Radiation Oncology/Hodgkin/Review

Review of Hodgkin's Lymphoma

Epidemiology edit

  • US incidence: ~8000
  • US deaths: ~1300
  • Age: bimodal, peak in 20's and 50's
  • Risk factors: likely genetic predisposition (increased incidence in Jews, siblings, HLA antigens)
  • Two separate entities
    • Classical Hodgkin's Lymphoma (CHL) - Reed-Sternberg cells
    • Lymphocyte-predominant Hodgkin's Lymphoma (LPHL) - "popcorn" lymphocyte cells

Clinical Presentation & Workup edit

  • Clinical presentation: lymph node mass(es)
  • Diagnosis
    • Excisional lymph node biopsy
    • Core needle biopsy may be adequate
    • FNA is insufficient
  • Pathology
    • CHL: Reed-Sternberg cells sufficient, CD15+ and CD30+
    • LPHL: CD20+ and CD45+, epithelial membrane antigen
  • Workup
    • Determination of B symptoms: fever >38C, drenching sweats, weight loss >10% weight
    • Exam: lymphoid regions, liver, spleen
    • Labs: CBC, differential, ESR, LDH, albumin, LFT, Bun/Cr
    • Bone marrow biopsy: Stage IB/IIB, III-IV
    • Imaging: CT neck/chest/abdomen/pelvis or PET/CT
      • PET: higher sensitivity for nodal regions (92% vs 83%) and organ involvement (86% vs 37%), though more false positives
  • Staging (Ann Arbor system; EORTC unfavorable criteria):
    • Early stage favorable (I-II, no unfavorable features)
    • Early stage unfavorable bulky (I-II, bulky mediastinum ratio >0.33 or size >= 10cm)
    • Early stage unfavorable non-bulky (I-II, B symptoms, or >3 sites of disease, or ESR >50)
    • Advanced (III-IV)
    • Advanced unfavorable (age >=45, male, stage IV, albumin <4, WBC >15k, WBC <600
  • Response criteria
    • Need for additional treatment based on response
    • 2007 IWG Guidelines using IHC, flow cytometry, PET: CR, PR, SD, relapsed, PD