Hodgkin's lymphoma medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hodgkin's lymphoma}} | {{Hodgkin's lymphoma}} | ||
{{CMG}}; {{AE}} {{AS}} | {{CMG}}; {{AE}} {{AS}}{{M.B}} | ||
==Overview== | ==Overview== | ||
| Line 20: | Line 20: | ||
| doi = 10.1056/NEJMoa1000067 | | doi = 10.1056/NEJMoa1000067 | ||
| pmid = 20818855 | | pmid = 20818855 | ||
}}</ref><ref | }}</ref><ref name="Cancer.ca">Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015</ref> | ||
* The type of Hodgkin's lymphoma (most people have classic Hodgkin's lymphoma) | * The type of Hodgkin's lymphoma (most people have classic Hodgkin's lymphoma) | ||
* The stage at diagnosis | * The stage at diagnosis | ||
| Line 28: | Line 28: | ||
* Symptoms, namely weight loss, night sweats, and fever | * Symptoms, namely weight loss, night sweats, and fever | ||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | {| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | ||
|+ '''Medical therapy for Hodgkin's lymphoma''' | |+ '''Medical therapy for Hodgkin's lymphoma''' | ||
! style="background: #4479BA; color:#FFF;" | Stage | ! style="background: #4479BA; color:#FFF;" | Stage | ||
| Line 35: | Line 35: | ||
! style="background: #4479BA; color:#FFF;" | Stem cell transplant | ! style="background: #4479BA; color:#FFF;" | Stem cell transplant | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" | | colspan="4" style="padding: 5px 5px; background: #DCDCDC;" | '''Stage I & II''' | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Stage I | | style="padding: 5px 5px; background: #F5F5F5;" | Stage I | ||
| Line 49: | Line 49: | ||
| style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | --------- | | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | --------- | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" | | colspan="4" style="padding: 5px 5px; background: #DCDCDC;" | '''Stage III & IV''' | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Stage III | | style="padding: 5px 5px; background: #F5F5F5;" | Stage III | ||
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| style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | --------- | | style="padding: 5px 5px; text-align: center; background: #F5F5F5;" | --------- | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" | | colspan="4" style="padding: 5px 5px; background: #DCDCDC;" | '''Recurrent disease''' | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Recurrence | | style="padding: 5px 5px; background: #F5F5F5;" | Recurrence | ||
| Line 83: | Line 83: | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Stem cell transplant may be offered | | style="padding: 5px 5px; background: #F5F5F5;" | Stem cell transplant may be offered | ||
|} | |} | ||
===Medical therapy during pregnancy<ref name=”cancergov”>National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/publications/pdq</ref>=== | ===Medical therapy during pregnancy<ref name="”cancergov”">National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/publications/pdq</ref>=== | ||
====First trimester of pregnancy==== | ====First trimester of pregnancy==== | ||
* < 32 weeks | * < 32 weeks | ||
| Line 98: | Line 98: | ||
:* Radiation therapy to relieve breathing problems caused by a large tumor in the chest | :* Radiation therapy to relieve breathing problems caused by a large tumor in the chest | ||
===Chemotherapy=== | ===Chemotherapy=== | ||
*Chemotherapy may be used:<ref | *Chemotherapy may be used:<ref name="Cancer.ca">Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015</ref> | ||
:* As the primary treatment, with or without radiation therapy, to destroy cancer cells | :* As the primary treatment, with or without radiation therapy, to destroy cancer cells | ||
:* To treat relapsed Hodgkin's lymphoma (that comes back after treatment) or refractory Hodgkin's lymphoma (that is resistant to the initial treatment) | :* To treat relapsed Hodgkin's lymphoma (that comes back after treatment) or refractory Hodgkin's lymphoma (that is resistant to the initial treatment) | ||
:* To control the symptoms of advanced (palliative chemotherapy) | :* To control the symptoms of advanced (palliative chemotherapy) | ||
===Radiation therapy=== | ===Radiation therapy=== | ||
* Radiation may be used for Hodgkin's lymphoma (HL):<ref | * Radiation may be used for Hodgkin's lymphoma (HL):<ref name="Cancer.ca">Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015</ref><ref>{{Cite journal | ||
| author = [[J. M. Andrieu]], [[C. Bayle-Weisgerber]], [[M. Boiron]], [[J. F. Briere]], [[P. Clot]], [[M. Dana]], [[C. Jacquillat]], [[M. Katz]] & [[F. Teillet]] | | author = [[J. M. Andrieu]], [[C. Bayle-Weisgerber]], [[M. Boiron]], [[J. F. Briere]], [[P. Clot]], [[M. Dana]], [[C. Jacquillat]], [[M. Katz]] & [[F. Teillet]] | ||
| title = The chemotherapy--radiotherapy sequence in the management of Hodgkin's disease. Results of a clinical trial | | title = The chemotherapy--radiotherapy sequence in the management of Hodgkin's disease. Results of a clinical trial | ||
| Line 148: | Line 148: | ||
:* Is used when low-dose radiation is given to the entire body in preparation for a stem cell transplant | :* Is used when low-dose radiation is given to the entire body in preparation for a stem cell transplant | ||
====Stem cell transplantation==== | ====Stem cell transplantation==== | ||
* Stem cell transplantation may be considered for individuals with Hodgkin's lymphoma in the following cases:<ref | * Stem cell transplantation may be considered for individuals with Hodgkin's lymphoma in the following cases:<ref name="Cancer.ca">Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015</ref> | ||
:* When the Hodgkin's lymphoma is not responding to other treatments or standard treatment has failed to work (refractory disease) | :* When the Hodgkin's lymphoma is not responding to other treatments or standard treatment has failed to work (refractory disease) | ||
:* If the Hodgkin's lymphoma comes back after an initial response to treatment (relapsed disease) | :* If the Hodgkin's lymphoma comes back after an initial response to treatment (relapsed disease) | ||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | {| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | ||
|+ '''Complications of Medical Therapy''' | |+ '''Complications of Medical Therapy''' | ||
| style="background: #4479BA;; color:#FFF;" | Complications of Chemotherapy<ref | | style="background: #4479BA;; color:#FFF;" | Complications of Chemotherapy<ref name="Cancer.ca">Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015</ref> | ||
| style="background: #4479BA;; color:#FFF;" | Complications of Radiotherapy<ref | | style="background: #4479BA;; color:#FFF;" | Complications of Radiotherapy<ref name="Cancer.ca">Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015</ref> | ||
|- | |- | ||
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Skin reactions | | style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Skin reactions | ||
Revision as of 19:19, 15 October 2018
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Hodgkin's lymphoma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Hodgkin's lymphoma medical therapy On the Web |
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American Roentgen Ray Society Images of Hodgkin's lymphoma medical therapy |
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Risk calculators and risk factors for Hodgkin's lymphoma medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]Mohsen Basiri M.D.
Overview
The optimal therapy for Hodgkin's lymphoma depends on the stage at diagnosis, age, type, and size of tumor. The predominant therapy for Hodgkin's lymphoma is chemotherapy. Adjunctive radiation therapy and stem cell transplant may be required.
Medical Therapy
The medical therapy for Hodgkin's lymphoma depends on the following: [1][2]
- The type of Hodgkin's lymphoma (most people have classic Hodgkin's lymphoma)
- The stage at diagnosis
- Width of the tumor > 4 inches (10 cm) vs. ≤ 4 inches
- Age
- Concomitant diseases
- Symptoms, namely weight loss, night sweats, and fever
Medical therapy during pregnancy[3]
First trimester of pregnancy
- < 32 weeks
- Watchful waiting when the cancer is above the diaphragm and is slow-growing
- > 32 weeks
- Delivery may be induced, systemic chemotherapy using one or more drugs
- Radiation therapy above the diaphragm (A lead shield is used to protect the fetus from the radiation as much as possible)
Second half of pregnancy
- < 32 weeks
- Watchful waiting, most women can delay treatment until after the baby is born
- > 32 weeks
- Systemic chemotherapy using one or more drugs
- Steroid therapy
- Radiation therapy to relieve breathing problems caused by a large tumor in the chest
Chemotherapy
- Chemotherapy may be used:[2]
- As the primary treatment, with or without radiation therapy, to destroy cancer cells
- To treat relapsed Hodgkin's lymphoma (that comes back after treatment) or refractory Hodgkin's lymphoma (that is resistant to the initial treatment)
- To control the symptoms of advanced (palliative chemotherapy)
Radiation therapy
- As the primary treatment with chemotherapy to reduce the risk of recurrence
- For stage I & II Hodgkin's lymphoma, given after chemotherapy to the areas where the Hodgkin's lymphoma was initially found or before chemotherapy to shrink a large tumor. Radiation therapy may be given alone:
- If the person cannot tolerate chemotherapy because of other health issues
- If the Hodgkin's lymphoma is localized in a small area of lymph nodes
- For nodular lymphocyte predominant Hodgkin's lymphoma when no B symptoms are present
- For stage III Hodgkin's lymphoma, given after chemotherapy if the Hodgkin's lymphoma is localized in an area of the body and can be included in the radiation field
- For relapsed or primary refractory Hodgkin's lymphoma if the original treatment was chemotherapy only and the Hodgkin's lymphoma remains or returns in only a single area
- To shrink bulky tumors before chemotherapy
- Alone, in certain situations
- For early stage favorable Hodgkin's lymphoma when the person cannot tolerate chemotherapy because of other health problems
- When the Hodgkin's lymphoma is a small localized area and the lymph nodes are very small
- For early stage nodular lymphocyte predominant Hodgkin's lymphoma without B symptoms
- To control the symptoms of advanced Hodgkin's lymphoma (palliative radiation therapy)
- The dose and schedule for the radiation therapy are determined by:
- The extent of the disease
- Whether or not the radiation therapy is given with chemotherapy
- Whether the treatment is intended to be curative or palliative
External beam radiation therapy
Hodgkin's lymphoma is often treated with external beam radiation therapy. A machine directs radiation to the tumor and some of the surrounding tissue.
Radiation field
- Each person’s situation is unique, and the radiation fields may be adjusted depending on the extent of the disease. Radiation treatments are given to different areas of the body when treating Hodgkin's lymphoma. The radiation field is the part of the body that receives the radiation. Some of radiation fields to treat Hodgkin's lymphoma are:
- Involved field: only the lymph node areas with Hodgkin's lymphoma (the standard field used in combination with chemotherapy)
- Chemotherapy is given first, followed by involved field radiation to the original site of the disease
- Mantle field: lymph nodes in the neck, chest and axilla
- Upper abdominal field: lymph nodes in the upper abdomen and possibly the spleen
- Pelvic field, or Inverted (upside down) Y field: lymph nodes in the pelvis and groin
- Extended field: the mantle field and uppermost part of the inverted Y field
- This is seldom used anymore because nearly all people with Hodgkin's lymphoma are treated with chemotherapy
- Total nodal irradiation
- Is the term used when radiation is given to all fields
- Is basically a combination of the mantle and inverted Y fields
- May be used for people with widespread, advanced stage disease
- Is used when low-dose radiation is given to the entire body in preparation for a stem cell transplant
Stem cell transplantation
- Stem cell transplantation may be considered for individuals with Hodgkin's lymphoma in the following cases:[2]
- When the Hodgkin's lymphoma is not responding to other treatments or standard treatment has failed to work (refractory disease)
- If the Hodgkin's lymphoma comes back after an initial response to treatment (relapsed disease)
| Complications of Chemotherapy[2] | Complications of Radiotherapy[2] |
| Skin reactions | Skin changes |
| Nausea and vomiting | Nausea and vomiting |
| Sore throat and painful swallowing | Sore mouth |
| Taste changes | Loss of appetite |
| Fatigue | Fatigue |
| Diarrhea | Diarrhea |
| Bone marrow suppression | Bone marrow suppression |
| Dental cavities | Constipation |
| Thyroid problems | Hair loss |
| Fertility problems | Cystitis |
| Heart and lung problems | Muscle and joint pain |
| Second cancers | Second cancers |
| Pain at the injection site | |
| Inflammation of the vein | |
| Allergic reactions | |
| Organ damage | |
| Fluid retention |
References
- ↑ Andreas Engert, Annette Plutschow, Hans Theodor Eich, Andreas Lohri, Bernd Dorken, Peter Borchmann, Bernhard Berger, Richard Greil, Kay C. Willborn, Martin Wilhelm, Jurgen Debus, Michael J. Eble, Martin Sokler, Antony Ho, Andreas Rank, Arnold Ganser, Lorenz Trumper, Carsten Bokemeyer, Hartmut Kirchner, Jorg Schubert, Zdenek Kral, Michael Fuchs, Hans-Konrad Muller-Hermelink, Rolf-Peter Muller & Volker Diehl (2010). "Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma". The New England journal of medicine. 363 (7): 640–652. doi:10.1056/NEJMoa1000067. PMID 20818855. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015
- ↑ National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/publications/pdq
- ↑ J. M. Andrieu, C. Bayle-Weisgerber, M. Boiron, J. F. Briere, P. Clot, M. Dana, C. Jacquillat, M. Katz & F. Teillet (1979). "The chemotherapy--radiotherapy sequence in the management of Hodgkin's disease. Results of a clinical trial". European journal of cancer. 15 (2): 153–161. PMID 374084. Unknown parameter
|month=ignored (help)