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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
What factors are considered to be a favourable prognosis?
no B symptoms present and no bulky mediastinal disease
26
what is the treatment for nLPHD stage 1-2A?
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
27
patients with stage 1-2 with B symptoms should be treated?
they are considered poor prognosis stage 1-2 and should be treated with the same treatment as for stage 3-4
28
stage 3 and 4 HD treatment
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
29
what chemo agents should be used with elderly patients with HD
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
30
what is the treatment for children and seniors with HD?
children and elderly should be treated with ABVD and low dose IFRT (15-25Gy)
31
treatment after sage 1-2 relapse HD
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
32
treatment after stage 3-4 relapse HD
high dose chemo and stem cell transplant
33
when is stem cell treatment given in HD
initial bulky relapse, areas of residual disease after high dose chemo , or all involved sites at the time of relapse
34
causes of NHD
-HIV/AIDS, epstein barr-virus, helicobacter pylori bscteria prior xrt exposure
35
most common involved nodal sites in NHD
Neck is most common in 70% groin is second with 60% and axilla is at 50%
36
what is more commonly involved in NHD than HD
More often the bone marrow and mesenteric LN ( in the abdominal wall) is involved in NHD than HD
37
Most common extra nodal sites involved in NHD
Gi tract is most common then the Walyders Ring
38
which has a worse prognosis HD or NHD?
NHD has a 2.3x worse prognosis than HD
39
What age are most people dx with NHD diagnosed at
Mostly in the elderly >60 y.o.
40
lymphatic spread HD
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
common sites of distant mets in HD
viscera, spleen, liver and bone marrow
42
Natural history low vs high grade NHD at diagnosis
low grade (indolent) NHL typically have metastases to other lymph nodes, bone marrow and spleen. Whereas, high grade (aggressive) NHL typically do not
43
presentation of NHD
sameas HD
44
What is different between the diagnosis of HD and NHD
NHD requires a bone marrow test as there is a higher propensity for bone marrow involvement
45
diagnostic methods HD and NHD
CBC, liver and renal function tests, chest X-ray and ct for imaging, LN biopsy where there are accessible LN
46
types of NHD and %
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
what is unique about the severity of NHD
Patients who have indolent (low grade) lymphoma can spontaneously become the aggressive type and can regress as well
48
when is stem cell transplant used for NHD
Bone marrow/stem cell transplants for patients who have relapse or have an indolent lymphoma that has transformed into an aggressive lymphoma
49
What is tumour lysis syndrome?
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
indolent low grade NHD treatment
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
treatment after relapse for NHD
chemotherapy will be given. Often it includes fludarabine in combination with adriamycin or mitozantrone and dexamethasone (FAD or FMD)
52
chemo agents used for NHD
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
HD is radio _______.
sensitive
54
Mantle fields in HD
encompases lymph nodes in the neck, chest and axilla
55
mini mantle field in HD
same as mantle field but excluding the mediastinal lymph nodes
56
inverted Y field in XRT
encompases the infradiaphragmatic lymph nodes (para-aortic, iliac, inguinal and femoral lymph nodes)
57
total nodal irradiation in HD
is used when both the mantle field with the inverted Y field are irradiated together
58
subtotal nodal irradiation in HD
same as total nodal irradiation but excludes pelvic nodes
59
NHD is radio ____.
sensitive
60
when is XRT given as a sole modality for HD?
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
doses for EBRT alone in HD
35-44Gy
62
Tx NHD
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
what chemo agents are used for NHD?
CHOP (cyclophosphamide, vincrisinte, doxorubicin and prednisone) or R-CHOP (CHOP + rituximab)
64
NHD chemo, XRT first or second
usually Cx followed by XRT
65
TX stage 1,2 diffuse large b cell NHD DLBCL
chemo (CHOP or RCHOP)) then XRT IFRT which is a dose of 40-55Gy
66
Tx stage 3 and 4 diffuse large b cell NHD (DLBCL)
aggressive RCHOP or CHOP alone usually XRT does not play a role
67
treatment of follicular stage 1 and 2 NHD
XRT alone
68
treatment for stage 3-4 follicular NHD
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
treatment of peripheral t cell lymphomas
3-6 cycles of CHOP and IFRT
70
When is CHOP vs RCHOP used in NHD
RCHOP is used only for B cell lymphomas CHOP for B cell or T cell lymphomas
71
treatment of small lymphocytic lymphomas SLL
usually CHOP but small localized stage 1-2 SLL can be given XRT at a dose of 30Gy
72
Mantle cell lymphoma treatment MCL
MCL is treated with high dose chemotherapy or stem cell transplant
73
most common site of involvement in NHD
GI (specifically small and large bowel followed by ileum, colon and rectum )
74
DLBCL (diffuse large Bcell lymphoma ) gastric cancer treatment
RCHOP followed by 30-36Gy art
75
MALT (mucosal associated lymphoid tissue) gastric tumour treatment
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
most intestinal lymphomas are which subtype of lymphoma?
DLBCL- diffuse large b cell lymphoma
77
whats the treatment for waldeyers ring lymphoma
-involved field XRT and doxorubicin based chemotherapy
78
treatment of salivary gland lymphoma
radiation therapy
79
thyroid lymphoma treatment
moderate dose XRT 40-45Gy
80
breast lymphoma tx
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
pcnsl TREATMENT
high dose methotrexate and WBRT
82
Cutaneous lymphoma treatment
total body electron XRT

Skin Radiation therapy (40 decks)

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