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Skin Radiation therapy > Hodgkins and Non-hodgkins Lymphoma > Flashcards

Hodgkins and Non-hodgkins Lymphoma Flashcards

1
Q

ages for HD

A

bimodal age distribution 25-30yo and 70-80yo

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2
Q

HD almost always begins in the _____.

A

lymph nodes

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3
Q

many HD cases are associated with which virus?

A

Epstein Barr virus

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4
Q

HD has which 2 LN most commonly + at presentation

A

80% cervical, 50% mediastinal

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5
Q

most common presentation of HD

A

Painless lymphadenopathy

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6
Q

what are B symptoms?

A

night sweats, weight loss of >10%, fever

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7
Q

symptoms of HD?

A

b symptoms in 1/3 of pts, parities and alcohol induced pain in tissues affected by HD

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8
Q

What special test is performed on HD patients with Symptoms

A

Bone marrow needle biopsy

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9
Q

diagnostic methods in HD

A

CBC, platelet count, liver and renal function tests, imaging: chest X-ray, CT of thorax, abode pelvis , FDG PET scan

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10
Q

what extra diagnostic test is given in an HD patient with an abnormal liver function test but a normal CT

A

a percutaneous liver biopsy

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11
Q

what is the name of the staging system used for HD

A

Ann-arbour staging system

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12
Q

Ann-Arbour staging system

A

I- involvement of 1 LN region
II-involvement of 2 LN regions on the same side of the diaphragm or localized involvement for an extra lymphatic organ of one or more LN regions on the same side of the diaphragm
III-involvement of LN regions on both sides of the diaphragm which can include the spleen, or localized involvement of extra lymphatic organ or both
IV-diffuse involvement of one or more extra lymphatic involvement with or without lymph node involvement

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13
Q

what is considered to be an enlarged/ involved LN in the staging of HD

A

A LN that exceeds 1cm

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14
Q

what is the neoplastic HD cell

A

-starts as a monoclonal B cell and then transforms into Reed-sternburg cells

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15
Q

which is more common HD or NHD

A

NHD is 8x more common than HD

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16
Q

what are the 5 subtypes if HD

A

there are 4 classical HD types: nodular sclerosis, lymphocyte rich, mixed cellularity and Lymphocyte depleted as well as nodular lymphocyte predominance (NLPHD)

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17
Q

Which subtype of HD has the best prognosis? when is it diagnosed?

A

the HD with the best prognosis is nLPHD nodular lymphocyte predominance HD and is most commonly diagnosed in young people

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18
Q

what is the most common type of HD?

A

nodular sclerosing HD (NSHD) is most common but has a worse prognosis than LPHD

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19
Q

which type of HD has the worst prognosis?

A

lymphocyte depleted HD has the worst prognosis and usually presents late

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20
Q

best to worst prognosis HD

A

nodular Lymphocyte predominance, nodular sclerosing, mixed cellularity, lymphocyte depleted

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21
Q

chemo agents used in the tx of HD

A

ABVD (Adryamyicin, bleomyacin, vinblastine and dacarzabine)

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22
Q

typical treatment for stage III and iV HD

A

chemotherapy (ABVD), Then 26-30 Gy XRT

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23
Q

stage 1-2A ( Favourable) disease hd treatment

A

4 cycles ABVD + 36gy IFRT (INVOLVED FIELD RADIATION THERAPY) unfavourable prognosis has essentially the same treatment

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24
Q

Margins 3D treatment planning in HD XRT

A

GTV- palpable or enlarged nodes or avid nodes as seen on CT or PET scans
CTV- GTV+ entire involved nodal region and adjacent uninvolved LN in some instances
PTV=CTV +1-1.5cm margin

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25
Q

What factors are considered to be a favourable prognosis?

A

no B symptoms present and no bulky mediastinal disease

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26
Q

what is the treatment for nLPHD stage 1-2A?

A

N.B. nLPHD has the best prognosis, therefore a dose of 30-36Gy with IFRT (involved fields radiation therapy) is or extended fields usually sufficient

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27
Q

patients with stage 1-2 with B symptoms should be treated?

A

they are considered poor prognosis stage 1-2 and should be treated with the same treatment as for stage 3-4

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28
Q

stage 3 and 4 HD treatment

A

before starting chemo, every patient should be put on allopurinol to prevent tumour lysis syndrome.
chemo of either ABVD ( 6-8 CYCLES) or ABVD-MOPP (for 12 months) then IFRT if there was an incomplete response to the chemo, if there is complete response then no further treatment is required

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29
Q

what chemo agents should be used with elderly patients with HD

A

in adults over 65 the regimens of PAVe ( procarzabine, Alkaline and Vinblastine)and ChlVPP (vinblastine,chlorambucil, procarzabine, and prednisone) and VBM vinblastine, bleomycin and ,methotrexate

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30
Q

what is the treatment for children and seniors with HD?

A

children and elderly should be treated with ABVD and low dose IFRT (15-25Gy)

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31
Q

treatment after sage 1-2 relapse HD

A

if pt received no XRT, chemo should be the salvage treatment. If chemo was the initial treatment and radiation may b added but for patients previously XRT only 15-25Gy should be added, in areas not treated by XRT 30-35GY may be given

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32
Q

treatment after stage 3-4 relapse HD

A

high dose chemo and stem cell transplant

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33
Q

when is stem cell treatment given in HD

A

initial bulky relapse, areas of residual disease after high dose chemo , or all involved sites at the time of relapse

34
Q

causes of NHD

A

-HIV/AIDS, epstein barr-virus, helicobacter pylori bscteria prior xrt exposure

35
Q

most common involved nodal sites in NHD

A

Neck is most common in 70% groin is second with 60% and axilla is at 50%

36
Q

what is more commonly involved in NHD than HD

A

More often the bone marrow and mesenteric LN ( in the abdominal wall) is involved in NHD than HD

37
Q

Most common extra nodal sites involved in NHD

A

Gi tract is most common then the Walyders Ring

38
Q

which has a worse prognosis HD or NHD?

A

NHD has a 2.3x worse prognosis than HD

39
Q

What age are most people dx with NHD diagnosed at

A

Mostly in the elderly >60 y.o.

40
Q

lymphatic spread HD

A

Lymphatic spread: cervical to supraclavicular to the axillary and finally to the mediastinal and hilar lymph nodes. It is unusual for a lymph node group to be skipped.

41
Q

common sites of distant mets in HD

A

viscera, spleen, liver and bone marrow

42
Q

Natural history low vs high grade NHD at diagnosis

A

low grade (indolent) NHL typically have metastases to other lymph nodes, bone marrow and spleen. Whereas, high grade (aggressive) NHL typically do not

43
Q

presentation of NHD

A

sameas HD

44
Q

What is different between the diagnosis of HD and NHD

A

NHD requires a bone marrow test as there is a higher propensity for bone marrow involvement

45
Q

diagnostic methods HD and NHD

A

CBC, liver and renal function tests, chest X-ray and ct for imaging, LN biopsy where there are accessible LN

46
Q

types of NHD and %

A

most are B cell lymphoma (85%) the rest are T cell lymphoma (15%)
B Cell subtypes: diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma and Burkitt lymphoma
T cell subtypes: peripheral T-cell lymphoma & cutaneous T-cell lymphoma

47
Q

what is unique about the severity of NHD

A

Patients who have indolent (low grade) lymphoma can spontaneously become the aggressive type and can regress as well

48
Q

when is stem cell transplant used for NHD

A

Bone marrow/stem cell transplants for patients who have relapse or have an indolent lymphoma that has transformed into an aggressive lymphoma

49
Q

What is tumour lysis syndrome?

A

Tumor lysis syndrome is a group of metabolic abnormalities that can occur as a complication during the treatment of cancer, where large amounts of tumor cells are killed off (lysed) at the same time by the treatment, releasing their contents into the bloodstream.

50
Q

indolent low grade NHD treatment

A

rarely curable but has long clinical course. Most often EBRT is used for this grade and stage of disease however, RCVP (rituximab, cyclophosphamide, vincristine and prednisolone) is used as a systemic chemotherapy

51
Q

treatment after relapse for NHD

A

chemotherapy will be given. Often it includes fludarabine in combination with adriamycin or mitozantrone and dexamethasone (FAD or FMD)

52
Q

chemo agents used for NHD

A

RCHOP (rituximab, cyclophosphamide, Adriamycin, vincristine and prednisolone) is the most widely used combination chemotherapy . The first four drugs are given intravenously on day 1 of a 21-day cycle with oral steroids on the first 5 days. Usually there is 6-8 cycles

53
Q

HD is radio _______.

A

sensitive

54
Q

Mantle fields in HD

A

encompases lymph nodes in the neck, chest and axilla

55
Q

mini mantle field in HD

A

same as mantle field but excluding the mediastinal lymph nodes

56
Q

inverted Y field in XRT

A

encompases the infradiaphragmatic lymph nodes (para-aortic, iliac, inguinal and femoral lymph nodes)

57
Q

total nodal irradiation in HD

A

is used when both the mantle field with the inverted Y field are irradiated together

58
Q

subtotal nodal irradiation in HD

A

same as total nodal irradiation but excludes pelvic nodes

59
Q

NHD is radio ____.

A

sensitive

60
Q

when is XRT given as a sole modality for HD?

A

given as sole treatment for patients who cannot tolerate Cx, who have localized Hodgkin’s lymphoma to a small area of lymph nodes (i.e. limited to areas of known disease) and who have nodular lymphocyte predominant Hodgkin’s lymphoma without B symptoms

61
Q

doses for EBRT alone in HD

A

35-44Gy

62
Q

Tx NHD

A

Radiation therapy is given adjuvantly or in combination with Cx for advanced/aggressive lymphomas. Radiation therapy can also be given alone for indolent non-Hodgkin’s lymphoma in early stages

63
Q

what chemo agents are used for NHD?

A

CHOP (cyclophosphamide, vincrisinte, doxorubicin and prednisone) or R-CHOP (CHOP + rituximab)

64
Q

NHD chemo, XRT first or second

A

usually Cx followed by XRT

65
Q

TX stage 1,2 diffuse large b cell NHD DLBCL

A

chemo (CHOP or RCHOP)) then XRT IFRT which is a dose of 40-55Gy

66
Q

Tx stage 3 and 4 diffuse large b cell NHD (DLBCL)

A

aggressive RCHOP or CHOP alone usually XRT does not play a role

67
Q

treatment of follicular stage 1 and 2 NHD

A

XRT alone

68
Q

treatment for stage 3-4 follicular NHD

A

Treatment is necessary when the lymphoma becomes symptomatic. small field low dose XRT or alkylating agents ( chlorambucil or cyclophosphamide ) also radioimmunotherapy agents can be used (zevalin and bexxar)

69
Q

treatment of peripheral t cell lymphomas

A

3-6 cycles of CHOP and IFRT

70
Q

When is CHOP vs RCHOP used in NHD

A

RCHOP is used only for B cell lymphomas CHOP for B cell or T cell lymphomas

71
Q

treatment of small lymphocytic lymphomas SLL

A

usually CHOP but small localized stage 1-2 SLL can be given XRT at a dose of 30Gy

72
Q

Mantle cell lymphoma treatment MCL

A

MCL is treated with high dose chemotherapy or stem cell transplant

73
Q

most common site of involvement in NHD

A

GI (specifically small and large bowel followed by ileum, colon and rectum )

74
Q

DLBCL (diffuse large Bcell lymphoma ) gastric cancer treatment

A

RCHOP followed by 30-36Gy art

75
Q

MALT (mucosal associated lymphoid tissue) gastric tumour treatment

A

antibiotics as H pylori bacteria is associated with 90% of these tumours. antibiotics used are: ampicillin, prilosec, etc. if the antibiotics fail then XRT is used at a dose of 30Gy

76
Q

most intestinal lymphomas are which subtype of lymphoma?

A

DLBCL- diffuse large b cell lymphoma

77
Q

whats the treatment for waldeyers ring lymphoma

A

-involved field XRT and doxorubicin based chemotherapy

78
Q

treatment of salivary gland lymphoma

A

radiation therapy

79
Q

thyroid lymphoma treatment

A

moderate dose XRT 40-45Gy

80
Q

breast lymphoma tx

A

art to the whole breast of 45-50Gy , these lymphomas often occur due to lactation or pregnancy, ipsilateral LN are also treated and 40-45Gy and CNS prophylaxis is used in high grade tumours

81
Q

pcnsl TREATMENT

A

high dose methotrexate and WBRT

82
Q

Cutaneous lymphoma treatment

A

total body electron XRT

Skin Radiation therapy (40 decks)

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