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38 Cards in this Set
- Front
- Back
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Hodgkin's Disease
What increased risk do first-degree relatives of patients with HD have? |
Hodgkin's Disease
What increased risk do first-degree relatives of patients with HD have? Five-fold |
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Hodgkin's Disease
What is the hallmark pathologic finding in classic HD? |
Hodgkin's Disease
What is the hallmark pathologic finding in classic HD? Reed-Sternberg cell - Binucleate CD15+/CD30+ cells - Dervied from monoclonal B cells |
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Hodgkin's Disease
Among the 50% of patients who present with mediastinal disease, what is the most common histology? |
Hodgkin's Disease
Among the 50% of patients who present with mediastinal disease, what is the most common histology? Nodular sclerosis HL (NSHL) |
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Hodgkin's Disease
Among all patients with HD, what percentage experience B symptoms? |
Hodgkin's Disease
Among all patients with HD, what percentage experience B symptoms? 33% |
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Hodgkin's Disease
What percentage of patients with early stage HD have B symptoms? |
Hodgkin's Disease
What percentage of patients with early stage HD have B symptoms? 15-20% |
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Hodgkin's Disease
What are the two primary classes of HD and their IHC characteristics? |
Hodgkin's Disease
What are the two primary classes of HD and their IHC characteristics? Classic HL (CHL) - CD15+, CD30+ - CD45- Nodular lymphocyte predominant HL (NLPHL) - CD15-, CD30- - CD45+, CD20+ |
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Hodgkin's Disease
What are the subtypes of classic HD? |
Hodgkin's Disease
What are the subtypes of classic HD and their predominance? Nodular sclerosis (HSHL) 70% Mixed cellularity (MCHL) 20% Lymphocyte rich (LRHL) 10% Lymphocyte depleted (LDHL) <5% |
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Hodgkin's Disease
What primary class of HD has the best overall survival? |
Hodgkin's Disease
What primary class of HD has the best overall survival? NLPHL may have occasional late relapse but has best overall survival |
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Hodgkin's Disease
What is the most common presentation of HD? |
Hodgkin's Disease
What is the most common presentation of HD? 80% present with cervical lymphadenopathy |
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Hodgkin's Disease
What are the unique characteristics of the subtypes of CHD? |
Hodgkin's Disease
What are the unique characteristics of the subtypes of CHD? NS - Med often involved; 1/3 have B sx MC - More commonly presents as adv dz; often with subclinical subdiaphragmatic disease in pts clinically staged I-II above the diaphragm LD - Rare but most adv with B sx in older patients - Worst prognosis - Associated with HIV |
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Hodgkin's Disease
What are the unique features of NLPHD? |
Hodgkin's Disease
What are the unique features of NLPHD? CD15-, CD30-, CD45+, CD20+ Often stage I-II B symptoms < 10% More common in patients > 40 |
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Hodgkin's Disease
Workup |
Hodgkin's Disease
Workup - CBC with diff, LFTs, Chem10 - ESR, liver panel, preg test, HIV test - MUGA & LVEF before ABVD - Path: Excisional LN biopsy - Bone marrow biopsy if - B symptoms, bulky disease - Stage III -IV, recurrent disease - CXR; CT C/A/P, PET - Dental consult if neck tx |
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Hodgkin's Disease
Ann Arbor staging |
Hodgkin's Disease
Ann Arbor staging I Single lymph node region or extralymphatic site II Two or more lymph node regions on same side of diaphgragm or local extralymphatic extension plus one or more lymph node regions on same side of diaphragm III Lymph node regions on both side of diaphragm +/- local extralymphatic involvement IV Diffuse involvement of one or more extralymphatic organs or sites |
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Hodgkin's Disease
Ann Arbor staging suffixes - B - E - X |
Hodgkin's Disease
Ann Arbor staging suffixes - B - Unexplained wt loss (>10% in 6m prior a dx) - Unexplained fever >38C - Drenching night sweats - E: Extranodal disease - X: Bulky disease - Greater than 10 cm - > 1/3 intrathoracic diameter at T5/6 |
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Hodgkin's Disease
Lymph node groups |
Hodgkin's Disease
Lymph node groups - Waldeyer's ring - Occip/cerv/preauricular/supraclav - Infraclavicular - Axillary - Epitrochlear - Mediastinal - R and L hilar (separate) - Paraaortic - Splenic - Mesenteric - Iliac - Inguinal/femoral - Popliteal |
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Hodgkin's Disease
Prognosis early stage disease |
Hodgkin's Disease
Prognosis early stage disease With chemoRT - 5-year FFF 95% - 5-year OS >95% |
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Hodgkin's Disease
In advanced disease, poor prognostic factors and ref |
Hodgkin's Disease
Poor prognostic factors and ref (NEJM 1998) - Male gender - Age > 45 years - Stage IV - Hgb < 10.5 - WBC > 15K - Lymphocytosis < 0.6 x 10EE9/L - Albumin < 40 g/L |
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Hodgkin's Disease
Prognosis with <= 3 versus > 3 poor prognostic factors |
Hodgkin's Disease
Prognosis with <= 3 versus > 3 poor prognostic factors <=3: 5-yr FFP 70% >3: 5-yr FFP 50% |
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Hodgkin's Disease
MOPP |
Hodgkin's Disease
MOPP - Mechlorethamine - Oncovin (vincristine) - Procarbazine - Prednisone |
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Hodgkin's Disease
ABVD |
Hodgkin's Disease
ABVD - Adriamycin (doxorubicin) - Bleomycin - Vinblastine - Dacarbazine Decreased sterility and second malignancies vs MOPP |
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Hodgkin's Disease
Stanford V regimen |
Hodgkin's Disease
Stanford V regimen - Mechlorethamine - Vincristine - Prednisone - Doxorubicin - Bleomycin - Vinblastine - Etoposide Decreased bleomycin and doxorubicin toxicity vs ABVD |
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Hodgkin's Disease
EORTC H6F |
292 stage I-II favorable
1 No lapartotomy with STLI 2 Negative laparotomy - NS/LP: mantle 40 Gy - MC/LD: STLI alone 3 Positive laparotomy --> chemoRT No diff in 6-yr DFS or OS with or without lap |
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Hodgkin's Disease
EORTC H7VF |
Hodgkin's Disease
EORTC H7VF Mantle alone is insufficient even for very favorable dz. 40 pts with very favorable NS or LP - Women < 40 with IA nonbulky dz - ESR < 50 OS 96% but RFS only 73% |
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Hodgkin's Disease
EORTC H7F |
Hodgkin's Disease
EORTC H7F ChemoRT improves RFS but not OS EBVP x 6 with IFRT vs STNI + splenic RT 5 yr RFS 92 v 81% but no diff OS (98 v 96%) |
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Hodgkin's Disease
GHSG HD7 |
Hodgkin's Disease
GHSG HD7 622 pts with favorable I-II dz - No bulky or extranodal disease - No elevated ESR, <= 2 nodal regions EFRT 30 GY + 10 Gy boost vs ABVS x 2 and EFRT ChemoRT improved 5yr DFS (90% v 75%) but no diff in OS (94%) |
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Hodgkin's Disease
SWOG 9133/CALGB 9391 |
Hodgkin's Disease
SWOG 9133/CALGB 9391 348 pts with favorable I-IIA Doxorubicin and vinblastine x 3 with STLI (36-40 Gy) vs STLI alone (36-40 Gy) ChemoRT improved overall response and 3yr FFS (04% vs 81%) but no OS |
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Hodgkin's Disease
Stanford G4 |
Hodgkin's Disease
Stanford G4 87 pts with nonbulky favorable I-IIA disease Stanford V x 8 weeks then IFRT 30 Gy 8yr FFP 96% and OS 98% |
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Hodgkin's Disease
GHSG HD10 |
Hodgkin's Disease
GHSG HD10 1131 pts with favorable I-II disease with no risk factors 2 x 2 factorial design: ABVD x 2 or 4 cycles then IFRT 20 Gy or 30 Gy Median follow-up 2 years - No diff between any arms - FFF 97% - OS 98.5% |
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Hodgkin's Disease
EORTC H9F |
Hodgkin's Disease
EORTC H9F 783 pts with favorable IA-IIB All EBVP x 6 with CR (79% 783) No IFRT or IFRT 20 Gy or IFRT 36 Gy Median followup 33 months. Improved 4yr EFS - 70% with no IFRT - 84% with 20 Gy IFRT - 87% with 36 Gy EFRT No diff in OS (98% all arms) |
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Hodgkin's Disease
Stanford G5 |
Hodgkin's Disease
Stanford G5 Currently accruing Favorable I-IIA patients Risk-adapted Stanford V-C and low-dose IFRT |
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HD: Unilateral cervical field
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The unilateral cervical field includes the ipsilateral SCV. The top border begins at the mentum and extends to 1 cm superior to the lower tip of the mastoid process. Laterally the field includes the medial 2/3 of the clavicle then courses inferiorly along the clavicle with a 2-cm inferior margin. Medially it proceeds along the ipsilateral transverse processes unless medial nodes close to the vertebral bodies or the ipsilateral SCV nodes are involved. For involved nodes near the VB, the field includes the VB in their entirely. For the involved SCV, the field includes the contrlalateral transverse processes. Unless involved nodes are present at the larynx, I include a laryngeal block at 20 Gy. I also calculate the max cord dose and include a posterior cervical cord block if the dose exceeds 40 Gy.
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Mediastinal Field
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In HD the mediastinal field includes the medial SCL nodes even if they're not involved. If NHL the mediastinal field is limited to the mediastinum. With arms up if the axilla is involved or akimbo otherwise, the superior boder is at the C5-6 interspace or at the top of the larynx if the SCV is involved. It courses laterally to include the postop chemo volume with a 1.5-cm margin then inferiorly to 5 cm below the carina or 2 cm below the prechemo volume. The hila are included with a 1-cm margin unless initially involved; in that setting, it would have a 1.5-cm margin.
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Axillary Field
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The ipsilateral axillary, infraclavicular, and SCV regions are treated when the axilla is involved. With the arms up the upper border is at the C5-6 interspace. It extends laterally to include the proximal 2/3 of the clavicle then courses inferiorly, flashing the axilla, to the tip of the scapula or 2 cm below the lowest axillary node then medially to the medial margin of the chest wall and superiorly along the medial chest wall and the inferior aspect of the 4th rib. The field then runs superiorly along the ipsi transverse processes to the C5-6 interspace. If the SCV is involved, I include the vertebral bodies.
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Speel Field
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I treat the spleen only if abnormal imaging suggests involvement. In that case the postchemotherapy volume with a 1.5-cm margin is treated.
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Abdomen (PA) Field
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The para-aortic field extends from the top of T11 and at least 2 cm above the prechemo volume to the edge of the transverse processes and at least 2 cm from the postchemo volume down to the bottom of L4 and at least 2 cm below the prechemo volume.
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Mantle field
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The mantle field begins at the mentum and extends to 1 cm above the inferior tip of the mastoid process. It includes 2/3 of the proximal clavicle, flashes the axilla, and extends at to the tiip of the scapula and 2cm below the lowest axillary node. Moving medially to the medial aspect of the chest wall, the field continues superiorly along the chest wall then follows the inferior aspect of the 4th rib to the mediastinum with a 1.5-cm margin. Inferiorly it reaches the diaphragm.
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Inverted Y Field
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The inverted Y field begins at the level of the diaphragm at the right transverse process then extends left to include the spleen with a 1-5-cm margin. It proceeds to the left renal hilum then inferiorly along the left transverse processes with a 1-cm margin to the SI joint where it deviates laterally with 2 cm on the bony pelvis through the femoral head and along the medial aspect of the femur to about 3 cm below the ischial tuberosities. The field bisects the obturator foramen and reaches the left side of the coccyx sparing some bladder.
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Inguinal Field
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The inguinal field includes the femoral and externior iliac regions. It begins in the middle of the SI joint and extends laterally to the greater trochanter and 2 cm lateral to initially involved nodes. It courses inferiorly to 5 cm below the lesser trochanter then medially to the medial border of the obturator foramen with at least 2 cm margin medial to the involved nodes. If the common iliac nodes were involved, the field would begin at the L4-5 interspace and at least 2 cm above the superior most involved nodes.
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