Devita, Hellman, and Rosenberg's Cancer

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

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

Question 30.43. A 25-year-old man with stage IIA nodular sclerosing HL was treated with

total nodal RT 3 years ago. The patient now presents with a new enlarged

lymph node in the groin. A biopsy of the node confirms a diagnosis of

recurrent HL, nodular sclerosing type. The patient has no “B” symptoms.

A restaging workup includes a CT scan of the chest, abdomen, and pelvis,

and PET scanning. Recurrent disease is found in nodes above and below

the diaphragm. A bone marrow biopsy is negative for HL. The patient

is classified with clinical stage IIIA. Which of the following statements is

TRUE?

A. Because the patient has recurrent disease after initial curative therapy,

he should be treated with high-dose chemotherapy and allogeneic or

autologous stem cell transplant.

B. Patients with early-stage HL who relapse after RT fare worse than

patients who relapse after initial conventional chemotherapy, suggest-

ing that RT affects drug resistance and can compromise chemother-

apy outcome.

C. Treatment with Adriamycin, bleomycin, vinblastine, dacarbazine

(ABVD) chemotherapy results in superior disease-free survival com-

pared with nitrogen mustard, Oncovin, procarbazine, prednisone

(MOPP) regimen in patients with recurrent HL after RT.

D. Advanced relapsing patients with “B” symptoms after prior RT

have a low 10-year survival when treated with conventional salvage

chemotherapy (<10%) and should be considered for autologous stem

cell transplant as initial therapy rather than conventional chemother-

apy.

Question 30.44. The following statements about standard treatment strategy in HL are

true, EXCEPT:

A. Early stages, favorable patients: radiation alone (extended field).

B. Early stages, unfavorable patients: moderate amount of chemother-

apy (typically four cycles) plus radiation.

C. Patients who receive pelvic irradiation for subdiaphragmatic HL have

a high risk of loss of fertility. The risk of loss of fertility in women is

minimal, particularly in women aged less than 25 years at the time

of treatment.

D. Advanced stages: extensive chemotherapy (typically eight cycles) with

or without consolidation RT (usually local).