Hodgkins

Front 1

Subtypes of classic HD

Back 1

Nodular sclerosing (most common)

Lymphocyte depleted

Lymphocyte rich

Mixed cellularity

NB: Nodular lymphocyte predominant is a separate category.

Front 2

Subtype with the best prognosis

Back 2

Lymphocyte rich

Front 3

Subtype with the worst prognosis

Back 3

Lymphocyte depleted

Front 4

CD markers in classic HD

Back 4

CD15+

CD30+

CD45 negative

CD20 negative

Tip: 15-20-30-45, sign alterates beginning with positive

Front 5

CD markers in nodular lymphocyte predominant HD

Back 5

Opposite of classic HD

CD15 negative

CD20 +

CD30 negative

CD45 +

Front 6

Which labs have prognostic significance in HD?

Back 6

ESR

LDH

CBC

Albumin

Front 7

What merits a BMBx in HD?

Back 7

1. B symptoms
2. Stages III-IV
3. Bulky disease
4. Recurrent disease

Front 8

How are the cervical, infraclavicular and supraclavicular nodes classified in HD grouping?

Back 8

Cervical and sclav are ONE region

Infaclavicular is separate

Front 9

LN stations in the chest

Back 9

Mediastinum

Left hilum

Right hilum

NB: The hila are counted separately!

Front 10

What constitutes Waldeyer's ring?

Back 10

Pharyngeal tonsils (adenoids)

Palatine tonsils

Lingual tonsil (BOT)

Front 11

Is the spleen considered an extranodal site?

Back 11

NO. It is a LN region.

Front 12

Stage I

Back 12

Single LN region or

Single extralymphatic organ/site (IE)

Front 13

Stage II

Back 13

1. ≥2 LN regions on the same side of the diaphragm or
2. Involvement of a single extranodal site and regional nodes on the same side of the diaphragm

Front 14

Stage III

Back 14

1. Involvement of LN regions on both sides of the diaphragm

NB: Additional involvement of an extranodal site is designated IIIE

Front 15

Stage IV

Back 15

1. Multifocal involvement of ≥1 extralymphatic +/- associated nodal involvement
2. Isolated involvement of an extralymphatic organ + distant nodal involvement
3. Involvement of CSF, bone marrow, liver, or pleura

Front 16

Unfavorable factors in early HD (NCCN)

Back 16

1. Bulky disease (1/3 mediastinum or >10 cm)
2. >3 involved sites
3. ESR >50
4. B symptoms

Front 17

Chemo Regimens Commonly Used in HD

Back 17

ABVD

Stanford V

Dose-escalated BEACOPP

Front 18

What is ABVD?

Back 18

Adriamycin

Bleomycin

VinBLAStine

Dacarbazine

Front 19

What is Stanford V?

Back 19

MOPE-ABV (actually 7 agents)

Mechlorethamine

Oncovin (vinCRIStine)

Prednisone

Etoposide

Adriamycin

Bleomycin

VinBLAStine

Front 20

What is BEACOPP?

Back 20

Bleomycin

Etoposide

Adrimycin

Cyclophosphamide

Oncovin (vinCRIStine)

Procarbazine

Prednisone

Front 21

Tx for Stage IA-IIA Favorable HD (NCCN)

Back 21

ABVD x 2-4 cycles --> Restage --> ISRT

Chemo Alternative: Stanford V x 8 wks

Front 22

Tx for bulky Stage I-II HD (NCCN)

Back 22

ABVD x 4 cycles --> Restage --> ABVD x 2 (6 total) --> ISRT

Chemo alternatives:

- Stanford V x 12 wks

- Escalated BEACOPP x 2 cycles + ABVD x 2

Front 23

Tx for Nonbulky but Unfavorable Stage I-II HD (NCCN)

Back 23

ABVD x 2 --> Restage --> ABVD x 2-4 + ISRT

Chemo alternative: Stanford V x 12 wks

Front 24

Tx for Stage III-IV HD (NCCN)

Back 24

ABVD x 2 --> Restage -->ABVD x 4 --> ISRT to initially bulky or PET+ sites

Front 25

Tx for Nodular Lymphocyte Predominant HD (NCCN)

Back 25

Favorable Stage I-II: ISRT alone

Unfavorable Stage I-II: Chemo + ISRT --> Restage

Stage III-IVA: Chemo +/- Rituximab +/- ISRT

Stage IIIB-IVB: Chemo +/- Rituximab +/- ISRT

Front 26

Involved Site RT

Back 26

Treat prechemo/prebiopsy GTV sparing adjacent uninvolved organs

Front 27

Dose for Nonbulky Dz

Back 27

30 Gy

NB: 20 Gy may be sufficient in favorable Stage I-IIA disease with ESR <50, no extralymphatic involvement and only 1-2 LN regions involved

Front 28

Dose for Bulky Dz

Back 28

36 Gy

Front 29

Studies that support chemoRT over RT alone

Back 29

EORTC H7F

EORTC H8F (only one with improved OS)

German HD7

SWOG S9133

All studies showed improved long-term relapse

Front 30

Studies that support a more limited RT field

Back 30

GPMC

German HD8

Milan

EORTC H8U

All had similar OS, indicating that more extensive RT was not needed.

Front 31

What is the evidence for 20 Gy after ABVD in early stage, favorable patients?

Back 31

German HD10

EORTC GELA H9F

Front 32

Describe German HD10

Back 32

2x2 Noninferiority study

Favorable Stage I-IIA:

Question #1) 2 vs 4 cycles of ABVD

Question #2) 20 vs 30 Gy

Front 33

Significance of German HD10

Back 33

Demonstrated noninferior freedom from tx failure, 5 yr PFS and OS between the various chemo and RT arms

Ergo, 2 cycles of ABVD and 20 Gy RT are sufficient for favorable, Stage I-IIA Hodgkins

Front 34

Where is the inferior border of a mantle field?

Back 34

T11-12

Front 35

What is omitted from a mini-mantle field?

Back 35

Mediastinum, hilae`

Front 36

What is included in a mantle field?

Back 36

Bilateral cervical

SCV

Infraclavicular

Mediastinum

Bilateral hilae

Bilateral axillae

Front 37

What is omitted from a modified mantle?

Back 37

Axillae

Front 38

What is included in an inverted Y?

Back 38

Paraaortic

Bilateral pelvic

Bilateral inguinofemoral

+/- Spleen

Front 39

What is included in total nodal irradiation?

Back 39

Mantle + Inverted Y + Spleen

Front 40

What is included in Subtotal Nodal Irradiation?

Back 40

Mantle + Inverted but exclude the pelvis