Bruce D. Cheson, MD; Gilles Salles, MD, PhD


June 13, 2013

In This Article

Who Would You Scan?

Dr. Salles: It is very important to see patients and examine them, and to get a medical history. From time to time, if you have the feeling that you are close to a resurgence of the disease with a lymph node growing in the abdomen and other symptoms, you can do some imaging. But systematic surveillance with CT is probably not mandatory or at least can be spaced at quite long intervals in these patients, and it may depend on the presentation of the disease. That's my personal feeling when I see patients for many years.

Dr. Cheson: Would you have a different policy in a patient who had a complete remission vs one who had a good partial remission? Would you be more likely to scan the latter patient more often?

Dr. Salles: If we have curable diseases, and if you have a partial remission with PET positivity, you need to scan these patients. In follicular disease, if we have a patient who is PET/CT-negative, we can wait up to 1 year before we have to repeat any imaging if we need to do it.

Dr. Cheson: How about the patient who still has a small lesion?

Dr. Salles: There is no urgency to do surveillance if the patient isn't symptomatic and is in good shape.

Dr. Cheson: The curves in your studies were impressive, especially the Trotman and colleagues study.[4] Do you react to the patient who has a positive CT scan right off of the bat, or do you wait until there is evidence of disease progression?

Dr. Salles: It depends somewhat on the medical history, the treatment received, and the age of the patient. In younger patients with an unequivocally positive PET/CT at the end of chemotherapy, I would be tempted to intervene and try to document the persistence of the disease and offer alternative strategies to these patients, including some more intensive treatment. In patients who are older and in whom results are not very clear, I tend to wait and get another image in 6 months, for instance, depending on the clinic.

Dr. Cheson: It would be a good topic for a clinical trial, wouldn't it?

Dr. Salles: Yes, but complicated to carry out.

Dr. Cheson: Thank you, Gilles, and thank you for joining us for Medscape Oncology Insights. This is Bruce Cheson, reporting from ASCO 2013 in Chicago.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: