Role of active follow-up for early diagnosis of relapse after elective end of therapies

Objective. To evaluate the role of active follow-up for the detection of relapses occurring after completion of therapy in children with cancer. Methods. The clinical records of all children who had a cancer relapse more than 3 months after the end of therapies in the period 1985-2000 were reviewed. Relapses were defined "diagnosed at a scheduled visit" or "at an unscheduled visit" based upon how the visit that lead to the suspected diagnosis was scheduled. information was collected on how the first suspicion of relapse was made. Survival after relapse was calculated, by type of visit and tumor type. Results. Among 739 children who completed therapy for a malignant tumor in first complete remission (CR), 101 relapses [74 after solid tumors (ST), 27 after eukemia/lymphoma (L)] occurred after a median time of 12 months (range 3-87). Fifty-one (50.5%) first relapses were diagnosed during a visit scheduled because of symptoms (36 ST, 15 L), and 50 relapses (49.5%) at a regularly scheduled visit (38 ST, 12 L). Overall, 75% of relapses were first Suspected on clinical basis, 16% via imaging, and only 9% via lab tests. Survival more than 10 years from first relapse was 25.7% (SE: 0.05%), with no significant differences between relapses diagnosed at a scheduled visit (20.5%), or at an unscheduled visit (32.1%; P=0.826). Children with L had a better overall survival (OS, 70.6%) as compared to those with ST (9.2%, P < 0.001), probably because of a more extensive use of stem cell transplantation (SCT) as part of the salvage regimens. Conclusions. Scheduled follow-up programs failed to detect relapses in 50% of cases presented here. Survival after relapse is not affected by whether relapse was detected at a scheduled or an unscheduled visit.