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Contrasting the Clinical Course of Patients With Mediastinal Large B Cell Lymphoma and Mediastinal Classic Hodgkin's Lymphoma
I. J. Radiation Oncology d Biology d Physics
S542
Volume 69, Number 3, Supplement, 2007
Results: PET-GTV was larger than CT-GTV in 6 cases (18%). PET-PTV was larger than CT-PTV in 2 cases (peripheral T cell lymphoma and NK/T cell lymphoma), but PET-PTV was equal to CT-PTV in the other 4 cases because PET-CTV was not different from that of CT-CTV. PET-GTV and PET-PTV were almost equal to CT-GTV and CT-PTV respectively, in 19 cases (58%), and PET-GTV was not defined due to false-negative or false-positive in 8 cases (24%). Seven of the false-negative or -positive cases were MALT lymphoma. PET-GTV was not significantly smaller than CT-GTV in these cases. Conclusions: FDG-PET was effective in defining GTV and making radiation treatment plans in malignant lymphoma, especially in aggressive type, but efficacy was limited in indolent lymphoma. These results suggest that FDG-PET for RTP is recommended for patients with aggressive lymphoma. Author Disclosure: M. Hasegawa, None; I. Asakawa, None; T. Tamamoto, None; T. Shinkai, None; K. Iwata, None; C. Kajitani, None; F. Uto, None; N. Shirone, None; H. Yoshimura, None; K. Kichikawa, None.
2607
Contrasting the Clinical Course of Patients With Mediastinal Large B Cell Lymphoma and Mediastinal Classic Hodgkin’s Lymphoma
D. P. Singh1, E. Al-Hattab2, A. Muhs1, M. Petzar3, S. Bernstein2, L. S. Constine1 1 Department of Radiation Oncology, University of Rochester Cancer Center, Rochester, NY, 2Division of Hematology/ Oncology, University of Rochester Cancer Center, Rochester, NY, 3Pathology and Lab Medicine, University of Rochester School of Medicine, Rochester, NY
Purpose/Objective(s): Primary mediastinal large B cell lymphoma (MLBCL) and classical Hodgkin’s lymphoma (CHL) with mediastinal dominance have overlapping pathologic features, but are treated with different chemotherapeutic regimens. In fact, MLBCL has a molecular signature [2p(REL)/9p(JAK-2) amplification, rare BCL2 rearrangements or BCL6 translocations] which differs from other large B-cell lymphomas but has similarities with CHL. We were interested in determining whether their clinical courses supported the apparent underlying biologic relationship. Methods/Materials: Eligibility criteria included a diagnosis of MLBCL or CHL based on mediastinal or node biopsy, with the mediastinal site being the dominant area of disease. Forty adult patients with MLBCL and CHL were treated at our institute between 1/1990 and 12/2005. Thirty-five patients were evaluable (incomplete records on 5). Twenty-two patients had CHL (CD 15+ and CD 30+) and 13 had MLBCL (CD 20+ and 79a+). Results: Patients with CHL were younger with a mean/median age of 28.1/23.7 years (range 10.2–58.0), compared with 39.5/37.5 (range 14.2–67.8) for patients with MLBCL (p = .051). Females comprised 73% of the CHL group and 54% of the MLBCL group. CHL patients presented less dramatically with cough and chest pain (64%), compared to shortness of breath (69%) in the MLBCL group. All but one patient with CHL was clinical stage I/II, compared with MLBCL patients (stage I = 4, stage II = 5, stage III = 3 and stage IV = 1). The mean size of the medistinal mass was 8.8 cm (range 2.8–15 cm, n = 14) in CHL group compared with 10.9 cm (range 4–17 cm, n = 11) in the MLBCL group (p = .17). Twenty-one patients with CHL received chemotherapy with ABVD (n = 19) or Stanford V (n = 1), compared to standard CHOP ± Rituximab for the 13 MLBCL patients. Involved field radiation was used in 20/22 patients with CHL and 8/13 patients with MLBCL. Overall survival was 4.6 years (range 0.2–11.0 years) for CHL and 3.9 years (range 0.8–11.1 years) for MLBCL (p = .036) (Figure). Two patients with MLBCL died at 1.7 and 1.9 years. Six patients (5 with CHL and 1 with MLBCL) relapsed, which was uniformly in the mediastinum. All of these patients were salvaged (to date) with second line chemotherapy (n = 1) or transplant (n = 5). Conclusions: Patients with MLBCL and CHL with mediastinal dominance have an excellent prognosis. Despite their shared molecular/pathologic similarities, they may differ slightly in their demographics and clinical presentation. Additional histochemical analyses are in process in order to explore possible associations with various demographic and clinical features.
Author Disclosure: D.P. Singh, None; E. Al-Hattab, None; A. Muhs, None; M. Petzar, None; S. Bernstein, None; L.S. Constine, None.
2608
Intensity Modulated Radiotherapy for Non-Hodgkin’s Lymphoma of Waldeyer’s Ring for Parotid Preservation
N. P. Mendenhall, D. T. Chang, D. A. Louis, R. J. Amdur, C. G. Morris, K. R. Olivier University of Florida/Shands Cancer Center, Gainesville, FL Purpose/Objective(s): To determine if intensity-modulated radiotherapy (IMRT) reduces the dose to the parotid glands for treatment of non-Hodgkin’s lymphoma (NHL) of Waldeyer’s ring.
S542
Volume 69, Number 3, Supplement, 2007
Results: PET-GTV was larger than CT-GTV in 6 cases (18%). PET-PTV was larger than CT-PTV in 2 cases (peripheral T cell lymphoma and NK/T cell lymphoma), but PET-PTV was equal to CT-PTV in the other 4 cases because PET-CTV was not different from that of CT-CTV. PET-GTV and PET-PTV were almost equal to CT-GTV and CT-PTV respectively, in 19 cases (58%), and PET-GTV was not defined due to false-negative or false-positive in 8 cases (24%). Seven of the false-negative or -positive cases were MALT lymphoma. PET-GTV was not significantly smaller than CT-GTV in these cases. Conclusions: FDG-PET was effective in defining GTV and making radiation treatment plans in malignant lymphoma, especially in aggressive type, but efficacy was limited in indolent lymphoma. These results suggest that FDG-PET for RTP is recommended for patients with aggressive lymphoma. Author Disclosure: M. Hasegawa, None; I. Asakawa, None; T. Tamamoto, None; T. Shinkai, None; K. Iwata, None; C. Kajitani, None; F. Uto, None; N. Shirone, None; H. Yoshimura, None; K. Kichikawa, None.
2607
Contrasting the Clinical Course of Patients With Mediastinal Large B Cell Lymphoma and Mediastinal Classic Hodgkin’s Lymphoma
D. P. Singh1, E. Al-Hattab2, A. Muhs1, M. Petzar3, S. Bernstein2, L. S. Constine1 1 Department of Radiation Oncology, University of Rochester Cancer Center, Rochester, NY, 2Division of Hematology/ Oncology, University of Rochester Cancer Center, Rochester, NY, 3Pathology and Lab Medicine, University of Rochester School of Medicine, Rochester, NY
Purpose/Objective(s): Primary mediastinal large B cell lymphoma (MLBCL) and classical Hodgkin’s lymphoma (CHL) with mediastinal dominance have overlapping pathologic features, but are treated with different chemotherapeutic regimens. In fact, MLBCL has a molecular signature [2p(REL)/9p(JAK-2) amplification, rare BCL2 rearrangements or BCL6 translocations] which differs from other large B-cell lymphomas but has similarities with CHL. We were interested in determining whether their clinical courses supported the apparent underlying biologic relationship. Methods/Materials: Eligibility criteria included a diagnosis of MLBCL or CHL based on mediastinal or node biopsy, with the mediastinal site being the dominant area of disease. Forty adult patients with MLBCL and CHL were treated at our institute between 1/1990 and 12/2005. Thirty-five patients were evaluable (incomplete records on 5). Twenty-two patients had CHL (CD 15+ and CD 30+) and 13 had MLBCL (CD 20+ and 79a+). Results: Patients with CHL were younger with a mean/median age of 28.1/23.7 years (range 10.2–58.0), compared with 39.5/37.5 (range 14.2–67.8) for patients with MLBCL (p = .051). Females comprised 73% of the CHL group and 54% of the MLBCL group. CHL patients presented less dramatically with cough and chest pain (64%), compared to shortness of breath (69%) in the MLBCL group. All but one patient with CHL was clinical stage I/II, compared with MLBCL patients (stage I = 4, stage II = 5, stage III = 3 and stage IV = 1). The mean size of the medistinal mass was 8.8 cm (range 2.8–15 cm, n = 14) in CHL group compared with 10.9 cm (range 4–17 cm, n = 11) in the MLBCL group (p = .17). Twenty-one patients with CHL received chemotherapy with ABVD (n = 19) or Stanford V (n = 1), compared to standard CHOP ± Rituximab for the 13 MLBCL patients. Involved field radiation was used in 20/22 patients with CHL and 8/13 patients with MLBCL. Overall survival was 4.6 years (range 0.2–11.0 years) for CHL and 3.9 years (range 0.8–11.1 years) for MLBCL (p = .036) (Figure). Two patients with MLBCL died at 1.7 and 1.9 years. Six patients (5 with CHL and 1 with MLBCL) relapsed, which was uniformly in the mediastinum. All of these patients were salvaged (to date) with second line chemotherapy (n = 1) or transplant (n = 5). Conclusions: Patients with MLBCL and CHL with mediastinal dominance have an excellent prognosis. Despite their shared molecular/pathologic similarities, they may differ slightly in their demographics and clinical presentation. Additional histochemical analyses are in process in order to explore possible associations with various demographic and clinical features.
Author Disclosure: D.P. Singh, None; E. Al-Hattab, None; A. Muhs, None; M. Petzar, None; S. Bernstein, None; L.S. Constine, None.
2608
Intensity Modulated Radiotherapy for Non-Hodgkin’s Lymphoma of Waldeyer’s Ring for Parotid Preservation
N. P. Mendenhall, D. T. Chang, D. A. Louis, R. J. Amdur, C. G. Morris, K. R. Olivier University of Florida/Shands Cancer Center, Gainesville, FL Purpose/Objective(s): To determine if intensity-modulated radiotherapy (IMRT) reduces the dose to the parotid glands for treatment of non-Hodgkin’s lymphoma (NHL) of Waldeyer’s ring.