Role of active follow-up for early diagnosis of relapse after elective end of therapies

Biasotti, Simona; Garaventa, Alberto; Padovani, P; Faraci, Maura; Fioredda, Francesca; Hanau, Guia; Grisolia, Francesca; Parodi, Stefano; Haupt, Riccardo

doi:10.1002/pbc.20356

Cited by 20 publications

(19 citation statements)

References 21 publications

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“…Surveillance imaging for detection of disease recurrence might identify relapse before clinical symptoms develop [11]. The rate of salvage is partially dependent upon tumor type and grade and partly upon tumor burden at the time of relapse [12, 13]. Intuitively, for some tumors, the earlier detection would be expected to contribute to improved salvage rates.…”

Section: Roles Of Surveillance Imagingmentioning

confidence: 99%

“…Intuitively, for some tumors, the earlier detection would be expected to contribute to improved salvage rates. However, for some diseases such as sarcoma, Hodgkin disease [14–16] and others [12], detection of recurrence prior to development of symptoms has not improved salvage.…”

Section: Roles Of Surveillance Imagingmentioning

confidence: 99%

“…The usefulness of ongoing surveillance imaging remains controversial [9, 12, 13, 17] Chong et al [18] recently reported on the radiation exposure burden placed on survivors of various cancers. Five-year cumulative estimates of individual radiation exposures were calculated to range from 10 mSv to 642 mSv (median, 61 mSv) resulting from 690 imaging procedures.…”

Section: Roles Of Surveillance Imagingmentioning

confidence: 99%

“…In an additional retrospective study of more than 700 children in first complete remission from a variety of malignancies, Biasotti et al [12] found the median age to relapse being 12 months (range, 3–87 months). Of the 739 patients who completed therapy, six developed a second malignant tumor and 173 developed relapse of their primary disease.…”

Section: Need For Outcomes Analysis Of Surveillance Imaging Studiesmentioning

confidence: 99%

“…Seventy-five percent of relapses were suspected clinically, 16% were identified by imaging and 9% by laboratory results. They further pointed out that routine scheduled surveillance appointments failed to detect half of the relapse cases they report [12]. Similarly, Howell et al [17] reported 37 recurrences of solid tumors in a cohort of 186 pediatric patients followed for a median of almost 6 years.…”

Section: Need For Outcomes Analysis Of Surveillance Imaging Studiesmentioning

confidence: 99%

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Oncological imaging: tumor surveillance in children

Kaste

2011

Pediatr Radiol

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As the need for accurate diagnostic imaging often continues throughout a cancer survivor’s life, imaging methods with the least toxicity must be used so as to provide needed information without contributing to long-term sequelae that might compound toxicities inherent with the primary disease and its treatment. In this regard, the costs, benefits and potential risks of post-therapy monitoring for disease recurrence warrant periodic review. Unfortunately, few analyses are available regarding the impact of surveillance imaging on the detection of disease recurrence, salvage rates of relapse disease and long-term survival outcomes for pediatric cancer survivors. This review will examine the role and limitations of surveillance imaging in pediatric oncology.

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Section: Roles Of Surveillance Imagingmentioning

confidence: 99%

Section: Roles Of Surveillance Imagingmentioning

confidence: 99%

Section: Roles Of Surveillance Imagingmentioning

confidence: 99%

Section: Need For Outcomes Analysis Of Surveillance Imaging Studiesmentioning

confidence: 99%

Section: Need For Outcomes Analysis Of Surveillance Imaging Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Oncological imaging: tumor surveillance in children

Kaste

2011

Pediatr Radiol

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A systematic review of evidence for and against routine surveillance imaging after completing treatment for childhood extracranial solid tumors

et al. 2020

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Background Regular off‐treatment imaging is often used to assess for recurrence of disease after childhood cancer treatment. It is unclear if this increases survival, or what burden surveillance places on patients, families, or health‐care services. This systematic review examines the impact of routine surveillance imaging after treatment of pediatric extracranial solid tumors. Methods Collaborative patient and public involvement informed the design and interpretation of this work. Thirteen electronic databases, conference proceedings, and trial registries were searched alongside reference list checking and forward citation searching from 1990 onwards. Studies were screened and data were extracted by two researchers. Risk of bias was assessed using a modified ROBINS‐I tool. Relevant outcomes were overall survival, psychological distress indicators, number of imaging tests, cost‐effectiveness, and qualitative data regarding experiences of surveillance programs. PROSPERO (CRD42018103764). Results Of 17 727 records identified, 55 studies of 10 207 patients were included. All studies used observational methods. Risk of bias for all except one study was moderate, serious, or critical. Data were too few to conduct meta‐analysis; however, narrative synthesis was performed. Surveillance strategies varied, and poorly reported, involving many scans and substantial radiation exposure (eg, neuroblastoma, median 133.5 mSv). For most diseases, surveillance imaging was not associated with increased overall survival, with the probable exception of Wilms tumor. No qualitative or psychological distress data were identified. Conclusions At present, there is insufficient evidence to evaluate the effects of routine surveillance imaging on survival in most pediatric extracranial solid tumors. More high‐quality data are required, preferably through randomized controlled trials with well‐conducted qualitative elements.

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Is routine pelvic surveillance imaging necessary in patients with Wilms tumor?

Kaste

Brady

Yee

et al. 2012

Cancer

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Background It is unclear if routine pelvic imaging is needed in patients with Wilms’ tumor. Thus, our primary objective examined the role of routine pelvic computed tomography (CT) in a cohort of pediatric patients with Wilms’ tumor. Methods With IRB approval we retrospectively identified 110 Wilms’ tumor patients diagnosed between January 1999 and December 2009; surveillance imaging continued through March 2011. We estimated survival (OS) and event-free survival (EFS), and dosimetry from dose length product (DLP) conversion to effective dose (ED) for every CT in a subgroup of 80 patients scanned using contemporary scanners (2002–2011). MOSFET dosimeters were placed within organs of anthropomorphic phantoms to directly calculate truncal ED. EDDLP was correlated with EDMOSFET to calculate potential pelvic dose savings. Results Eighty patients underwent 605 CT examinations containing DLP information: 352 chest, abdomen and pelvis, 123 chest-abdomen, 102 chest only, 18 abdomen-pelvis, 9 abdomen only, one limited to pelvis. Respective 5-year OS and EFS estimates were 92.8% ± 3.0% and 2.6% ± 4.3%. Sixteen patients (16/110; 15%) relapsed a median of 11.3 months (range, 5.0 months to 7.3 years) after diagnosis; four died of disease recurrence. Three patients developed pelvic relapse, all symptomatic. Estimated ED savings from gender-neutral CT surveillance performed at 120 kVp without pelvic imaging was calculated: 30.5%, 30.4%, 39.4%, and 44.9% for the average 1, 5, 10, and 15 year old patient, respectively. Conclusions Omitting pelvic CT from routine off-therapy follow-up of Wilms’ tumor patients saves an average 30–45% effective dose without compromising disease detection.

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Role of active follow-up for early diagnosis of relapse after elective end of therapies

Abstract: Scheduled follow-up programs failed to detect relapses in 50% of cases presented here. Survival after relapse is not affected by whether relapse was detected at a scheduled or an unscheduled visit.

Cited by 20 publications

References 21 publications

Oncological imaging: tumor surveillance in children

Oncological imaging: tumor surveillance in children

A systematic review of evidence for and against routine surveillance imaging after completing treatment for childhood extracranial solid tumors

Is routine pelvic surveillance imaging necessary in patients with Wilms tumor?

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