Non-hodgkin's%20lymphoma Treatment

Treatment

Radiotherapy

Local radiotherapy is a recommended initial therapy for patients with limited stage disease as it increases survival rates in these patients
Studies have shown that addition of radiation therapy to chemotherapy in patients with bulky disease resulted in improved treatment outcome
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) is the recommended appropriate field for NHL as it is aimed directly at the lymph nodes containing the involved structure and site of skin involvement on cutaneous lymphomas
- Concentrated on the involved node and extranodal extensions, reducing the field exposed to radiation, thereby sparing other organs from unnecessary radiation exposure
- Recommended doses:
  - FL, MZL: 24-30 Gy
  - MCL: 24-36 Gy
  - DLBCL: 40-55 Gy (as primary treatment); 20-36 Gy (in combination with HCT); 30-36 (after complete response to chemotherapy); 36-50 Gy (after partial response to chemotherapy); 40-55 Gy (refractory disease)
  - PTCL: 30-36 Gy (consolidation); 40-50 Gy (complementary with partial response to chemotherapy); 40-55Gy (as primary treatment); 20-36 Gy (in combination with HCT)
  - T-cell/NK-cell lymphomas: 50-55 Gy (as primary treatment); 45-56 Gy (in combination therapy)
  - MF/SS with limited or localized skin involvement: 8-12 Gy; 24-30 Gy for unilesional presentation
External beam radiation therapy (EBRT) is an option for the initial management of patients with cutaneous lymphomas with solitary or regional disease
- Recommended doses:
  - Primary cutaneous MZL and primary cutaneous follicle center lymphoma: 24-30 Gy
  - MF/SS: 8-12 Gy (individual plaque and tumor lesions); 24-30 Gy (unilesional presentation)
Total skin electron beam therapy (TSEBT), either alone or in combination with adjuvant therapy, may be considered for early-stage MF
- Recommended dose: 12-36 Gy (4-6 Gy/week); individual tumors: 4-12 Gy

New treatment option now available for patients with HR+/HER2- aBC/MBC, PIK3CA mutations

31 Mar 2021

At the recent webinar entitled Pik Me Up: Mutation Matters, Consultant Medical Oncologist Dr Senthil Rajappa discussed the role of PI3Kα-specific inhibitor alpelisib (TREZILENT^®, Novartis) in managing patients with HR+/HER2- aBC/MBC and PIK3CA mutations while Senior Consultant Pathologist Professor Dr Pathmanathan Rajadurai explained the process of detecting PIK3CA mutations in patients.

The changing treatment landscape for premenopausal women with advanced breast cancer: Focus on ribociclib

Dr. Wong Seng Weng, Dr. Lee Guek Eng, 19 Mar 2021

In Singapore, advanced breast cancer (aBC) is the leading cause of cancer death in women 30–49 years of age. For premenopausal women diagnosed with hormone receptor (HR)-positive, HER2-negative BC, cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors provide new hope. Currently, ribociclib is the only CDK4/6 inhibitor studied in the first-line setting for premenopausal women with HR+/HER2- aBC, in the phase III MONALEESA-7 trial. Two experts, Dr Wong Seng Weng, Medical Director & Consultant Medical Oncologist at The Cancer Centre, Paragon Medical & Mount Elizabeth Novena Specialist Centre, and Dr Lee Guek Eng, Senior Consultant & Specialist in Medical Oncology at Icon Cancer Centre and Program Director of the Young Women Cancer Program, weigh in with their views on managing premenopausal women with aBC.

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).