hodgkin's%20lymphoma
HODGKIN'S LYMPHOMA

Hodgkin's lymphoma is a malignancy that arises from germinal center B cell.

Histologically, there is a presence of multinucleated giant cells in a mixed inflammatory background.

It is also known as Hodgkin's disease, Hodgkin lymphoma or Hodgkin disease.

It commonly affects individuals ages 15-30 years old and those 55 years old and above.

The key morphologic characteristics include presence of Reed-Sternberg cells and lymphocyte-predominant cells.

Radiotherapy

Involved-Site Radiation Therapy (ISRT)

  • Radiation aimed directly at the lymph nodes containing the Hodgkin's lymphoma
    • May also target nearby structures
  • Concentrated on the involved node & extranodal extensions, reducing the field exposed to radiation, thereby sparing other organs from unnecessary radiation exposure
  • Recommended primary therapy for patients with non-bulky nodular lymphocyte-predominant Hodgkin's lymphoma clinical (NLPHL) stage IA/IIA
  • Used in combination with chemotherapeutic regimens with or without Rituximab in patients with nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) clinical stage IB/IIB or bulky nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) clinical stage IA/IIA
  • Also recommended for patients with nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) clinical stage IIIA/IVA & IIIB/IVB with or without chemotherapeutic regimens & Rituximab
  • Recommended doses:
    • Nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) (Monotherapy): 30-36 Gy for involved regions; 25-30 Gy for uninvolved regions
    • Favorable Stage I/II classic Hodgkin's lymphoma (CHL) (in combination with chemotherapeutic regimens): 20-30 Gy with Doxorubicin, Bleomycin, Vinblastine, & Dacarbazine (ABVD); 30 Gy with Mechlorethamine, Doxorubicin, Vinblastine, Vincristine, Bleomycin, Etoposide, & Prednisone (Stanford V)
    • Unfavorable Stage I/II classic Hodgkin's lymphoma (CHL) (in combination with chemotherapeutic regimens): 30 Gy with Doxorubicin, Bleomycin, Vinblastine, & Dacarbazine (ABVD) or  Bleomycin, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Procarbazine, & Prednisone (BEACOPP)
    • Non-bulky Stage IB/IIB classic Hodgkin's lymphoma (CHL) (in combination with chemotherapeutic regimens): 30 Gy
    • Bulky classic Hodgkin's lymphoma (CHL): 30-36 Gy with Doxorubicin, Bleomycin, Vinblastine, & Dacarbazine (ABVD); 36 Gy with Mechlorethamine, Doxorubicin, Vinblastine, Vincristine, Bleomycin, Etoposide, & Prednisone (Stanford V)
    • Deauville 3-4 during re-evaluation after completion of primary therapy: 30-45 Gy
  • Not to be used for high cervical regions & axillae in women

Involved-Field Radiation Therapy (IFRT)

  • Technique that aims at the lymph node regions with Hodgkin's lymphoma
  • Affects larger areas compared to involved-site radiation therapy, exposing nearby organs to unnecessary radiation doses
  • May be used for favorable classic Hodgkin's lymphoma (CHL) but depending on the treatment site
  • Doses of 30-36 Gy is also be used for stage I-II nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) & stage III-IV bulky classic Hodgkin's lymphoma patients (CHL)

Palliative Radiation Therapy

  • May be given to advanced nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) patients with bulky disease
  • May help alleviate discomfort & pain via disease regression
  • Doses of 30-36 Gy is recommended
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