Radiation Oncology/Hodgkin/Review

Review of Hodgkin's Lymphoma Epidemiology US incidence: ~8000 US deaths: ~1300 Age: bimodal, peak in 20's and 50's Risk factors: likely genetic predisposition (increased incidence in Jews, siblings, HLA antigens) Two separate entities Classical Hodgkin's Lymphoma (CHL) - Reed-Sternberg cells Lymphocyte-predominant Hodgkin's Lymphoma (LPHL) - "popcorn" lymphocyte cells Clinical Presentation & Workup Clinical presentation: lymph node mass(es) Diagnosis Excisional lymph node biopsy Core needle biopsy may be adequate FNA is insufficient Pathology CHL: Reed-Sternberg cells sufficient, CD15+ and CD30+ LPHL: CD20+ and CD45+, epithelial membrane antigen Workup Determination of B symptoms: fever >38C, drenching sweats, weight loss >10% weight Exam: lymphoid regions, liver, spleen Labs: CBC, differential, ESR, LDH, albumin, LFT, Bun/Cr Bone marrow biopsy: Stage IB/IIB, III-IV Imaging: CT neck/chest/abdomen/pelvis or PET/CT PET: higher sensitivity for nodal regions (92% vs 83%) and organ involvement (86% vs 37%), though more false positives Staging (Ann Arbor system; EORTC unfavorable criteria): Early stage favorable (I-II, no unfavorable features) Early stage unfavorable bulky (I-II, bulky mediastinum ratio >0.33 or size >= 10cm) Early stage unfavorable non-bulky (I-II, B symptoms, or >3 sites of disease, or ESR >50) Advanced (III-IV) Advanced unfavorable (age >=45, male, stage IV, albumin <4, WBC >15k, WBC <600 Response criteria Need for additional treatment based on response 2007 IWG Guidelines using IHC, flow cytometry, PET: CR, PR, SD, relapsed, PD