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INTERMEDIATE STAGE HODGKIN LYMPHOMA SANTHURI VIRANNA 2 ND YEAR - - PowerPoint PPT Presentation
INTERMEDIATE STAGE HODGKIN LYMPHOMA SANTHURI VIRANNA 2 ND YEAR - - PowerPoint PPT Presentation
INTERMEDIATE STAGE HODGKIN LYMPHOMA SANTHURI VIRANNA 2 ND YEAR CLINICAL RADIATION ONCOLOGY REGISTRAR UNIVERSITY OF CAPE TOWN GROOTE SCHUUR HOSPITAL SUPERVISOR: DR ZAINAB MOHAMED 16/02/2019 DISCLOSURE Nothing to disclose CASE SUMMARY 16
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CASE SUMMARY 16 year old female, Miss S.S
Reviewed Lymphoma MDT at GSH May 2018: Classic Hodgkin lymphoma
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BACKGROUND
Symptoms x 6/12
- Bilateral neck masses, painful, rapidly growing
- B symptoms: drenching night sweats, no fever or significant weight
loss
- Other disease related symptoms: fatigue
Grade 10 scholar, no co-morbidities, no family history,
social support
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EXAMINATION
ECOG PS 1 LN examination
- Right neck: level II-IV, 6x6 cm nodal mass
- Left neck: level III-V, 4x4 cm nodal mass
- ENT, axilla, inguinal, spleen: normal
Chest/abdomen: unremarkable
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WORK UP Cervical LN biopsy 05/2018
Classic HL, nodular
sclerosis
CD30 +, CD15 +,
CD 20 -, EBER -
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CHEST X-RAY
MMR < 0.35
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STAGING PET
- CT
Homogenous increased BM uptake
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BONE MARROW BIOPSY
Adequate quality Non-specific reactive changes No morphological evidence of involvement with HL
and no granulomas seen
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RISK STRATIFICATION
Ann Arbor stage IIB, no bulk Intermediate stage EORTC/ LYSA: elevated ESR, ≥4 nodal areas GHSG: elevated ESR, ≥ 3 nodal areas
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MANAGEMENT
ERNA LVEF 65% Reproductive
counselling
ABVD x 2
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INTERIM PET
- CT
Right paratracheal LN (25 mm, previously 34mm) Deauville 3 MDT: complete metabolic response Staging PET
- CT
Interim PET
- CT
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MANAGEMENT
ABVD x 2 (total 4 cycles) ISRT 30.60Gy
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ISRT VMAT Total dose 30.60 Gy in 17 fractions, 1.8Gy/fraction
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FOLLOW UP
6 weeks post RT (March 2019) End of treatment PET
- CT
3 monthly 1st two years, then 6 monthly for 3 years,
then annually
Follow up for 10 years
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DISCUSSION POINTS
The role of BM biopsy for diffuse uptake on PET
- CT
Treatment intensification
- Early intensification with esc. BEACOPP after positive interim PET
(Deauville 3 or 4?)
- More intensive treatment: esc. BEACOPP (2 cycles) followed by
ABVD + ISRT
Long term toxicity and special considerations in a
young patient
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