April 28, 2012 長庚醫院 放射腫瘤科 林信吟醫師

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?