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 year old female, Miss S.S  Reviewed Lymphoma MDT at GSH  May 2018: Classic Hodgkin lymphoma

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

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

WORK UP Cervical LN biopsy 05/2018  Classic HL, nodular sclerosis  CD30 +, CD15 +, CD 20 -, EBER -

CHEST X-RAY MMR < 0.35

STAGING PET -CT Homogenous increased BM uptake

BONE MARROW BIOPSY  Adequate quality  Non-specific reactive changes  No morphological evidence of involvement with HL and no granulomas seen

RISK STRATIFICATION  Ann Arbor stage IIB, no bulk  Intermediate stage  EORTC/ LYSA: elevated ESR, ≥4 nodal areas  GHSG: elevated ESR, ≥ 3 nodal areas

MANAGEMENT  ERNA LVEF 65%  Reproductive counselling  ABVD x 2

INTERIM PET -CT Right paratracheal LN (25 mm, previously 34mm) Deauville 3 MDT: complete metabolic response Staging PET -CT Interim PET -CT

MANAGEMENT  ABVD x 2 (total 4 cycles)  ISRT 30.60Gy

ISRT VMAT Total dose 30.60 Gy in 17 fractions, 1.8Gy/fraction

FOLLOW UP  6 weeks post RT (March 2019)  End of treatment PET -CT  3 monthly 1 st two years, then 6 monthly for 3 years, then annually  Follow up for 10 years

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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