To Surveil or Not to Surveil
A partir des données des registres danois et suédois des cancers incluant respectivement 525 et 696 patients atteints d'un lymphome à grandes cellules B et connaissant une première rémission complète, cette étude analyse, dans ces deux populations, l'efficacité d'une surveillance de routine par imagerie pour détecter une éventuelle récidive et pour améliorer la survie après les traitements
It is logical that for a patient with an aggressive malignancy, for whom potentially curative therapy is available after relapse, early diagnosis of relapse identified by surveillance imaging might be beneficial. Diffuse large B-cell lymphoma fits these criteria. We have known for many years that patients who experience relapse from complete remission can be cured with autologous bone marrow transplantation.1,2 However, it has been difficult to prove the benefit of surveillance imaging in this clinical setting.
A study carried out by physicians at the Mayo Clinic, the University of Iowa, and the Centre Lyon Berard in Lyon, France, tried to estimate the value of postremission surveillance imaging for patients with diffuse large B-cell lymphoma in a retrospective analysis.3 They studied a large number of patients who achieved complete remission with a regimen containing an anthracycline and rituximab. Twenty percent of the patients experienced relapse during the period of observation, but most of the relapses were identified at a time other than a scheduled follow-up visit. Surveillance imaging uniquely detected relapse in only 1.6% of patients. There was no difference in survival in patients whose relapse was detected at a routine follow-up visit versus those detected because of the onset of new symptoms. The authors concluded that these data did not support the use of routine surveillance imaging in diffuse large B-cell lymphoma.3
A study from Korea evaluated routine imaging during remission in an attempt to identify early relapses.4 The authors found that routine imaging led to unsatisfactorily high false-positive imaging results and did not improve treatment outcome. A study from Australia5 found that the positive predictive value of positron emission tomography (PET)/computed tomography (CT) imaging in remission was 80% in patients with a high International Prognostic Index score, and the authors concluded that routine surveillance imaging with PET/CT scans might be reasonable in this subgroup of patients. A study by Petrausch et al6 from Zurich, Switzerland, found that the positive predictive value of surveillance PET scans in patients age > 60 years with symptoms of relapse was sufficiently high enough to recommended surveillance imaging in this group. However, if the patient had symptoms of relapse, one might argue that this was not surveillance imaging [...]
Journal of Clinical Oncology , éditorial, 2015