Devita, Hellman, and Rosenberg's Cancer

LWBK1006-30 LWW-Govindan-Review December 12, 2011 19:35

418 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 30.24. Which of the following regarding testicular lymphoma is false?

A. Most common testicular neoplasia in men older than 60 years

B. The most common histology is follicular lymphoma

C. Orchiectomy is recommended as the initial therapy

D. A and B

Question 30.25. A 25-year-old college student has had a sore throat for 4 weeks associ-

ated with pain on swallowing. A 4-cm mass in the right tonsil is found

showing DLBCL by biopsy. Further staging reveals no other adenopathy

or hepatosplenomegaly. CT scan of the neck, chest, and abdomen reveals

no further abnormality. The patient is classified as Eastern Collaborative

Oncology Group (ECOG) PS 0. A bone marrow biopsy does not reveal

evidence of lymphoma involvement. The CBC and LDH are normal. You

recommend:

A. CHOP every 3 weeks for eight cycles

B. CHOP and rituximab every 3 weeks for eight cycles

C. CHOP for three cycles followed by RT

D. CHOP and rituximab for three cycles followed by RT

Question 30.26. A 42-year-old woman presents with enlarged cervical lymph nodes

16 months after initial therapy with R-CHOP chemoimmunotherapy

for DLBCL, stage IVB. She now has no “B” symptoms and her phys-

ical examination results are unremarkable except for multiple enlarged

left cervical lymph nodes, the largest being 2.5×4 cm. CBC shows a

hemoglobin level of 11 g/dL, WBC of 4300/L with absolute neutrophil

count of 3000/mm^3 , and platelet count of 300,000/L. LDH is normal.

The patient is classified as ECOG PS 0. A biopsy of a left cervical lymph

node reveals DLBCL. PET-CT scan of the chest, abdomen, and pelvis

shows no detectable disease elsewhere. A bone marrow biopsy does not

reveal evidence of lymphoma. What would you recommend?

A. CHOP and rituximab for three cycles followed by RT

B. Radioimmunotherapy (Bexxar or Zevalin)

C. Two cycles of rituximab-ifosfamide, cisplatin, and etoposide (R-ICE)

chemotherapy followed by autologous peripheral blood stem cell

transplantation with BEAM

D. Fludarabine, busulfan, and thymoglobulin reduced-intensity allo-

geneic stem cell transplantation