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aRoutine blood work: Complete blood count, erythrocyte sedimentation rate, and liver function tests. bPatients who had neck radiotherapy.

cFor women who had supradiaphragmatic irradiation. Annual breast MRI or ultrasound ages 25-29; annual mammogram ages 30 and above.

aRoutine blood work: Complete blood count, erythrocyte sedimentation rate, and liver function tests. bPatients who had neck radiotherapy.

cFor women who had supradiaphragmatic irradiation. Annual breast MRI or ultrasound ages 25-29; annual mammogram ages 30 and above.

Despite lack of data showing a positive impact on outcome with aggressive posttreatment follow-up, many physicians utilize physical examination, blood work, and imaging studies fairly frequently during the first 2 years after therapy. This is usually followed by a less intensive schedule (Table 76.1). Typical follow-up consists of visits every 3-4 months during the first 2 years and every 6 months until year 5, and annually thereafter. These visits are generally used for physical examination, blood work, chest radiograph, and selected imaging studies. Despite such an intensive follow-up schedule, most of the relapses are detected in symptomatic patients. A study of 210 HL patients in complete remission after therapy revealed that 30 of 37 relapsed patients had symptoms of disease.3 Only four asymptomatic relapses were detected by routine evaluation. Widespread use of sensitive imaging methods such as FDG-PET (18F-fluorodeoxyglucose positron emission tomography) is likely to improve the early detection rate, although it is difficult to project whether such early detection will result in improved outcome. Imaging studies such as PET scanning, with or without computed tomography (CT) scanning, are used three to four times a year during the first 2 years of follow-up despite a lack of prospective studies evaluating their impact on outcome and their cost-benefit ratio.

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