|Year : 2016 | Volume
| Issue : 6 | Page : 69-70
|Date of Web Publication||30-Nov-2016|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Lymphoma. J Can Res Ther 2016;12, Suppl S2:69-70
Dosimetric comparison of intensity modulated radiation therapy vs Rapid arc vs 3D conformal radiation therapy in Hodgkin's and non-Hodgkin's lymphoma undergoing mediastinal irradiation
Pareek Vibhay , Bhalavat Rajendra, Chandra Manish
Department of Radiotherapy, Jupiter Hospital, Thane, Maharashtra, India, E-mail: [email protected]
Introduction: The irradiation techniques in Hodgkin's and Non-Hodgkin's Lymphoma have seen evolution from conventional to conformal radiation techniques and to the recent involved nodes Radiation therapy. With advent in advancements in IMRT techniques and recent modification in the form of Rapid arc (VMAT), the role needs to be evaluated in the dosimetric advantages as compared to the standard 3D Conformal Radiation Therapy used. This study evaluates the role of different radiation techniques in the dose conformality to PTV and dose assessment to organs at risk. Materials and Methods: 20 patients were selected for the medical records of Jupiter Hospital, Thane who were diagnosed with Hodgkin's Lymphoma (n = 9) and Non-Hodgkin's Lymphoma (n = 11). Three different plans with 3DCRT, VMAT and IMRT were constructed with specific dose constraints to organs at risk (OARs) including Breasts, thyroid Gland, bilateral lungs and heart, and compared using Dose volume Histograms, Conformity and Heterogeneity index (C.I; H.I) and Monitoring Units (MU) and statistical analysis done for the same. Results: The PTV coverage was obtained in all three plans (V 95% >95%). The C.I index was found to be better for both IMRT and VMAT compared to 3DCRT (P < 0.005). The breasts and lungs showed volumes receiving higher doses were reduced with IMRT and VMAT compared to 3DCRT however large volumes receiving low doses was high with IMRT and VMAT. Thyroid and Heart showed significant decrease in the higher dose received with IMRT and VMAT compared to 3DCRT. The low doses received showed no significance in the three different techniques. The heart and thyroids were found to be better spared with IMRT and VMAT. On one on one scoring IMRT was found to score better compared to VMAT. Conclusions: IMRT showed better target coverage and OAR sparing at higher doses with expected large volumes receiving low doses. Thyroid and Heart were better spared with IMRT and VMAT. On overall scoring IMRT was found to provide better coverage and OAR sparing compared to VMAT and 3DCRT. So, IMRT can be considered to be useful in cases where acute toxicities associated with irradiation need to be considered.
A rare case of Hodgkin's lymphoma of tonsil and role of radiotherapy
Aparna Suryadevara, V. Chandi Priya , Deleep K. Gudipudi, Nagarjun Reddy
Department of Radiation Oncology, Basavatarakam Indo American Hospital and Research Institute, Hyderabad, Telangana, India, E-mail: [email protected]
Introduction: Lymphoma of tonsil is a very rare disease with very few cases reported in literature. Non-Hodgkin's lymphoma of tonsil is more commonly reported in literature than Hodgkin's lymphoma. We present a case report of Hodgkins Lymphona of tonsil and role of radiotherapy. Materials and Methods: A 28 yo female patient (Pt) presented to our institute with history of throat pain, repeated attacks of tonsillitis and left ear pain for 1 year 10 months. She also had left neck swelling for 4 months. No past history of any medical problems. On examination patient had mass and enlargement of left tonsil with left cervical lymph nodes. Pt had FNAC of neck node followed by left tonsillectomy with final histopathology (HPE) and immunohistochemistry (IHC) positive for Hodgkin's lymphoma (HD). Whole body 18FDG-PET-CT scan showed metabolic lesions in left tonsil with left level II, III, IV lymphnodes, (Stage IIE). She received 4 cycles of ABVD chemotherapy. PET-CT scan showed complete response after 4 cycles of chemotherapy. Patient was given consolidation EBRT (IFRT) by IMRT technique. She received a dose of 30 Gy in 15 fractions. She tolerated the treatment well and is on followup. Conclusions: Hodgkin's lymphoma of tonsil is a rare disease and respond well to chemotherapy similar to other subsites of Hodgkin's lymphoma. Patient with complete response (CR) after chemotherapy need to be consolidated with EBRT, a dose of 30 Gy with conventional fractionation. Conformal RT is preferred techniques for better sparing the OARs, as most of the patients are young and have CR with chemo-RT with good overall survival.
A rare case of primary non-Hodgkins lymphoma of testis
Anil Khurana , Anbu, Nupur Bansal, Paramjeet Kaur, Ashok K. Chauhan
Department of Radiotherapy, Pt BD Sharma, PGIMS, Rohtak, Haryana, India, E-mail: [email protected]
Introduction: Testicular non-Hodgkin's lymphoma (NHL) is a rare extranodal presentation accounting for 1% of all NHL, 2% of extranodallymphoma, and 5% of tumors of testis. Aim: A case of NHL testis in a 62 years old male, treated with left radical inguinal orchidectomy and adjuvant combination chemotherapy. Materials and Methods: A 62 years old male patient present with chief complaints of swelling in his left scrotal region for the past 4 months with associated local pain on and off. A CECT scan of abdomen showed bulky left testis and epididymis with multiple well defined hypodense areas of varying size. Largest one measuring 2.1 × 1.4 cm. Also there is evidence of well-defined hypodense area seen involving right testis measuring 1.5 × 1.3 cm with mild fluid in right scrotal sac. Patient underwent left radical inguinal orchidectomy. Histopathological examination of orchidectomy specimen showed NHL of diffuse large B cell type. Immunohistochemical analysis showed diffuse positivity of LCA and CD 20, focal positivity of CD 5. CK, Vimetin, AFP, CD 30, PLAP were negative. Results: The whole body PET Scan did not show any abnormality. The patient was diagnosed as a case of Primary NHL of left testis - Diffuse large B cell type. The patient was planned for chemotherapy with CHOP regimen. The patient received 6 courses of chemotherapy with Inj. Cyclophosphamide 1 gram iv, Inj. Doxorubicin 70 mg iv, Inj. Vincristine 2 mg iv and Tab. Prednisolone 100 mg od day 1 - day 5 in 3 weekly interval. Patient is on regular follow-up now without any evidence of disease. Conclusion: To conclude, taking into account the rarity of this disease, standardizing the therapeutic and preventive strategies through randomized trials is difficult; treatment will continue to evolve with improved understanding of the molecular and genetic characteristics of testicular lymphoma, identification of patients at higher risk of relapse and with incorporation of newer drugs into current regimes of chemotherapy.
Primary bone lymphoma: An experience of a Regional Cancer Centre from India
Rohit Mahajan , Budhi S. Yadav, Suresh C. Sharma, Sushmita Ghoshal, Rakesh Kapoor, Narendra Kumar
Department of Radiotherapy, Maharishi Markandeshwar Institute Of Medical Sciences And Research, Ambala, India, E-mail: [email protected]
Background: Primary bone lymphoma (PBL) is a rare disease, representing less than 5% of all extranodal non-Hodgkin lymphomas (NHL). The optimal treatment strategy is still unclear. Here we report our institutional outcome analysis of patients diagnosed with PBL. Materials and Methods: From 2007 to 2014, the medical records of 22 patients with PBL reviewed. Analysis was done for symptoms, patient, disease and treatment related characteristics. All patients were treated with chemotherapy with or without radiotherapy. Treatment response and impact of different prognostic factors onclinical outcome was analyzed. Results: Median age of presentation was 44 years (range 18-70 years). Total 19 (86.4%) patients were ≤60 years of age and 3 (13.6%) were >60 years. Out of all, 18 were males and 4 were females. Ann Arbor clinical stage at diagnosis was stage I in 13 (59.1%), stage II in 3 (13.6%), stage III in 2 (9.1%), and stage IV in 4 (18.2%) patients respectively. Spine was most common site of involvement seen in 12 (54.5%) patients. Diffuse large B cell lymphoma histology was seen in 8 (36.4%) patients and 8 (36.4%) had NHL-high grade. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) was given to 20 (90.9%) patients while 2 (9.1%) patients received R-CHOP. Radiotherapy (30-40 Gy) was delivered in 19 (86.4%) patients. The median follow-up period was 40 months (range: 8-105 months). The overall response rate was 86.3% with complete response (CR) in 15 (68.1%) and partial response (PR) in 4 (18.2%) patients respectively. Relapses was seen in 3 (13.5%) patients, 2 nodal and 1 in the bone. Disease free survival (DFS) and overall survival (OS) at 5-year was 56.6% and 72.7% respectively. CR after initial treatment was associated with a significant better OS, 80% vs 25% respectively (P < 0.0001). Age, sex, stage, International prognostic index (IPI), histologic subtype and number of sites had no significant influence on OS. Combining radiation therapy with chemotherapy (with or without rituximab) also did not improve the OS or DFS of patients. Conclusion: In spite of small number of patients reported in this study, conventional chemotherapy remains an effective treatment option for patients with PBL. OS was found to be affected by the initial response to treatment.
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