Hodgkin Lymphoma Treatment (More)

Front 1

Summarize the evidence that suggests consolidative RT is more important in patients treated with Stanford V chemo compared to ABVD chemo

Back 1

2 RCTs have compared ABVD and stanford V regimens for HD:
1. Gobbi et al. compared ABVD vs. Stanford V (vs. a 3rd regimen). RT was not mandatory and was used in 66% of the Stanford V arm and 62% of the ABVD arm. 5 year EFS significantly favored ABVD (78% vs. 54%).

2. Hoskin et al. randomized unfavorable stage I-II and stage III-IV HL pts to ABVD or Stanford V-based regimens. Initially, IFRT was required to a site initially > 5cm, though in the later part of the study, RT was optional for the ABVD arm. Ultimately, 53% in the ABVD arm and 73% in the stanford V arm rcv'd IFRT. Despite the higher rate of consolidative RT, 5 yr PFS (ABVD 76%; Stanford V 74%) and OS (ABVD 90%; Stanford V 92%) were not significantly different. (JCO 2009)

Front 2

Describe a mantle field

Back 2

classic comprehensive field including major nodal regions above the diaphragm (inf border is T10-T11)

Front 3

Describe a mini-mantle field

Back 3

mantle without mediastinal, hilar, and neck nodal regions (just infraclavicular and axillary?)

Front 4

Describe a modified mantle field

Back 4

mantle without axilla and neck nodal regions. (Just infraclavicular, supraclavicular, mediastinal, and hilar?)

Front 5

What is covered in total lymphoid irradiation (TLI)?

Back 5

TLI includes a mantle field --> an inverted Y field (para-aortic and pelvic nodes) and spleen field.

Front 6

How is STLI different from TLI?

Back 6

STLI excludes iliac and inguinal regions

Front 7

At what dose should the larynx be blocked in a mantle field?

Back 7

consider blocking through entire course, unless there is midplane disease. Otherwise, consider blocking after ~20 Gy.

Front 8

What is the subcarinal block in a mantle field used to block? After what dose is it used?

Back 8

the subcarinal block in a mantle field is used to block the heart. Consider blocking after 15Gy in patients who have a CR after initial chemo, otherwise after 30Gy.

Front 9

In pts treated for HL, what is the RR for a 2nd solid malignancy after 30 years?

Back 9

In pts who survive > 5 years, the overall RR is 2-3 for a solid malignancy after 30 years compared to the general population

Front 10

Which type of secondary cancer occurs sooner after HL treatment: leukemias or solid malignancies?

Back 10

Leukemias tend to occur < 5 years after treatment, whereas solid malignancies typically occur > 7 years after tx.