Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission.

BACKGROUND: The objective of this study was to compare the outcomes of patients with classical Hodgkin lymphoma (cHL) who achieved complete remission with frontline therapy and then underwent either clinical surveillance or routine surveillance imaging. METHODS: In total, 241 patients who were newly diagnosed with cHL between January 2000 and December 2010 at 3 participating tertiary care centers and achieved complete remission after first-line therapy were retrospectively analyzed. Of these, there were 174 patients in the routine surveillance imaging group and 67 patients in the clinical surveillance group, based on the intended mode of surveillance. In the routine surveillance imaging group, the intended plan of surveillance included computed tomography and/or positron emission tomography scans; whereas, in the clinical surveillance group, the intended plan of surveillance was clinical examination and laboratory studies, and scans were obtained only to evaluate concerning signs or symptoms. Baseline patient characteristics, prognostic features, treatment records, and outcomes were collected. The primary objective was to compare overall survival for patients in both groups. For secondary objectives, we compared the success of second-line therapy and estimated the costs of imaging for each group. RESULTS: After 5 years of follow-up, the overall survival rate was 97% (95% confidence interval, 92%-99%) in the routine surveillance imaging group and 96% (95% confidence interval, 87%-99%) in the clinical surveillance group (P = .41). There were few relapses in each group, and all patients who relapsed in both groups achieved complete remission with second-line therapy. The charges associated with routine surveillance imaging were significantly higher than those for the clinical surveillance strategy, with no apparent clinical benefit. CONCLUSIONS: Clinical surveillance was not inferior to routine surveillance imaging in patients with cHL who achieved complete remission with frontline therapy. Routine surveillance imaging was associated with significantly increased estimated imaging charges.

Repeatability and sources of variability in multi-center assessment of segmental foot kinematics in normal adults.

Multi-site application of biomechanical models can be a powerful tool as quantitative methods are employed to improve clinical care and to assess larger populations for research purposes. However, the use of such models depends on adequate validation to assure reliability in inter-site measures. We assessed repeatability and sources of variability associated with the assessment of segmental foot kinematics using the Milwaukee Foot Model during multiple testing sessions at two sites. Six healthy ambulators were instrumented and tested during comfortable ambulation; data were analyzed with variance components analysis using a mixed effects linear model. Results indicated that the largest source of variability was inter-subject; measurement error associated with Site and Session fell below 3.5 degrees in over 80% of position measurements and below 2.5 degrees in over 80% of ROM measurements. These findings support the continued use of the segmental foot model at multiple sites for clinical and research purposes.