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72 Cards in this Set
- Front
- Back
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in mixed cellularity HD patients present with
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advanced disease
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which is more favorable mixed cellularity or NSHD
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NSHD
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what has the worst prognosis of all HD
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lymphocyte-depleted
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which has the best prognosis
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nLPHD
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do men or women have worse outcome
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men
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what 4 things may influence the treatment decision and prognosis
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B symptoms
# of sites involved disease in lower abdomen extensive splenic involvement |
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the most important prognostic factor influencing therapy is
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Ann Arbor Staging
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what is the most effective single agent for treatment
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radiation therapy
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what was the initial drug combo in chemo
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MOPP
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what is MOPP
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nitrogen mustard
vincristine procarbazine prednisone |
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what is the gold standard of chemo tx
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ABVD
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why is ABVD the gold standard
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it decreases the side effects associated with MOPP and is more effective
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what is the dose combined for adults?
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20-36Gy
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why do we first treat with chemo?
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to shrink tumor so we can not treat as much area with radiation
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what is the recommended dose for radiation alone
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30-44Gy
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what is the dose when RT combined with chemo?
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20-30Gy non bulky
20-36Gy bulk |
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what is the fraction per day
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1.5-1.8Gy
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what is the most common energies
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6-10MV
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what is the most common energy for the abdomen
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15MV
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if treating large field what distance should we treat
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105-140cm
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when we separate treatment to adhacent fields we use a
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gap
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what does the classic mantle involve
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all major lymph node regions above diaphragm
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the classic mantles borders are
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inferior mandible to level of insertion of the diaphragm
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what 5 things do we want to block with classic mantle
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lung
occipital region spinal cord larynx humeral heads |
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what part of the lung do we want to block? occipital region?
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ant/post
post only |
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what does the classic inverted Y port consist of
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retroperitoneal, pelvic nodes, and spleen
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what are the borders of the inverted Y
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inferior is L4-L5 to include common iliac nodes
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the para-aortic field corresponds to width of the
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transverse processes
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what are the margins of the pelvic field
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1.5-2cm lateral to widest point of bony pelvis
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the margin of the pelvic field should inferiorly extend to the
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lesser trochanters
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what is GTV
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individual nodes that are involved and enlarged
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what is CTV
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GTV plus entire involved lymph node region
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what is extended CTV
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CTV plus any lymph nodes at risk
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what is PTV
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what your wanting to treat plus whole margin
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what is stage I to IIA nodular lymphocyte predominance treated to
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30-36Gy
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if have favorable prognosis, treated with
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chemno and RT
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what is dose if favorable prognosis
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30-40Gy
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what % of stage I or II have B symptoms
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15-20%
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how are stage III to IV patients treated
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systemic chemo
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what is the 5 year survival rate for stage III to IV
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73%
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dose of ____ is used for pediatric patients
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15-25Gy
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what is the survival rate for pediatrics
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90%
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why is staging hampered during pregnancy
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you can't image them
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if relapse occurs after combined therapy then what needs to be done
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high dose chemo with autologous bone marrow or stem cell
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what is 5 year survival rate for relapse
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50%
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what is the follow up for the first 2 years
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2-4 months
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what is the follow up for 3rd and 4th years
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4-6 months
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what are some side effects
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hair loss
sore throat difficulty swallowing altered taste dry cough blood count suppression |
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what side effect develops in half the patients
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subclinical hypothyroidism
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what is herpes zoster
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shingles
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herpes zoster can occur in what % of patients
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10-15%
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what is Lhermittes
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electrical sensation sent down arms and legs
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lhermitte's develops in what % or patients w/ significant amount of spine in field
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10-15%
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what are the nost important long term hazards
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secondary malignancies
cardiovascular disease |
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what were the estimated cases of hodgkins
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8190
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how many hodgkin deaths occured
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1070
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hodgkins nearly always begins in
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lymph nodes
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what is the typical presentation
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painless lymphadenopathy
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what are the presenting symptoms
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systemic symptoms
fever night sweats weight loss alcohol induced pain |
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the cervical nodes are included what % of the time
mediastinum? |
80%
50% |
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1/3 present with
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B symptoms
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what are B symptoms
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fever
night sweats weight loss |
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how is hodgkins staged
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ann arbor system
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what is stage I
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involvement of a single node
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what is stage IIA
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absence of B symptoms
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what is stage IIB
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present of B symptoms
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what is the neoplastic cel of hodgkins
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reedsternburg cell
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reedsternburg cells account for fewer than % of cells involved by HD
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1%
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what are the 4 subtypes
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nodular sclerosis
lymphocyte rich classic mixed cellularity lymphocyte depletion |
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what is nLPHD
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nodular lymphocyte predominance HD
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nLPHD present with
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early stage with solitary peripheral node, and systemic symptoms are uncommon
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what is the most common histologic subtype
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nodular sclerosis
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