What are the immediate side effects of radiotherapy for Hodgkin's When reading literature about RT note that toxicity only happens in tissue that had direct exposure to radiation (e.g. if the radiated lymph node was in the groin there won't be toxicity of heart). In this regard you have different ways of defining the field to be irradiated (see below on fields). The more limited the field is INRT < ISRT < IFRT the less normal tissue that gets exposed to radiation and the less side effects. HD16 - a huge study (1150 patients) which compared ABVD x2 +/- RT (dose=20Gy) for early-favorable Hodgkin's (patient with 1 or 2 sites of small disease with minimal symptoms) who attained a complete response to chemotherapy. The study showed 93% cure rate when RT was added compared to 86% cure rate without it. Note however that many of the relapsed cases were early and could be simply treated with RT. The rate of severe toxicity (defined as grade 3-4; broadly meaning toxicity that requires hospitalization (3) or is life threatening (4)) in patients who received RT was 3% (~20 patients out of 660). Mostly difficulty swallowing (dysphagia) in 1% or ulcers/inflammation of the mouth (mucositis) in 1%. Unfortunately, they did not publish the full list of all side effects at all grades. https://pubmed.ncbi.nlm.nih.gov/31498753/ HD17 - a study which compared escBEACOPP x2 + ABVD x2 +/- RT (dose=30Gy) for early-unfavorable Hodgkin's (patient with localized disease that can be included in a limited radiation field, but with a higher burden as compared to early-favorable). Outcomes of the study were spectacular - cure rate of 95+% but note that this regimen is very different than the ABVD x3 or ABVD x4. The most common acute (immediate) radiotherapy-associated side effects were difficulty swallowing (dysphagia) seen in 6% of patients (but there was dysphagia also in 2% of those without RT) and ulcers/inflammation of the mouth (mucositis) seen in 2%. https://pubmed.ncbi.nlm.nih.gov/33539742/ Erel Joffe MD Lymphoma Service Memorial Sloan Kettering Cancer Center Comments are for educational purposes only and should not be regarded medical advice #Hodgkin #hodgkinslymphoma #radiotherapy #frontline_chemo Radiation fields* Extended-field radiation (EFRT): Radiation that includes not only the clinically involved nodes but also the adjacent, clinically uninvolved nodes; this is called mantle-field or inverted-Y field; EFRT is not used in modern treatment of Hodgkin lymphoma Involved-field radiation (IFRT): Radiation field that encompasses all of the clinically involved regions (eg, the mediastinum and the low-supraclavicular fields) Involved-site radiation (ISRT): Radiation field that includes pre- and post-chemotherapy nodal volumes plus a 1.5-cm margin of healthy tissue Involved-node radiation (INRT): Radiation field that includes pre- and post-chemotherapy nodal volumes plus a 1-cm margin of healthy tissue; there are increasing data to support this, but it is still considered experimental * From: Yahalom J., Hoppe B.S., Yang J.C., Hoppe R.T. (2020) Principles of Radiation Therapy for Hodgkin Lymphoma. In: Engert A., Younes A. (eds) Hodgkin Lymphoma. Hematologic Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-030-32482-7_9 A good online slide presentation which shows you what RT is all about can be found at https://lymphoma-action.org.uk/sites/default/files/media/documents/2018-09/6.Radiotherapy.pdf

Hvad er de umiddelbare bivirkninger af strålebehandling til Hodgkins Når du læser litteratur om RT, skal du være opmærksom på, at toksicitet kun sker i væv, der var direkte udsat for stråling (hvis den udstrålede lymfeknude var i lysken, vil der ikke være toksicitet i hjertet). I denne forbindelse har du forskellige måder at definere det felt, der skal bestråles (se nedenfor om felter). Jo mere begrænset feltet er INRT < ISRT < IFRT, jo mindre normalt væv bliver udsat for stråling og jo færre bivirkninger. HD16 - en enorm undersøgelse (1150 patienter), som sammenlignede ABVD x2 +/- RT (dosis=20Gy) for tidligt gunstige Hodgkins (patient med 1 eller 2 steder med lille sygdom med minimale symptomer), som opnåede et fuldstændigt respons på kemoterapi. Undersøgelsen viste 93% helbredelsesrate, når RT blev tilføjet sammenlignet med 86% helbredelsesrate uden det. Bemærk dog, at mange af de tilbagefaldende tilfælde var tidlige og kunne simpelthen behandles med RT. Hyppigheden af ​​alvorlig toksicitet (defineret som grad 3-4; betyder bredt toksicitet, der kræver hospitalsindlæggelse (3) eller er livstruende (4)) hos patienter, der fik RT, var 3 % (~20 patienter ud af 660). Mest synkebesvær (dysfagi) hos 1 % eller sår/betændelse i munden (mucositis) hos 1 %. Desværre offentliggjorde de ikke den fulde liste over alle bivirkninger ved alle grader.https://pubmed.ncbi.nlm.nih.gov/31498753/ HD17 - en undersøgelse, der sammenlignede escBEACOPP x2 + ABVD x2 +/- RT (dosis=30Gy) for tidlig-ugunstig Hodgkins (patient med lokaliseret sygdom, der kan inkluderes i et begrænset strålingsfelt, men med en højere belastning sammenlignet med tidlig- gunstig). Resultaterne af undersøgelsen var spektakulære - helbredelsesrate på 95+%, men bemærk, at denne kur er meget anderledes end ABVD x3 eller ABVD x4. De mest almindelige akutte (umiddelbare) strålebehandlingsrelaterede bivirkninger var synkebesvær (dysfagi) set hos 6% af patienterne (men der var dysfagi også hos 2% af dem uden RT) og sår/betændelse i munden (mucositis) set i 2 %.https://pubmed.ncbi.nlm.nih.gov/33539742/ Erel Joffe MD Lymfomservice Memorial Sloan Kettering Cancer Center Kommentarer er kun til undervisningsformål og bør ikke betragtes som medicinsk rådgivning #Hodgkin #hodgkinslymfom #strålebehandling #frontline_kemo Strålingsfelter* Extended-field-stråling (EFRT): Stråling, der ikke kun omfatter de klinisk involverede knuder, men også de tilstødende, klinisk uinvolverede knudepunkter; dette kaldes kappefelt eller omvendt Y-felt; EFRT anvendes ikke i moderne behandling af Hodgkin lymfom Involved-field-stråling (IFRT): Strålingsfelt, der omfatter alle de klinisk involverede regioner (f.eks. mediastinum og de lav-supraclavikulære felter) Involvered-site radiation (ISRT): Strålingsfelt, der inkluderer præ- og post-kemoterapi nodalvolumener plus en 1,5 cm margin af sundt væv Involvered-node radiation (INRT): Strålingsfelt, der omfatter præ- og post-kemoterapi nodalvolumener plus en 1 cm margin af sundt væv; der er stigende data til at understøtte dette, men det betragtes stadig som eksperimentelt * Fra: Yahalom J., Hoppe B.S., Yang J.C., Hoppe R.T. (2020) Principper for strålebehandling for Hodgkin-lymfom. I: Engert A., Younes A. (red) Hodgkin Lymphoma. Hæmatologiske maligniteter. Springer, Cham.https://doi.org/10.1007/978-3-030-32482-7_9 En god online diaspræsentation, som viser dig, hvad RT handler om, kan findes på https://lymphoma-action.org.uk/sites/default/files/media/documents/2018-09/6.Radiotherapy.pdf