Hodgkin's%20lymphoma Treatment

Treatment

Radiotherapy

Advanced RT delivery techniques such as intensity-modulated RT (IMRT), volumetric modulated arc therapy (VMAT), breath hold or respiratory gating, image-guided RT (IGRT), proton therapy should be considered in special cases where radiation exposure of specific organs are reduced while achieving the primary goal of local tumor control

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 and extranodal extensions, reducing the field exposed to radiation, thereby sparing other organs from unnecessary radiation exposure
Recommended primary therapy for patients with NLPHL stage IA/IIA
Used in combination with chemotherapeutic regimens with or without Rituximab in patients with NLPHL clinical stage IB/IIB or bulky NLPHL clinical stage IA/IIA
Also recommended for patients with NLPHL clinical stage IIIA/IVA and IIIB/IVB with or without chemotherapeutic regimens and Rituximab
Not to be used for high cervical regions and axillae in women
Recommended doses:
- Combined modality therapy
  - 20-30 Gy (when treated with ABVD) for stage I-II non-bulky disease
  - 30 Gy for stage IB-IIB non-bulky disease
  - 30-36 Gy for bulky diseases in all stages
  - 36-45 Gy for sites of partial response to chemotherapy
ISRT alone (rare, except for NLPHL)
- 30-36 Gy in involved regions
- 25-30 Gy in uninvolved regions

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 CHL but depending on the treatment site
Doses of 30-36 Gy is also be used for stage I-II NLPHL and stage III-IV bulky CHL

Palliative Radiation Therapy

May be given to advanced NLPHL patients with bulky disease
May help alleviate discomfort and pain via disease regression
Doses of 4-30 Gy is recommended

Relationship between tumour response to systemic therapy and overall survival in unresectable hepatocellular carcinoma

Dr Raghav Sundar, 09 Sep 2019

Overall survival (OS) is currently the primary criteria in assessing the efficacy of a cancer treatment. Dr Raghav Sundar, a consultant medical oncologist at the National University Hospital, Singapore, details the crucial role played by tumour response in evaluating treatment efficacy, with a focus on the multiple kinase inhibitor lenvatinib in the treatment of hepatocellular carcinoma (HCC).

Carfilzomib-based triplet regimen a potential upfront treatment for high-risk MM

Pearl Toh, 22 Oct 2020

The combination therapy comprising carfilzomib, cyclophosphamide and dexamethasone (KCd) is effective, with a tolerable safety profile, in an Asian cohort with high-risk multiple myeloma (MM) — thus providing a more economical alternative as a potential upfront regimen in resource-limited settings, according to leading experts during a myeloma education webinar.

Optimizing metastatic hormone-sensitive prostate cancer treatment in advanced prostate cancer

Assoc Prof. Darren Poon, Assoc Prof. Edmund Chiong, 14 Jan 2021

Metastatic hormone-sensitive prostate cancer (mHSPC) refers to the condition whereby patients have metastatic prostate cancer and no prior hormonal therapy or androgen deprivation therapy (ADT). Typically, patients with mHSPC have been treated with ADT alone, following which, the overwhelming majority develop castration resistance over time and head towards eventual mortality. In recent years, the publication of various landmark trials has prompted dramatic changes in the mHSPC treatment landscape, and had favourably impacted overall survival (OS) in these patients. At a recent webinar, A/Prof Darren Poon, Honorary Consultant in Clinical Oncology, Hong Kong Sanatorium & Hospital, and Honorary Clinical Associate Professor, Department of Clinical Oncology, The Chinese University of Hong Kong, reviewed treatment options in mHSPC, while A/Prof Edmund Chiong, Head and Senior Consultant, Department of Urology, National University Hospital, Singapore, presented a case which was discussed by an esteemed panel of experts. This webinar was jointly organized by the Singapore Society of Oncology and the Singapore Urological Association, and supported by Astellas.