title: ACR appropriateness criteria follow-up of Hodgkin lymphoma.
abstract: The main objectives of follow-up studies after completion of treatment for Hodgkin lymphoma are detection of recurrence for salvage therapy and monitoring for sequelae of treatment. The focus of the follow-up shifts, with time after treatment, from detection of recurrence to long-term sequelae. A majority of recurrence is detected by history and physical examination. The yield for routine imaging studies and blood tests is low. Although routine surveillance CT scan can detect recurrence not detected by history and physical examination, its benefit in ultimate survival and cost-effectiveness is not well defined. Although PET scan is a useful tool in assessing response to treatment, its routine use for follow-up is not recommended. Long-term sequelae of treatment include secondary malignancy, cardiovascular disease, pneumonitis, reproductive dysfunction, and hypothyroidism. Follow-up strategies for these sequelae need to be individualized, as their risks in general depend on the dose and volume of radiation to these organs, chemotherapy, age at treatment, and predisposing factors for each sequela. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is either lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Electronic address: hac@uthscsa.edu.
authors.forename: Chul S
authors.initials: CS
authors.lastname: Ha
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors.forename: David C
authors.initials: DC
authors.lastname: Hodgson
authors.affiliation: Stanford School of Medicine, Stanford Cancer Center, Stanford, California; American Society of Clinical Oncology, Alexandria, Virginia.
authors.forename: Ranjana
authors.initials: R
authors.lastname: Advani
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Bouthaina S
authors.initials: BS
authors.lastname: Dabaja
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York.
authors.forename: Sughosh
authors.initials: S
authors.lastname: Dhakal
authors.affiliation: Dept of Hematology & Oncology, Emory University, Atlanta, Georgia; American Society of Clinical Oncology, Alexandria, Virginia.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.affiliation: University of Florida Proton Therapy Institute, Jacksonville, Florida.
authors.forename: Bradford S
authors.initials: BS
authors.lastname: Hoppe
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida.
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Mendenhall
authors.affiliation: Dept. of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; American Society of Clinical Oncology, Alexandria, Virginia.
authors.forename: Monika L
authors.initials: ML
authors.lastname: Metzger
authors.affiliation: Dept. of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: John P
authors.initials: JP
authors.lastname: Plastaras
authors.affiliation: Dept. of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Roberts
authors.affiliation: Dept. of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Ronald
authors.initials: R
authors.lastname: Shapiro
authors.affiliation: University of Chicago, Chicago, Illinois; American Society of Hematology, Washington DC.
authors.forename: Sonali
authors.initials: S
authors.lastname: Smith
authors.affiliation: Dept. of Radiation Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Terezakis
authors.affiliation: Dept. of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Winkfield
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; American Society of Clinical Oncology, Alexandria, Virginia.
authors.forename: Anas
authors.initials: A
authors.lastname: Younes
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York.
authors.forename: Louis S
authors.initials: LS
authors.lastname: Constine
mesh_terms: D003952:Diagnostic Imaging / Q000592:standards*; D019317:Evidence-Based Medicine; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011159:Population Surveillance; D011237:Predictive Value of Tests
keywords: Appropriateness Criteria; Hodgkin lymphoma; follow up; recurrence; surveillance; treatment sequela