Monitoring

Basic blood tests and imaging should be done at baseline and monitored during therapy. Full blood count with differential is monitored to assess treatment-induced bone marrow suppression. Metabolic panel and erythrocyte sedimentation rate are included as clinically indicated.

Thyroid function tests should be done at baseline and annually if patients receive radiotherapy to the neck, given the high incidence of hypothyroidism in this population.[174]

Chest x-ray and computed tomography scan are done at baseline and as clinically indicated during therapy thereafter.

Pulmonary function tests should be repeated during and after treatment as clinically indicated, especially in those patients who may have shown signs of pulmonary toxicity during treatment.

Post-treatment follow-up

It is recommended that patients are followed-up:[33]​

  • every 3 to 6 months for the first 1 to 2 years after treatment, then

  • every 6 to 12 months until year 3, and

  • annually thereafter.

Routine blood work and imaging are not necessary unless patients have concerning symptoms or abnormalities on examination.[179][180][181] Most recurrences are detected via investigation of symptoms with history, physical examination, and appropriate imaging.

Routine PET/CT surveillance is not recommended.[33]

Breast cancer screening

For women who have received radiotherapy to the chest or axilla, regular breast examination and breast cancer screening should be initiated 8 years after treatment (but not before age 25 years) or at 40 years of age, whichever occurs first.[33]

Mammography and breast magnetic resonance imaging (MRI), alternating every 6 months, are recommended for breast cancer screening in females who have received radiation to the chest between the age of 10 to 30 years.[33] The diagnostic value of breast MRI and mammogram is superior to either test alone to detect breast cancer in survivors of HL.[167]

Cardiac monitoring

Patients at risk for heart disease (due to anthracycline exposure or mediastinal radiotherapy) should be evaluated regularly for cardiac risk factors (smoking, hypercholesterolaemia, glucose intolerance).

Echocardiogram and multi-gated acquisition (MUGA) scan follow-up examinations should be obtained if heart disease is suspected, or monitored if already diagnosed.

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