-ray (CXR) in 23%, and abdominal x-ray (KUB) in 7%. Only one relapse (1%) wets ident ified by a routine laboratory study. The rate of relapse detection was highest for a combination of Hx and PE (78 of 10,000 examinations) fo llowed by CXR (26 of 10,000 examinations). The projected charges (1995 dollars) per relapse detected by routine follow-up Hx and PE were $11 ,000 compared with $68,000 for CXR and $142,000 for KUB. The 10-year a ctuarial survival rate following salvage therapy was 65% overall, 65% for patients in whom relapse was detected by Hx or PE, and 69% for pat ients in whom relapse was detected by radiographs (P = not significant ). Conclusion: The majority of relapses occurred within 5 years of tre atment and were identified by Hx and PE. CXR was useful during the fir st 3 years of follow-up evaluation. KUB, CBC, and laboratory studies a ccounted for nearly half of all follow-up charges and rarely led to th e detection of relapse. Their routine use as a method of relapse detec tion is questionable. In general, the method of relapse detection did not have a significant impact on the likelihood of successful salvage therapy. (C) 1991 by American Society of Clinical Oncology.