Hodgkin Lymphoma Treatment; What has Changed in the Last 30 Years.

INTRODUCTION: In this study, based on the Hodgkin lymphoma thesis made in 1990, current developments in Hodgkin lymphoma diagnosis, imaging and treatment are examined with case samples. Changes in treatment indication in the last 30 years, shrinkage in radiotherapy treatment areas and radiotherapy dose reductions are evaluated comparatively, taking into account historical processes.
METHODS: The demographic and clinical characteristics of the patients whose treatment was completed in the radiotherapy clinic of Ankara Numune Hospital between 1985-1990 will be summarized and the current imaging methods and treatment approaches at that time are compared with current approaches.
RESULTS: The data of 60 cases treated with the diagnosis of Hodgkin lymphoma in Ankara Numune Hospital between 1985-1990 are analyzed. The median age was 31. Histologic types and stages are distributed evenly between the groups. The initial involvement areas are such that; 34 cases start in the cervical-supraclavicular region (56%), eight in inguinofemoral (13%), seven in axillary (11%), five in mediastinal (8.2), three in the abdominal (5.3%), two in the tonsillar (3%), one in primary cerebral. Diseases that initiated under the diaphragm were 18% of the total. Mixcellular type constituted the most common group. In the 1980s, the standard treatment method for Stage IA and II A Hodgkin lymphoma was Sub Total Lymphoid Irradiation (Mantle, Inverted Y). In this period, the most advanced technique used in Hodgkin lymphoma imaging was Bi-Pedal Lymphangygraphy, while FDG PET-CT is the primary imaging method today. In this study, the number of recurrent patients is to be found 6 out of 58 who received radiotherapy. Four of them were outside the field, and two were within.
DISCUSSION AND CONCLUSION: The excessive number of out of field recurrences, side effects such as growth and development retardation, cardiac problems, and increase in secondary cancers caused (especially in the childhood age group) by wide-field radiotherapy applications; led researchers to seek new treatment modalities. Nowadays, applications of radiotherapy with reduced size and decreased dose combined with better chemotherapy practices. While improvements in both chemotherapy and radiotherapy techniques have increased the 5-year life above 90%, morbid side effects have remained anecdotal in historical articles.

Hodgkin Lenfoma Tedavisi; Son 30 Yýlda Neler Deðiþti

GÝRÝÞ ve AMAÇ: Bu çalýþmada 1990 yýlýnda yapýlmýþ Hodgkin lenfoma tezinden yola çýkýlarak günümüzde HL taný, görüntüleme ve tedavi sindeki güncel geliþim vaka örneklemleri ile incelenecektir. Son 30 yýldaki tedavi endikasyonu deðiþimleri, radyoterapi tedavi alanlarýndaki küçülmeler ve radyoterapi doz düþümleri tarihsel süreçler dikkate alýnarak karþýlaþmalý olarak deðerlendirilecektir.
YÖNTEM ve GEREÇLER: Yazarýn 1985- 1990 yýlarý arasýnda Ankara Numune Hastanesi Radyoterapi Kliniðinde tedavisi tamamlanan hastalarýn demografik ve klinik, özellikleri özetlenecek ve o tarihteki güncel görüntüleme yöntemleri ve tedavi yaklaþýmlarý, günümüzdeki yaklaþýmlarla kýyaslanacaktýr.
BULGULAR: 1985-1990 yýllarý arasýnda Ankara Numune Hastanesinde Hodgkin lenfoma tanýsý ile tedavi edilen 60 vakanýn verileri incelenmiþtir. Ortanca yaþ 31 olarak bulundu. Evre ve histolojik tip gruplar arasýnda eþit olarak daðýlmýþtý. Baþlangýç tutulum alanlar; servikal-supraklavikular bölge 34 vaka (% 56), inguinofemoral 8 vaka (%13), aksiller 7 vaka (%11), mediastinal 5 vaka (%8,2), abdominal 3 vaka (% 5,3), tonsil 2 vaka (%3), primer beyin 1 vaka olarak görüldü. Diafram altý baþlayan vakalar totalin % 18 lik bölümüydü. Mikssellüler tip en çok görülen gurubu oluþturdu. Bin dokuz yüz seksenli yýllarda Evre IA ve II A Hodgkin lenfoma da standart tedavi þekli Sub Total Lenfod Iþýnlama (Mantle, Inverted Y) idi. Bu dönemde Hodgkin lenfoma görüntülemesinde kullanýlan en geliþmiþ yöntem Bi-Pedal Lenfanjigrafi iken günümüzde FDG PET-CT primer görüntüleme yöntemidir. Bu çalýþmada radyoterapi alan 58 hastanýn 6 ýnde yineleme olmuþtur. Yinelemelerin 4 ü alan dýþý, 2 si alan içi olarak raporlanmýþtý
TARTIÞMA ve SONUÇ: Alandýþý nükslerin fazlalýðý ve geniþ alan radyoterapi uygulamalarýnýn özellikle çocukluk yaþ grubunda oluþturduðu büyüme geliþme gerilikleri, kardiak sorunlar, ikincil kanserlerin artýþý gibi yan etkiler araþtýrmacýlarý yeni tedavi þekilleri aramaya yöneltmiþtir. Günümüzde giderek boyut olarak küçülmüþ ve dozu azaltýlmýþ radyoteapi uygulamalarý iyi kemoterapi uygulamalarý ile eþleþtirilmiþtir. Hem kemoterapideki iyileþmeler hem de radyoterapi tekniðindeki geliþmeler 5 yýllýk yaþamý % 90 seviyelerinin üzerine çýkarýrken morbid yan etkiler tarihsel makalelerde anekdot olarak kalmýþtýr.