Expert Point of View: James O. Armitage, MD

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In an accompanying editorial entitled “Who Benefits From Surveillance Imaging?” James O. Armitage, MD, University of Nebraska Medical Center, Omaha, noted that data on surveillance imaging (CT or PET/CT) indicate a general absence of survival benefit in adults with lymphomas, while pointing out that the utility of such imaging may be dependent on prevalence of relapse in particular populations and may vary among different types of lymphoma.1 He emphasized that any program of surveillance imaging must be concerned with the costs and potential risks of imaging—including the risk associated with biopsies to document relapse and the potential anxiety and fear associated with imaging, as well as risk of second cancers related to radiation dose.

To Image or Not?

Returning to the question, “Who benefits from surveillance imaging?” Dr. Armitage concluded, “The report by Voss et al … suggests the answer is not children with Hodgkin’s lymphoma who achieve remission. However, it is still possible that in high-risk patients (ie, where the higher chance of relapse would increase the positive predictive value of an abnormal image) for whom potentially curative salvage therapy is available, these images might improve survival. One [such subgroup] is younger adults with high-risk diffuse large B-cell lymphoma. A clinical trial in this group of patients comparing routine follow-up using history, physical examination, and laboratory studies with the same evaluation plus surveillance imaging could have an important impact on practice—either to make surveillance routine or to decrease its use. Until such a trial is completed, surveillance imaging for patients with lymphoma in remission should not be routinely performed.” ■

Disclosure: Dr. Armitage has served as a consultant or advisor for Ziopharm, Seattle Genetics, Genentech, Allos, and Roche.


1. Armitage JO: Who benefits from surveillance imaging? J Clin Oncol. June 11, 2012 (early release online).

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