Refining the Role of Radiation Therapy in Pediatric Hodgkin Lymphoma

2012 ◽  
pp. 616-620
Author(s):  
Melissa M. Hudson ◽  
Louis S. Constine
Keyword(s):  
Radiation Therapy ◽  
Hodgkin Lymphoma ◽  
Young Patients ◽  
Treatment Strategies ◽  
Radiation Toxicity ◽  
Term Survival ◽  
Gonadal Dysfunction ◽  
Pediatric Hodgkin Lymphoma ◽  
Age Related

Overview: The role of radiation therapy in the treatment of pediatric Hodgkin lymphoma has continued to be refined, motivated by the desire to avoid disruption to normal tissue development and function and secondary carcinogenesis. Such progress has occurred in tandem with modifications of the multiagent chemotherapy regimens that have been used in place of or in combination with low-dose involved-field radiation that are also associated with dose-related risks of cardiopulmonary and gonadal dysfunction and leukemogenesis. Consequently, treatment strategies for young patients, who have an excellent prognosis of long-term survival, utilizes a risk-adapted approach that provides optimal efficacy for disease control whereas limiting toxicity associated with both radiation and chemotherapy. Because of the differences in age-related developmental status and gender-related sensitivity to chemotherapy and radiation toxicity, no single treatment approach is ideal for all pediatric patients. This manuscript summarizes results from published clinical trials with the goal of defining optimal treatment strategies for children and adolescents with Hodgkin lymphoma in regards to the use of radiation therapy.

scholarly journals Pediatric Hodgkin lymphoma: trade-offs between short- and long-term mortality risks

Blood ◽  
2012 ◽  
Vol 120 (11) ◽  
pp. 2195-2202 ◽  
Author(s):  
Jennifer M. Yeh ◽  
Lisa Diller
Keyword(s):  
Life Expectancy ◽  
Hodgkin Lymphoma ◽  
Late Effects ◽  
Survival Rates ◽  
Treatment Strategies ◽  
Careful Consideration ◽  
Term Survival ◽  
Pediatric Hodgkin Lymphoma ◽  
Trade Offs

Abstract As pediatric Hodgkin lymphoma (HL) survival rates approach > 95%, treatment decisions are increasingly based on minimizing late effects. Using a model-based approach, we explored whether the addition of radiotherapy contributes to improved overall long-term survival. We developed a state-transition model to simulate the lifetime HL clinical course, and we compared 2 treatment strategies: chemotherapy alone (CT) and chemoradiotherapy (CRT). Data on HL relapse, late recurrence, and excess second cancer and cardiac late-effects mortality were estimated from the published literature and databases. Outcomes included conditional life expectancy, cause-specific mortality, and proportion alive at age 50. For a hypothetical cohort of HL patients (diagnosis age 15), conditional life expectancy was 57.2 years with CT compared with 56.4 years with CRT. Estimated lifetime HL mortality risk was 3.6% with CT versus 2.2% with CRT. In contrast, combined risk of excess late-effects mortality was lower for CT (1.8% vs 7.4% with CRT). Among those alive at age 50, only 9.2% of those initially treated with CT were at risk for radiation-related late effects (100% for CRT). Initial treatment with CT may be associated with longer average per-person life expectancy. These results support the need for careful consideration of the risk-benefit profile of radiation as frontline therapy in pediatric patients.

Radiation pneumonitis in pediatric Hodgkin lymphoma patients receiving radiation therapy to the chest

2018 ◽  
Vol 8 (5) ◽  
pp. e364-e368 ◽  
Author(s):  
Gary D. Lewis ◽  
Jennifer E. Agrusa ◽  
Bin S. Teh ◽  
Maria M. Gramatges ◽  
Viral Kothari ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Hodgkin Lymphoma ◽  
Radiation Pneumonitis ◽  
Pediatric Hodgkin Lymphoma

scholarly journals Point/counterpoint: early-stage Hodgkin lymphoma and the role of radiation therapy

Hematology ◽  
2012 ◽  
Vol 2012 (1) ◽  
pp. 313-321 ◽  
Author(s):  
Ralph M. Meyer ◽  
Richard T. Hoppe
Keyword(s):  
Clinical Trials ◽  
Radiation Therapy ◽  
Hodgkin Lymphoma ◽  
Early Stage ◽  
Trial Protocol ◽  
Radiation Oncologist ◽  
Limited Stage ◽  
Considerable Debate

Abstract The results of recent clinical trials for the management of limited-stage Hodgkin lymphoma have led to considerable debate, especially regarding the role of radiation therapy. This review highlights those recent trials and provides perspectives regarding their interpretation from a radiation oncologist and a hematologist. The trial protocol is available at http://www.nejm.org/doi/suppl/10.1056/NEJMoa1111961/suppl_file/nejmoa1111961_protocol.pdf.

Pediatric Hodgkin Lymphoma, the Rationale for Radiation Therapy

2010 ◽  
pp. 67-79
Author(s):  
David C. Hodgson ◽  
Melissa M. Hudson ◽  
Louis S. Constine
Keyword(s):  
Radiation Therapy ◽  
Hodgkin Lymphoma ◽  
Pediatric Hodgkin Lymphoma

Kaposi's Sarcoma in Young Patients Treated with Orthovoltage Irradiation and Having a Minimum Follow-Up of Forty-Six Years

2009 ◽  
Vol 95 (3) ◽  
pp. 325-328 ◽  
Author(s):  
Stefano Pergolizzi ◽  
Anna Santacaterina ◽  
Michele Gaeta ◽  
Alfredo Blandino
Keyword(s):  
Renal Failure ◽  
Radiation Therapy ◽  
Chronic Renal Failure ◽  
Clinical Outcome ◽  
Kaposi's Sarcoma ◽  
Young Patients ◽  
Kaposi’S Sarcoma ◽  
Orthovoltage Radiotherapy

Purpose To describe the clinical outcome and to evaluate the role of orthovoltage radiotherapy in the treatment of young (less than 30 years old) Mediterranean men with Kaposi's sarcoma. Patients and methods We reviewed the records of 198 consecutive patients with Kaposi's sarcoma treated with orthovoltage radiation therapy at our department between January 1920 and December 1987. Result We found three young shepherds, aged less than 30 years, with an available follow-up ranging from 45 to 67 years. One patient died at the age of 84 years of chronic renal failure while suffering from cutaneous Kaposi's sarcoma; two patients are still alive with recurrent Kaposi's sarcoma. Conclusions We presume that an indolent form of Kaposi's sarcoma may occur in young men. This very indolent form can be controlled for the duration of the patient's life by judiciously applied radiation therapy.

scholarly journals Extracellular Vesicles: A Possible Link between HIV and Alzheimer’s Disease-Like Pathology in HIV Subjects?

Cells ◽  
2019 ◽  
Vol 8 (9) ◽  
pp. 968 ◽  
Author(s):  
Sunitha Kodidela ◽  
Kelli Gerth ◽  
Sanjana Haque ◽  
Yuqing Gong ◽  
Saifudeen Ismael ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Extracellular Vesicles ◽  
Treatment Strategies ◽  
Progressive Dementia ◽  
Hiv Patients ◽  
Age Related ◽  
Infected Cells ◽  
New Treatment

The longevity of people with HIV/AIDS has been prolonged with the use of antiretroviral therapy (ART). The age-related complications, especially cognitive deficits, rise as HIV patients live longer. Deposition of beta-amyloid (Aβ), a hallmark of Alzheimer’s disease (AD), has been observed in subjects with HIV-associated neurocognitive disorders (HAND). Various mechanisms such as neuroinflammation induced by HIV proteins (e.g., Tat, gp120, Nef), excitotoxicity, oxidative stress, and the use of ART contribute to the deposition of Aβ, leading to dementia. However, progressive dementia in older subjects with HIV might be due to HAND, AD, or both. Recently, extracellular vesicles (EVs)/exosomes, have gained recognition for their importance in understanding the pathology of both HAND and AD. EVs can serve as a possible link between HIV and AD, due to their ability to package and transport the toxic proteins implicated in both AD and HIV (Aβ/tau and gp120/tat, respectively). Given that Aß is also elevated in neuron-derived exosomes isolated from the plasma of HIV patients, it is reasonable to suggest that neuron-to-neuron exosomal transport of Aβ and tau also contributes to AD-like pathology in HIV-infected subjects. Therefore, exploring exosomal contents is likely to help distinguish HAND from AD. However, future prospective clinical studies need to be conducted to compare the exosomal contents in the plasma of HIV subjects with and without HAND as well as those with and without AD. This would help to find new markers and develop new treatment strategies to treat AD in HIV-positive subjects. This review presents comprehensive literatures on the mechanisms contributing to Aβ deposition in HIV-infected cells, the role of EVs in the propagation of Aβ in AD, the possible role of EVs in HIV-induced AD-like pathology, and finally, possible therapeutic targets or molecules to treat HIV subjects with AD.

Radiation Therapy Overcomes Adverse Prognostic Role of Cyclooxygenase-2 Expression on Reed-Sternberg Cells in Early Hodgkin Lymphoma

2015 ◽  
Vol 92 (1) ◽  
pp. 84-90 ◽  
Author(s):  
Francisco Mestre ◽  
Antonio Gutiérrez ◽  
Jose Rodriguez ◽  
Rafael Ramos ◽  
Juan Fernando Garcia ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Hodgkin Lymphoma ◽  
Cyclooxygenase 2 ◽  
Prognostic Role
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