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Evolving approaches to the TAILORING of therapy  for early stage Hodgkin Disease

The Summer Meeting of the Israeli Society of Hematology and Blood Transfusion – Lunch Debate. Evolving approaches to the TAILORING of therapy  for early stage Hodgkin Disease. SHOULD WE USE   Abraham Avigdor Combined modality therapy – modest CT and “mini” involved field RT   or

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Evolving approaches to the TAILORING of therapy  for early stage Hodgkin Disease

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  1. The Summer Meeting of the Israeli Society of Hematology and Blood Transfusion – Lunch Debate Evolving approaches to the TAILORING of therapy  for early stage Hodgkin Disease

  2. SHOULD WE USE   Abraham Avigdor Combined modality therapy – modest CT and “mini” involved field RT   or EldadDann Chemotherapy alone dropping IFRT completely

  3. IMAGING - PET /CT SCANS Affect planning of primary therapy and decision making and alterations in policy ?   Today because of the importance of a positive or negative PET during  therapy - both speakers will OBVIOUSLY relate to how this affects risk adjusted therapy planning and alterations of policy during therapy.

  4. CRITERIA for DEFINING RISK How to define , EARLY stage disease and Low or higher risk ( USA/ Canada) or Favorable and Unfavorable (European) categories is important. Accurate definition is essential in order to plan risk -adapted / tailored therapy. The different  groups have not always agreed on this and speakers will have to relate to this carefully and clearly.

  5. IMPORTANT for DEFINITION Age </> 50 years Number of nodal sites </> 3-4 A/B symptoms ESR </> 30 or 50 mm Bulk or no bulk (</> 10 cm) MT ratio </>0.35 Single node and LP histopathology Extranodal site Infradiaphragmatic disease

  6. At first glance this looks a simple issue and easy to debate, however the issue of OPTIMAL therapy for early stage HD remains a topic of intense debate.

  7. Close to 30 trials have been undertaken by the NCCA (Canada) and USA groups, and in Europe by EORTC and GELA groups and the German Hodgkin Lymphoma Study Group, while the National Comprehensive Cancer Network (NCCN) has expressed its view openly.

  8. "Dear Prof / Dr ....  My treating doctor tells me that I have early stage HD. He has done an excisional lymph node biopsy, bone marrow biopsy and a PET/CT scan on me. I do hope that he has staged me correctly according to today's guidelines and NCI criteria and has told me that I need treatment and that I can choose between two types. What I am asking you is WHAT THERAPY should I get ? By the way, I am only 24 years old, does that matter ? Will I have any late complications in 10-20 years time after I have been cured of HD ?"

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