Summary of follow-up recommendations for HL survivors according to NCCN, COG, and the Dutch BETER Consortium according to types of major late effects
| Treatment exposures . | NCCN . | COG . | Dutch BETER consortium . |
|---|---|---|---|
| Second malignancy | Breast cancer: Annual mammography and breast MRI screening, to start 8- to 10-y post -treatment, or at age 40, whichever comes first, for women with a history of chest RT between ages 10 and 30 y | Breast cancer: Annual breast self-examination beginning at puberty until age 25, then every 6 mo Annual mammogram and breast | Breast cancer: Screening only recommended for women with a history of RT to chest and/or axillae before age 40: Age 25-30: annual clinical breast examination and MRI |
| Lung cancer: Consider chest imaging for survivors with >30 pack-y history of smoking | MRI, beginning 8 y after radiation or at age 25, whichever occurs last Lung cancer: Imaging and surgery and/or oncology consultation, as clinically indicated | Age 30-60: annual clinical breast examination, mammography, and MRI Ago 60-70: biennial clinical breast examination and mammography Age 70-75: biennial mammagraphy through population screening | |
| Colorectal cancer: Colonoscopy every 10 y for survivors age ≥50, or by the age 40 for survivors at increased risk for colorectal cancer due to treatment history Skin cancer: Counseling on skin cancer risks | Colorectal cancer: Colonoscopy every 5 y, beginning at 10 y after radiation or at age 35, whichever comes first, for patients with RT of ≥30 Gy to the abdominal and/or pelvic region Thyroid nodule/cancer: Yearly thyroid examination Skin cancer: Annual dermatologic examination and monthly skin self-examination in patients with prior RT exposures | Thyroid nodule/cancer: See screening for thyroid dysfunction At this moment, screening for lung cancer, colorectal cancer, and skin cancer are not recommended, as evidence is lacking that this is effective in reducing morbidity and mortality | |
| CVD | Cardiac disease: Consider stress test and echocardiogram at 10-y intervals after treatment of patients with a history of chest RT | Cardiac disease: Periodic echocardiogram and ECG with frequency dependent on age at treatment exposure and cumulative doses in patients with a history of treatment with anthracyclines or chest RT | Screening only recommended after: Cardiotoxic CT with cumulative doses equivalent to doxorubicin ≥300 mg/m2 Chest RT only or combined with cardiotoxic CT, independent of dose |
| Carotid disease: Consider carotid ultrasound at 10-y intervals in patients with a history of neck RT CVD risk factors: Annual blood pressure, lipids, and aggressive management of cardiovascular risk factors | Carotid disease: Examination for diminished carotid pulses and carotid bruits in patients treated with neck RT | CVD: Echocardiogram every 5 y if treated with cardiotoxic CT; only once, 15 y after diagnosis, when treated with RT only Every 5 y, up to age 70: physical examination (eg, blood pressure), lipids, glucose, biomarkers (BNP or NTproBNP) ECG once 5 y after diagnosis | |
| Endocrinopathies | Hypothyroidism: Annual TSH for patients with a history of neck irradiation Infertility: | Hypothyroidism: Annual TSH, free T4 Infertility: Periodic follicle-stimulating FSH LH, and estradiol screening in patients with exposure to alkylating agents or pelvic RT | Thyroid dysfunction: For patients with a history of neck RT: Every 1-3 y palpation of thyroid gland |
| Reproductive counseling | Annual TSH, if abnormal: free T4 Infertility: When treated with alkylating CT or RT to gonadal region (before age 40 in women: counseling about reduced fertility span Men: testosterone if hypogonadism is suspected; women: LH, FSH, and estradiol |
| Treatment exposures . | NCCN . | COG . | Dutch BETER consortium . |
|---|---|---|---|
| Second malignancy | Breast cancer: Annual mammography and breast MRI screening, to start 8- to 10-y post -treatment, or at age 40, whichever comes first, for women with a history of chest RT between ages 10 and 30 y | Breast cancer: Annual breast self-examination beginning at puberty until age 25, then every 6 mo Annual mammogram and breast | Breast cancer: Screening only recommended for women with a history of RT to chest and/or axillae before age 40: Age 25-30: annual clinical breast examination and MRI |
| Lung cancer: Consider chest imaging for survivors with >30 pack-y history of smoking | MRI, beginning 8 y after radiation or at age 25, whichever occurs last Lung cancer: Imaging and surgery and/or oncology consultation, as clinically indicated | Age 30-60: annual clinical breast examination, mammography, and MRI Ago 60-70: biennial clinical breast examination and mammography Age 70-75: biennial mammagraphy through population screening | |
| Colorectal cancer: Colonoscopy every 10 y for survivors age ≥50, or by the age 40 for survivors at increased risk for colorectal cancer due to treatment history Skin cancer: Counseling on skin cancer risks | Colorectal cancer: Colonoscopy every 5 y, beginning at 10 y after radiation or at age 35, whichever comes first, for patients with RT of ≥30 Gy to the abdominal and/or pelvic region Thyroid nodule/cancer: Yearly thyroid examination Skin cancer: Annual dermatologic examination and monthly skin self-examination in patients with prior RT exposures | Thyroid nodule/cancer: See screening for thyroid dysfunction At this moment, screening for lung cancer, colorectal cancer, and skin cancer are not recommended, as evidence is lacking that this is effective in reducing morbidity and mortality | |
| CVD | Cardiac disease: Consider stress test and echocardiogram at 10-y intervals after treatment of patients with a history of chest RT | Cardiac disease: Periodic echocardiogram and ECG with frequency dependent on age at treatment exposure and cumulative doses in patients with a history of treatment with anthracyclines or chest RT | Screening only recommended after: Cardiotoxic CT with cumulative doses equivalent to doxorubicin ≥300 mg/m2 Chest RT only or combined with cardiotoxic CT, independent of dose |
| Carotid disease: Consider carotid ultrasound at 10-y intervals in patients with a history of neck RT CVD risk factors: Annual blood pressure, lipids, and aggressive management of cardiovascular risk factors | Carotid disease: Examination for diminished carotid pulses and carotid bruits in patients treated with neck RT | CVD: Echocardiogram every 5 y if treated with cardiotoxic CT; only once, 15 y after diagnosis, when treated with RT only Every 5 y, up to age 70: physical examination (eg, blood pressure), lipids, glucose, biomarkers (BNP or NTproBNP) ECG once 5 y after diagnosis | |
| Endocrinopathies | Hypothyroidism: Annual TSH for patients with a history of neck irradiation Infertility: | Hypothyroidism: Annual TSH, free T4 Infertility: Periodic follicle-stimulating FSH LH, and estradiol screening in patients with exposure to alkylating agents or pelvic RT | Thyroid dysfunction: For patients with a history of neck RT: Every 1-3 y palpation of thyroid gland |
| Reproductive counseling | Annual TSH, if abnormal: free T4 Infertility: When treated with alkylating CT or RT to gonadal region (before age 40 in women: counseling about reduced fertility span Men: testosterone if hypogonadism is suspected; women: LH, FSH, and estradiol |
BNP, B-type natriuretic peptide; COG, Children’s Oncology Group; CT, chemotherapy; ECG, electrocardiogram; FSH, follicle-stimulating hormone; LH, luteinizing hormone; MRI, magnetic resonance imaging; T4, thyroxine; TSH, thyroid stimulating hormone.