Positioning and immobilization of patients undergoing radiation therapy for Hodgkin's disease

The prognosis for patients with Hodgkin's disease is largely determined by the initial management, therefore, special attention must be given to the precision of the often complex treatment in these relatively young and curable patients. Positioning and immobilization is extremely important and may have a role in the final outcome of the treatment. Alpha Cradles, along with laser alignment systems, have been routinely used for these patients in our institution for approximately 10 years. Despite these efforts, difficulties are encountered in precisely reproducing the setup. A modification was therefore made to an Alpha Cradle to include an arm support with handles that fix the position of the patient's elevated arms during the treatment. This modification provides improved repositioning and alignment of the patients, which may have an impact on the final outcome of the treatment. The positioning device also offers improved patient comfort, and, as a result, reduced patient motion as evidence by the reduced number of adjustments required when port films are examined. Additionally, the described technique reduces the risks of over- or underdosage at the junction between the mantle and the para-aortic fields.     

Haematologic evaluation after radiation therapy in Hodgkin's disease.

Haematologic evaluation of 30 patients 2 to 7 years after radiation therapy for Hodgkin's disease was made. A complete general recovery of haematopoiesis occurred as concluded from the normal or even supranormal blood cell values. However, in only 5 of 28 patients was a complete local regeneration of haematopoiesis observed in the sternal marrow biopsies after 38 to 48 Gy. In the other cases, haematopoiesis was numerically or morphologically abnormal or totally absent.     

Radiographic features of recurrent intrathoracic Hodgkin's disease following radiation therapy.

Of 254 consecutive, surgically staged, IA-IIIB Hodgkin's disease patients treated at the Joint Center for Radiation Therapy between April 1969 and July 1976, 21 developed intrathoracic relapses. This study evaluated the radiographic features of relapse in these 21 patients. The superior mediastinum (nine patients) and the lung parenchyma (10) were the most frequent sites of involvement. In contrast to patients who initially had Hodgkin's disease, extranodal lung relapses were not associated with radiographically detectable relapses in the hilum or mediastinum. The appearance of the pulmonary relapses included both single and multiple nodules, with or without cavitation, and with both sharp and irregular margins. Due to this nonspecific appearance at relapse, tissue should be obtained in patients suspected of having recurrent Hodgkin's disease.     

Osteonecrosis in Hodgkin's disease

Four patients suffering from Hodgkin's disease developed osteonecrosis following therapy and both femoral heads were involved in each case. Retrospective review of abdominal radiographs taken for follow-up lymphography demonstrated that the earliest radiological changes in bone were evident between five and 18 months after treatment was started and between six and 21 months before the onset of symptoms. The clinical implications are discussed.     

Primary pulmonary Hodgkin's disease: CT findings in three patients

The computed tomography (CT) findings in three patients with primary pulmonary Hodgkin's disease are reported. Two patients had unilateral upper lobe cavitated masses and one patient had bilateral lower lobe nodules.     

Conservative surgery and radiation therapy for early stage breast cancer after previous mantle radiation for Hodgkin's disease

There is an increased incidence of breast cancer in female patients who have previously undergone mantle radiation for Hodgkin's disease. Lumpectomy followed by breast irradiation is generally considered to be contraindicated in such patients owing to the high cumulative radiation dose to the breast. Mastectomy is therefore recommended as the preferred treatment option in these women. We report two cases of breast cancer occurring in women previously treated with mantle radiation for Hodgkin's disease. Both women declined mastectomy and requested breast-conserving treatment.