Pediatric Burkitt's Lymphoma and Diffuse B-Cell Lymphoma: Are Surveillance Scans Required?

Abstract

Outcomes in pediatric B-Non-Hodgkin Lymphoma have improved with intensive chemotherapy protocols, with long-term survival now over 80%. However, long-term adverse effects of therapy and poor outcomes for patients who relapse remain challenges. In this study, we aimed to evaluate the potential risks and benefits of routine relapse surveillance imaging after the completion of therapy. We reviewed 44 B NHL patients diagnosed and treated at Texas Children’s Cancer Center in the period between 2000 to 2011. All cross-sectional diagnostic imaging examinations performed for disease assessment after completion of chemotherapy were reviewed and cumulative radiation dosage from these examinations and the frequency of relapse detection by these examinations were recorded. Only 3 patients of the 44 relapsed (6.8%), though none of the relapses were initially diagnosed by CT or FDG-PET scans. Median effective dose of ionizing radiation per patient was 40.3 mSv with an average of 49.1 mSv (range 0–276 mSv). This single-institution study highlights the low relapse rate in pediatric B-NHL with complete response at the end of therapy, the low sensitivity of early detection of relapse with surveillance CT or FDG-PET imaging, and the costs and potential increased risk of secondary malignancies from cumulative radiation exposure from surveillance imaging. We propose that routine surveillance CT or FDG-PET scans for these patients may not be necessary.

An update on Burkitt lymphoma: a review of pathogenesis and multimodality imaging assessment of disease presentation, treatment response, and recurrence

“…In adults, imaging surveillance with CT is performed, as described previously. In children, routine surveillance with cross-sectional imaging may not be warranted for patient achieving complete response after therapy given overall low rates of relapse along with increased costs and added risks of radiation exposure [51]. Thus, surveillance may be performed with cervical and abdominal ultrasound with chest radiography with CT or PET/CT reserved if there are signs of relapse.…”

Pediatric Lymphomas and Histiocytic Disorders of Childhood

“…There are also data demonstrating that PET scanning can produce false-negative results; therefore, a biopsy to prove residual or recurrent disease is required. 24 …”

Routine surveillance imaging after end of therapy for pediatric extracranial tumors: A retrospective analysis

“…Hence, a current recommendation is to tailor surveillance imaging to patients with high risk of recurrence and high likelihood of benefit . For non‐Hodgkin lymphoma, one study showed that while three of 44 patients developed recurrence, none was diagnosed by CT or PET scans . Two studies focusing on children with sarcoma and rhabdomyosarcoma, respectively, showed that regular imaging studies neither facilitated earlier detection of recurrence nor improved overall survival .…”