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Treatment Planning Hodgkin Lymphoma.

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Presentation on theme: "Treatment Planning Hodgkin Lymphoma."— Presentation transcript:

1 Treatment Planning Hodgkin Lymphoma

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3 LN groups above diaphragm:
Cervical Supraclavicular Infraclavicular Axillary Mediastinal Hilar LN groups below diaphragm: Para-aortic Iliac Inguinal Femoral

4 Hodgkin Lymphoma ►Incidence: 1% of new cancer cases
Bimodal age incidence: 1st in 20s & 2nd after 50 years 85% of children are boys ► Risk Factors: unclear Viral infection: EBV HIV

5 Pathology ► Histology: Reed -Sternberg cells ► The Rye classification:
Hodgkin Lymphoma Pathology ► Histology: Reed -Sternberg cells ► The Rye classification: According to clinical behavior and prognosis Lymphocyte predominant Nodular sclerosis Mixed cellularity Lymphocyte depletion

6 Mode of Spread Site of origin: nodal Spread: contiguous
Hodgkin Lymphoma Mode of Spread Site of origin: nodal Spread: contiguous Nodal distribution: axial Hematogenous dissemination: late CNS: rare (< 1%) Liver or bone marrow: uncommon

7 Diagnosis Painless lymphadenopathy: cervical in > 70%
Hodgkin Lymphoma Diagnosis ► Symptoms & Signs: Painless lymphadenopathy: cervical in > 70% Systemic symptoms: Fever, night sweats and weight loss ► Biopsy : FNA cytology or excision Bone marrow ? ► Imaging: Chest radiographs CT scans: neck, chest , abdomen and pelvis Bipedal lymphangiography: aortic and iliac nodes ? Bone scan: ? PET scan: ? ► Laboratory tests: CBC, chemistries, ESR

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9 Bipedal lymphangiography

10 Staging Classification
Hodgkin Lymphoma Staging Classification Description Stage Involvement of single LN region or lymphoid structure I Involvement of two or more LN regions on the same side of the diaphragm II Involvement of LN regions or structures on the both sides of the diaphragm III Involvement of one or more extranodal sites IV A: No symptoms B: Symptoms present Applicable to any stage X: Bulky

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13 Treatment ► Curable disease ► Surgery: Limited to diagnosis
Hodgkin Lymphoma Treatment ► Curable disease ► Surgery: Limited to diagnosis Laparotomy ? ► Radiotherapy: Early stage without risk factors (non-bulky stage IA or IIA) ► Chemotherapy: A dvanced stage III or stage IV Early stage with risk factor (symptoms or bulky ) ► Combined modality: chemotherapy + radiotherapy ?

14 Radiotherapy Techniques-1
Hodgkin Lymphoma Radiotherapy Techniques-1 ► Target Volumes: depends on the stage of the disease LN groups above diaphragm (Mantle field) LN groups below diaphragm+ spleen (Inverted Y field) Total Nodal Irradiation (Mantle field + Inverted Y field) LN groups of known disease only (Involved field) Only curative in combination with chemotherapy ► Patient positioning & immobilization: Supine The arms raised above the head The chin extended

15 Radiotherapy Techniques-2
Hodgkin Lymphoma Radiotherapy Techniques-2 ► Methods: External Beam: megavoltage radiation, photons, 4-6 MV ► Fields arrangement: Problem of Matching Fields ? Opposed anterior and posterior fields ?? ► Dose /Time / Fractionation: 35-40 Gy without chemotherapy, conventional schedule 20-25 Gy with chemotherapy ► Beam Modifications: Shields (5 HVL) over: lung, humeral head, larynx Gap between: Inferior border of mantle Superior border of periaortic fields

16 Subtotal nodal Irradiation
Mantle Field Inverted Y field Subtotal nodal Irradiation Total Nodal Irradiation

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18 Morbidity Directly related to the area treated ► Acute: ► Acute:
Hodgkin Lymphoma Morbidity Directly related to the area treated Mantle fields Inverted Y fields Inverted Y fields ► Acute: Occipital epilation Dysphagia Myeolsuppression Xerostomia ► Acute: Nausea vomiting Diarrhea Myeolsuppression ► Late: Hypothyroidism Pneumonitis Pericarditis ► Late: Infertility

19 Thank You


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