april 28, 2012 長庚醫院 放射腫瘤科 林信吟醫師
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Hodgkin’s Lymphoma (HL) Chart Round and Overview, focusing on Early-stage Favorable HL, in the era of CMT (Combined Modality Treatment). April 28, 2012 長庚醫院 放射腫瘤科 林信吟醫師. Q : Demographics & descriptive Epidemiology of HL in Taiwan?. Current status in the US can also be described - PowerPoint PPT PresentationTRANSCRIPT
Hodgkin’s Lymphoma (HL)Chart Round and Overview, focusing on
Early-stage Favorable Early-stage Favorable HL, in the era of
CMTCMT (Combined Modality Treatment)
April 28, 2012長庚醫院 放射腫瘤科
林信吟醫師
Q: Demographics & descriptive Epidemiology of HL in Taiwan?
Current status in the US can also be describedTry to point out the differences between the US and Taiwan
Q: Describe pathology in brief
Q: Staging Classification
Q: Unfavorable factors for early-stage HL?
Q: Unfavorable factors for advanced-stage HL?
International Prognostic Score (IPS)
Q: In early-stage favorable HL, compare outcomes with CMT vs. RT alone
In the 1990s, CRT vs. RT alone was evaluated at least 4 major RCTs:
Q: In HL patients receiving CMT, how about RT volume ?(Is more extensive RT volume than IFRT necessary?)
At least 4 RCTs have compared IFRT to more extensive RT fields in HL pts receiving CMT:
EORTC H8 trial addressed the issue of RT volume
Q: In early-stage favorable HL,summarize the evidence to support the implementation of reduced RT reduced RT dosedose after induction C/T
Use of < 30 Gy in early-stage favorable HL after initial C/T has been studied in two RCTs:GHSG H10H10 trialEORTC-GELA H9F trial
Q: The investigation of C/T as a C/T as a single modalitysingle modality in limited-stage disease?【 CMT vs. C/T alone 】
【 After initial C/T ---> Consolidative RT vs. Observation alone 】
In additionEORTC H9-F trials compare 3 radiation dose levels (one of which is the arm without consolidative RT after initial C/T)
Interim results show CMT indeed provides much better tumor control (HR = 0.27 【 0.17, 0.43 】 ) as compared to C/T alone group
【 Ongoing 】 In patients who have a PET-documented CR after 2 cycles of C/T, EORTC H10 trial is to compare ABVD alone vs. ABVD + INRT
Q: Risk of long-term solid solid cancer cancer among survivors of HL?
Q: In early-stage UnfavorableUnfavorable HL, whether Tx results can be improved with more intensive C/T followed by dose-reduced IFRTdose-reduced IFRT?
GHSG HD 11 trial has addressed this issue
Q: Prognostic Value of early interim FDG-PET in HL?
Q: Whether patients with FDG-PET (+) during and/or after C/T can be rendered disease free with consolidative IFRT?