Hodgkin's lymphoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]
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]
- 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[2]
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:[1]
- 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
- Radiation may be used for Hodgkin's lymphoma (HL):[3]
- 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:[4]
- 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)
| Complication of Chemotherapy[5] | Complication of Radiotherapy[6] |
|---|---|
| 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
- ↑ 1.0 1.1 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
- ↑ Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015
- ↑ Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015
- ↑ Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015
- ↑ Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015