8-16-Engert-chemotherapy.pdf |
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Chemotherapy of malignant lymphoma |
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HL treated with MOPP and ABVD Patients in advanced stages |
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US Intergroup Trial E2496 ABVD vs Stanford V in Advanced Stages |
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GHSG HD9 trial FFTF by treatment arm |
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GHSG HD9 trial OS by treatment arm |
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Brentuximab Vedotin Mechanism of action |
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ECHELON-1: Phase III Trial BV + AVD vs. ABVD in frontline advanced cHL |
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Non Hodgkin lymphoma Subtypes |
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GELA LNH-98.5: Trial design |
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GELA LNH-98.5 10-year follow-upOverall survival |
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Standard Regimen for DLBCL Patients |
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Results with R-CHOP in DLBCL |
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How to further improve DLBCL |
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International Hodgkin Symposium12.-15.10.2013, Köln, Gürzenich |
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Aggressive NHL: Prognostic factors - aaIPI |
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2016 0815-Engert-advanced stages |
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Slide Number 1 |
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Treatment of advanced stage Hodgkin lymphoma |
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Hodgkin Lymphom – Historische PrognoseÜberleben von Hodgkin-Patienten in Köln 1960 bis 1967Alle Stadien, n=109 |
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Long-term Results of HL Patients in advanced Stages |
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Hodgkin LymphomaCumulative relative survival of HL pts in Sweden |
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Slide Number 11 |
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GHSG HD9 trial FFTF by treatment arm |
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GHSG HD9 trial OS by treatment arm |
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HD12 pts with no bulk and no rest (PFS n=388) |
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HD12 patients with bulk only (PFS; n=402) |
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HD12 pts with bulk and rest (PFS n=613) |
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Slide Number 18 |
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Reconstructed individual OS ABVD versus 6xBEACOPPesc |
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TRM of BEACOPP escalated* Multivariate model |
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ECHELON-1: Phase III Trial BV + AVD vs. ABVD in frontline advanced cHL |
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BV: Increased Pulmonary Toxicity Phase I Combination of BV and ABVD |
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GHSG HD18 trial for advanced stages |
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Slide Number 34 |
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RATHL: Impact of BleomycinPFS for PET-negative patients (ITT) |
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UK RATHL TrialPFS for PET-negative patients (ITT) |
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Comparing RATHL and HD18PFS at 3 years |
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Advanced stage HLSummary |
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International Hodgkin Symposium12.-15.10.2013, Köln, Gürzenich |
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2016 0815-Engert-R&R HL |
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Relapsed and refractoryHodgkin Lymphoma |
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Relapsed Hodgkin Lymphoma Selected conventional salvage regimen |
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HDR2: European Intergroup TrialRelapsed Hodgkin Lymphoma* |
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Slide Number 11 |
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Slide Number 12 |
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Brentuximab Vedotin (SGN-35) Mechanism of action |
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Random. Phase III (AETHERA)BV in HL pts after auto-TX |
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International Hodgkin Symposium12.-15.10.2013, Köln, Gürzenich |
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2016 0824 Engert_current approaches_slides |
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Slide Number 1 |
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Current approaches and emerging therapies in the treatment of malignant lymphoma |
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Slide Number 15 |
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Slide Number 17 |
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HL treated with MOPP and ABVD Patients in advanced stages |
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US Intergroup Trial E2496 ABVD vs Stanford V in Advanced Stages |
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Slide Number 21 |
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Slide Number 22 |
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GHSG HD9 trial FFTF by treatment arm |
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GHSG HD9 trial OS by treatment arm |
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Slide Number 25 |
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How can we improve BEACOPPescalated? |
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Slide Number 27 |
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Brentuximab Vedotin Mechanism of action |
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ECHELON-1: Phase III Trial BV + AVD vs. ABVD in frontline advanced cHL |
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Slide Number 30 |
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Slide Number 31 |
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Slide Number 32 |
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Slide Number 33 |
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Non Hodgkin lymphoma Subtypes |
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Slide Number 35 |
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Slide Number 36 |
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Slide Number 37 |
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GELA LNH-98.5: Trial design |
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GELA LNH-98.5 10-year follow-upOverall survival |
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Standard Regimen for DLBCL Patients |
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Aggressive NHL: Prognostic factors - aaIPI |
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Results with R-CHOP in DLBCL |
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How to further improve DLBCL |
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DLBCL: Higher dose regimen |
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DLBCL: Salvage therapy |
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DLBCL: Conclusions |
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Slide Number 51 |
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2016 0824-Engert-CMT |
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Slide Number 1 |
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Combined Modality Treatment of Hodgkin Lymphoma |
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Slide Number 3 |
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Hodgkin LymphomaCumulative relative survival of HL pts in Sweden |
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Hodgkin Lymphoma Evolution of Radiotherapy |
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HD10: Long-term outcome |
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HD13: Progression-free survivalAll patients (ITT) |
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HD13: Overall survivalAll patients (ITT) |
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HD11: Long-term Outcome |
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UK NCRI RAPID trialEarly stage HL |
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H10 (#20051): study design |
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H10 (#20051): study design |
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UK RAPID; EORTC/LYSA H10 RT or no RT in PET-negative early stage HL |
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EORTC/GELA/IIL H10 StudyAccrual 2006 - 2011 |
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Slide Number 38 |
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New Antibodies and Moleculesin Malignant Lymphoma |
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Brentuximab Vedotin (SGN-35) Mechanism of action |
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Phase II Pivotal Study of BVSafety (AEs in ≥20% of pts) |
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PD-1 Blockade in HLBackground |
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Aleman case_duodenal NHL_020916_tp |
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Slide Number 1 |
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Case extranodal NHL woman born 1981 |
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Case extranodal NHL woman born 1981 |
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What would you do? |
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Target volume radiotherapy? |
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In case of RT what dose would you give? |
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Case extranodal NHL woman born 1981 |
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Case extranodal NHL woman born 1981 |
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Aleman_aggressive nodal NHL_RT volume dose and technique_draft_010916 |
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Slide Number 1 |
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Aggressive nodal NHL, the role of RT: volume, dose and technique |
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Aggressive nodal NHL, the role of radiotherapy: volume, dose and technique |
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Aggressive nodal NHL – early stageTarget volume |
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Aggressive nodal NHL – early stageTarget volume |
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Aggressive nodal NHL – advanced stageTarget volume |
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Aggressive nodal NHL – refractory diseaseTarget volume |
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Slide Number 9 |
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30 Gy vs 40-45 Gy |
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Slide Number 11 |
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Slide Number 12 |
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Palliative radiotherapy |
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Palliative radiotherapy |
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Slide Number 16 |
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RT technical isssues |
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Aggressive nodal NHL- early stagePrinciples of ISRT for Nodal Sites |
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Slide Number 19 |
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Questions? |
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Aleman_breast lyphoma_draft_290816 |
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Slide Number 1 |
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Extranodal lymphomas: Characteristics, the role of radiotherapy, volumes doses and techniques:Primary breast lymphoma |
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Breast lymphoma |
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Literature |
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Primary diffuse large B-cell lymphoma of the breast:a study by the International Extranodal Lymphoma Study Group |
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Primary diffuse large B-cell lymphoma of the breast:a study by the International Extranodal Lymphoma Study Group |
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Primary diffuse large B-cell lymphoma of the breast:a study by the International Extranodal Lymphoma Study Group |
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Primary diffuse large B-cell lymphoma of the breast:a study by the International Extranodal Lymphoma Study Group;cause specific survival, overall survival and progression free survival |
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Primary diffuse large B-cell lymphoma of the breast:a study by the International Extranodal Lymphoma Study Group |
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Primary diffuse large B-cell lymphoma of the breast:a study by the International Extranodal Lymphoma Study Group |
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Suggested algorithm for newly diagnosed PB-DLBCL |
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Suggested algorithm for newly diagnosed PB-DLBCL |
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Follicular and marginal zone primary breast lymphoma (PBL): results from International Extranodal Lymphoma Study Group |
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Follicular and marginal zone primary breast lymphoma (PBL): results from International Extranodal Lymphoma Study Group |
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15-year PFS and OS in follicular and marginal zone primary breast lymphoma |
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15-year cause specific survival in follicular and marginal zone primary breast lymphoma |
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Follicular and marginal zone primary breast lymphoma (PBL): results from International Extranodal Lymphoma Study Group |
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Breast Implant–Associated Anaplastic Large-Cell Lymphoma |
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Proposed TNM Staging for Breast Implant–Associated Anaplastic Large-Cell Lymphoma |
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Breast Implant–Associated Anaplastic Large-Cell Lymphoma(retrospective analysis 87 patients) |
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Breast Implant–Associated Anaplastic Large-Cell Lymphoma(retrospective analysis 87 patients) |
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Breast Implant–Associated Anaplastic Large-Cell Lymphoma(retrospective analysis 87 patients) |
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Radiotherapy |
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Breast lymphoma |
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Breast lymphoma |
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49-year old woman with DLBCL right breast in CR after chemo |
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Breast lymphoma |
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Questions? |
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Aleman_late effects after HL_2016_for participants |
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Slide Number 1 |
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Long term toxicityLate effects after Hodgkin lymphoma: incidence and clinical implications |
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Content |
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Slide Number 4 |
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Survival after Hodgkin lymphoma |
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HL treatment changes since 1965 |
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HL treatment changes since 1965 |
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Causes of second cancers |
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Causes of second cancers in relation to age |
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Slide Number 12 |
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Risks of Second Malignancy following HL combined results from 3 large studies* (n=9618) |
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Survival outcome after a second malignancyn=1319 ; treatment period: 1969 and 1997; median fup 12 years. |
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Survival outcome after a second malignancyn=1319 ; treatment period: 1969 and 1997; median fup 12 years. |
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Relative risks of SMN by age at HL diagnosis |
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From mantle field to IFRT |
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Literature on CRC risk after HL or childhood cancer and in A-bomb survivors |
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SIR & AER of CRC in 2,820 5-year Dutch HL survivors, diagnosed<51 years, treated1965-1995; median fup 21.5 years |
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Risk of CRC by HL treatment |
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Clinical implications |
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Slide Number 32 |
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Solid tumor risk by follow up intervalDutch 5 year HL survivors treated 1965-2000 at age 15-51 years (n=3,905) |
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Cumulative incidence any SMN by period |
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Cumulative incidence of solid tumors by treatment period |
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Cumulative incidence of leukemia (excluding MDS) |
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Trend in cumulative incidence* of lung cancer by period of treatment and sex in 5 year HL survivors (n=3,905) and the general population |
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Conclusions |
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Summary SMN |
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Causes cardiovascular damage |
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Slide Number 41 |
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Cardiovascular toxicity Differences in mechanisms |
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Literature cardiovascular disease after HL |
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Morbidity of cardiovascular disease (all events in 2524 5-year survivors of HL treated before age 51 between 1965-1995) |
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HL treatment |
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Nested case-control studies |
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Nested case-control studies |
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Valvular heart disease after HL89 cases and 200 controls nested in cohort of 1852 Dutch five-year survivors of HL treated between 1965 and 1995 |
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Valvular heart disease after HL89 cases and 200 controls nested in cohort of 1,852 Dutch five-year survivors of HL treated between 1965 and 1995 |
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Coronary heart disease after HL; 325 cases and 1,204 controls nested in a cohort of 2,617 Dutch 5‐year HL survivors treated between 1965 and 1995 |
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Dose-response by tertiles of age at HL treatment |
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Dose-associated cumulative incidence |
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Established CVD Risk factors |
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Established CVD Risk factors |
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Conclusions ischemic heart disease after HL |
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Cumulative incidence of all and first cardiovascular disease (in 2524 5-year survivors of HL treated before age 51 between 1965-1995) |
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Heart failure after HL (1st event) |
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Conclusions CVD after HL(literature and Dutch HL cohort) |
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Anthracyclines |
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Cardiovascular disease after therapy for HL: A detailed analysis of 9 collaborative EORTC-LYSA trials |
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CVD after therapy for HL: A detailed analysis of 9 collaborative EORTC-LYSA trials |
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Cardiovascular disease after therapy for HL: A detailed analysis of 9 collaborative EORTC-LYSA trials |
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Cardiovascular disease after therapy for HL: A detailed analysis of 9 collaborative EORTC-LYSA trials |
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Cardiovascular disease after therapy for HL: A detailed analysis of 9 collaborative EORTC-LYSA trials |
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Optimize treatment ? |
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Treatment optimization: |
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Limit risk of (treatment -related) side effectsPatient |
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Slide Number 69 |
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Future |
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Acknowledgements |
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Aleman_testicular lymphoma_draft_290816 |
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Slide Number 1 |
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Extranodal lymphomas: Characteristics, the role of radiotherapy, volumes doses and techniques:Testicular lymphoma |
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Testicular lymphoma |
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Testicular lymphoma |
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Slide Number 5 |
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Slide Number 6 |
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Slide Number 7 |
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Prognostic factors for PFS in PTL |
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Testicular lymphoma |
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Testicular lymphomaProphylactic RT contralateral testicle |
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Setup radiotherapy testicle |
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Testicular lymphoma |
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Testicular lymphoma |
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Aznar_HemMal_2016_template |
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Slide Number 1 |
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Deep inspiration breath hold in thoracic tumours: imaging and treatmentMarianne C Aznar |
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At Rigshospitalet |
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Lymphoma: a special case |
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Fusing prechemo and planning images |
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DIBH through the whole imaging chain |
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Rigshospitalet (The Finsen Center) |
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How to handle registration uncertainties ? |
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Respiration monitoring |
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CT + PET/CT |
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Slide Number 12 |
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Take home message (1) |
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PET/CT acquisition in practice |
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Methods: Image reconstruction |
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Some problems at start-up !! |
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Results: reduced respiration artifacts |
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Registration for contouring |
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Mediastinal lymphomaFree breathing vs. inspiration breath hold |
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Breath hold decreases the exposure of healthy tissues |
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Mean dose to lungs: 8.5Gy vs 12.8 Gy |
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Benefit: inter-patient variation |
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Benefit: over the whole group |
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DIBH + VMAT/IMRT |
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Combining DIBH and VMAT |
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Take home message (2): treatment planning |
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Position verification in DIBH |
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Daily 2D images: fuse on spine, check sternum |
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Can check heart position and lung inflation |
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Some challenges with CBCT in DIBH |
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Some possible compromises… |
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A note about margins… |
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Take home message (3): treatment delivery |
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Conclusion |
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Next frontiers? |
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DIBH and proton therapy? |
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TEDDI |
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Acknowledgments |
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Keep breathing |
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Extra slides |
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Slide Number 41 |
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Our experience with DIBH for breast cancer |
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DIBH + IMRT/RA |
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Fixed beam IMRT (sliding window)RPM integrated with linacBeam switches on and off automatically |
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DIBH + RA |
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What to choose: IMRT? DIBH or both? |
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Results: Dose |
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Results: Excess absolute risk (%) |
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Results: Life years lost (y) |
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Position verification in DIBH |
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Summary and future work |
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DIBH for lung cancer? |
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Slide Number 53 |
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Slide Number 54 |
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Potential of DIBH in lung cancer |
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Potential of DIBH in lung cancer |
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Slide Number 57 |
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Slide Number 58 |
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Titles in Arial |
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Slide Number 60 |
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Berthelsen - ESTRO Wien 2016 |
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Contouring workshop, Lena Specht |
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Davies_ESTRO_MZL systemic therapies_sept 2016 |
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Slide Number 1 |
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Systemic approaches to early and advanced marginal zone lymphoma |
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The faces of MZL |
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Splenic Marginal Zone Lymphoma |
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Slide Number 5 |
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Slide Number 6 |
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Slide Number 7 |
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Slide Number 8 |
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Rituximab |
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Outcomes in patients with splenic marginal zone lymphoma and marginal zone lymphoma treated with rituximab with or without chemotherapy or chemotherapy alone |
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Slide Number 11 |
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RESORT trial |
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Slide Number 13 |
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Slide Number 14 |
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Slide Number 15 |
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Nodal MZL |
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BR vs. R-CHOP as First Line Treatment in Patients with Indolent and Mantle Cell Lymphomas (MCL): Updated Results from the StiL NHL1 Study |
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Slide Number 18 |
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Slide Number 19 |
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Slide Number 20 |
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Slide Number 21 |
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Slide Number 22 |
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Slide Number 23 |
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Extranodal MZL |
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Slide Number 25 |
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Slide Number 26 |
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Slide Number 27 |
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Slide Number 28 |
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IELSG 19 |
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IELSG 19 |
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Slide Number 31 |
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Slide Number 32 |
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Lenalidomide |
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The R2 regimen (Fowler at al. Lancet Oncol 2014) |
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Slide Number 35 |
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Slide Number 36 |
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Toxicity of R2 |
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Exhausted T-cells |
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Slide Number 39 |
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Slide Number 40 |
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Idelalisib is highly selective for PI3Kδ isoform |
517 |
Overall response rate: 09 study |
518 |
Overall response rate by disease subgroups* |
519 |
Duration of response by disease group |
520 |
PFS: On study vs. last prior therapy |
521 |
Adverse events occurring in >12% of patients |
522 |
Slide Number 47 |
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B-cell receptor signalling. ..Inhibit and spare the chemotherapy |
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Slide Number 49 |
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Ibrutinib in B-cell lymphoma |
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Toxicity |
527 |
Ibrutininb in Mantle cell |
528 |
Other inhibitors of PI3K |
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Slide Number 54 |
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Slide Number 55 |
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Slide Number 56 |
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Slide Number 57 |
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Slide Number 58 |
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What about the other targets? |
535 |
Targeted chemotherapy in clinical development |
536 |
In summary… |
537 |
Davies_systemic DLBCL_Sept 2016_ESTO |
538 |
Slide Number 1 |
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Systemic management of Advanced Stage DLBCL |
539 |
Conflicts of Interest |
540 |
DLBCL is a curable disease |
541 |
The benefit of rituximab is maintained over time |
542 |
Events occur early… |
543 |
…but how can we improve the outcomes for those with less favourable prognosis? |
544 |
The NCCN-IPI…more discriminative than IPI |
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ESMO Guidelines |
546 |
Slide Number 10 |
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…but how can we improve the outcomes for those with less favourable prognosis? |
548 |
ESMO Guidelines |
549 |
Is there much yet to be achieved withconventional chemotherapy |
550 |
Intensified regimens…might they hold the answer? |
551 |
Dose Density: UK R-CHOP14 vs. 21 |
552 |
R-CHOP14 vs 21: no difference in outcome |
553 |
R-CHOP14 vs 21: no subgroup could be identified |
554 |
Other ways of improving dose intensity: GELA LNH03-2B |
555 |
Improved outcome in R-ACVBP arm |
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Slide Number 20 |
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Slide Number 21 |
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Slide Number 22 |
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Slide Number 23 |
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Slide Number 24 |
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Slide Number 25 |
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Baseline characteristics |
563 |
Toxicity |
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Progression Free Survival |
565 |
Ongoing approaches to intensification… |
566 |
Increasing dose intensity…High dose therapy |
567 |
…may improve PFS for poorer prognosis patients |
568 |
No mention so far of capitalising our insights from biology…… |
569 |
Overall survival of R-CHOP-treated patients in Lunenburg analysis |
570 |
MYC translocations |
571 |
MYC/BCL2 and dual translocation |
572 |
A role for intensified therapies? |
573 |
Meta-analysis (Howlett et al. BJH 2015) |
574 |
EXAMPLE HEADER UPPERCASE TEXT… |
575 |
Complex models of biological heterogeneity |
576 |
Slide Number 40 |
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Slide Number 41 |
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Slide Number 42 |
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Slide Number 43 |
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Differential outcomes with DA-EPOCH-R |
581 |
Differential outcome in the relapsed setting |
582 |
But how to distinguish phenotype? |
583 |
Slide Number 47 |
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Slide Number 48 |
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Slide Number 49 |
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Slide Number 50 |
587 |
Is it possible to reverse the adverse outcomes of ABC DLBCL? |
588 |
Slide Number 52 |
589 |
Disposition by cell of origin |
590 |
Gene mutations vs subtype (n=191) |
591 |
Slide Number 56 |
592 |
Slide Number 57 |
593 |
B-cell receptor signalling |
594 |
Ibrutinib: May target specific sub-types with novel agents |
595 |
Ibrutininb in combination with R-CHOP |
596 |
A second generation of BTKi: Enhanced kinase selectivity |
597 |
EXAMPLE HEADER UPPERCASE TEXT… |
598 |
Lenalidomide |
599 |
Differential response according to cell oforigin in DLBCL (n=40). Retrospective review. |
600 |
Slide Number 69 |
601 |
What about the GCB Phenotype? |
602 |
Activity in EZH2 mutated DLBCL (Ribrag et al ASH 2015) |
603 |
The paradigm for study design…. |
604 |
EXAMPLE HEADER UPPERCASE TEXT… |
605 |
Exhausted T-Cells and Checkpoint blockade therapy |
606 |
PD1/PD-L1 in DLBCL |
607 |
EXAMPLE HEADER UPPERCASE TEXT… |
608 |
Slide Number 81 |
609 |
Slide Number 82 |
610 |
Targeted chemotherapy in clinical development |
611 |
Conclusions |
612 |
Farewell, Lena Specht |
613 |
General principles of treatment Radiotherapy, Lena Specht |
618 |
Head and neck, Lena Specht |
646 |
Illidge advanced stage indolent lymphoma |
670 |
Slide Number 1 |
670 |
Slide Number 2 |
671 |
Decision making in Follicular Lymphoma |
672 |
Goals of therapy versus toxicity / tolerability in Follicular Lymphoma |
673 |
Follicular Lymphoma International Prognostic Index (FLIPI and F2) – |
674 |
Decision making in Initial treatment of Follicular Lymphoma |
675 |
Established definitions of when treatment required |
676 |
Treatments approaches for those requiring treatment (high tumour burden) |
677 |
Rituximab: An engineered murine/human chimeric monoclonal antibody – granted US FDA approval for treatment of cancer 1997 |
678 |
Rituximab-Chemotherapy in Untreated Advanced Follicular NHL |
679 |
Progression-Free Survival Dependson First-Line Treatment |
680 |
StiL R-Benda vs R-CHOPRummel MJ et al : Lancet Feb 20, 2013 |
684 |
StiL R-Benda vs R-CHOPRummel MJ et al : Lancet Feb 20, 2013 |
685 |
Maintenance Rituximab after Induction immunochemotherapyPRIMA: study design |
686 |
Safety and activity of lenalidomide and rituximab in untreated indolent lymphoma: an open-label, phase 2 trialFowler et al Lancet Oncol. 2014 Nov;15(12):15.Can cytotoxic chemotherapy be avoided ? |
688 |
Safety and activity of lenalidomide and rituximab in untreated indolent lymphoma: an open-label, phase 2 trialFowler et al Lancet Oncol. 2014 Nov;15(12):15.Response Rates of R2 |
689 |
Can cytotoxic chemotherapy be avoided ? The "RELEVANCE" Trial (Rituximab and Lenalidomide Versus Any Chemotherapy) |
690 |
Conclusions therapy in advanced stage FL |
691 |
Radioimmunotherapy – a unique tool targeting radiosensitivity |
692 |
B-cell lymphomas express several antigens that can be targeted |
693 |
Choice of radioisotope |
694 |
Penetration of Particulate and Electromagnetic Radiation |
695 |
Radiation delivery profile of conventional radiotherapy versus targeted radiotherapy |
696 |
Yttrium-90 Ibritumomab tiuxetan (ZevalinTM) |
697 |
90Y Ibritumomab Tiuxetan treatment is completed in 7 days |
698 |
131I Tositumomab (Anti-B1):Mechanism Of Action |
699 |
Treatment Regimen for131I Tositumomab (Licensed in USA – no longer available) |
700 |
Results of a phase 1 study of 177Lu-DOTA-HH1 anti body radionuclide (Betalutin) conjugate for patients with relapsed CD37+ non-Hodgkin lymphomas – Lugano 2015 |
701 |
Slide Number 33 |
702 |
Thorium-227 anti-CD22 |
703 |
Defining features of RIT in relapsed Follicular Lymphoma |
704 |
Pivotal Study of 131I Tositumomab Kaminski MS, et al. J Clin Oncol. 2001;19:3918–3928 |
705 |
Progression Free Survival of 131I Rituximab vs Last qualifying chemotherapy. Illidge et al Blood 2009 |
706 |
Duration of Responsein 90Y Ibritumomab Tiuxetan Trials |
707 |
Slide Number 39 |
708 |
Slide Number 40 |
709 |
Multivariate analysis of prognostic factors correlated with response to Zevalin for NHL |
710 |
Rituximab-Refractory Trial:Patient Response to Zevalin |
711 |
Bendamustine in Rituximab refractory FL |
712 |
Slide Number 44 |
713 |
Slide Number 45 |
714 |
Slide Number 46 |
715 |
Slide Number 47 |
716 |
Slide Number 48 |
717 |
Slide Number 49 |
718 |
Responses rates of Zevalin monotherapy versus R-chemo in first line therapy of Follicular NHL |
719 |
Conclusions – Role of RIT in Follicular lymphoma |
720 |
Illidge- Early stage HL |
721 |
Slide Number 1 |
721 |
The role of radiotherapy in Early stage stage HL |
722 |
Overview of talk |
723 |
Overall results of therapy for early disease |
724 |
Late effects to avoid as cures increase |
725 |
Slide Number 6 |
726 |
Objectives in Early stage Hodgkin Lymphoma |
727 |
Results from the trialsEarly stage disease |
728 |
Slide Number 9 |
729 |
Slide Number 10 |
730 |
Slide Number 11 |
731 |
Slide Number 12 |
732 |
NCIC CTG ECOG HD.6 TrialUnfavorable Cohort-Causes of Death |
733 |
NCIC CTG ECOG HD.6 TrialSmall numbers and unusual events |
734 |
What do we learn from NCIC/ECOG HD6 ? |
735 |
What don’t we learn from HD6 ? |
736 |
GHSG HD10, HD11 (CMT) Comparisonwith NCIC CTG HD.6 (ABVD alone) |
737 |
Slide Number 18 |
738 |
Key questions in using Combined Modality Treatment in early stage HL |
739 |
Transformation of RT Volumes / Doses in HLISRT – Specht L et al IJROBP 2014 |
740 |
The Challenge of 18FDG PET CT in HL : Converting large SUV numbers into Binary (Positive / Negative) and making sense of it |
741 |
Slide Number 22 |
742 |
UK NCRI RAPID in early HL study Demographics |
743 |
UK NCRI RAPID study PET scores after 3 cycles ABVD |
744 |
UK NCRI RAPID Trial |
745 |
UK NCRI RAPID TrialPer protocol analysis of randomised patients |
746 |
UK RAPID Deaths in IFRT arm that did not receive IFRT : Older patients tolerate ABVD badly |
747 |
UK NCRI RAPID TrialPFS in the randomised PET –ve population (per protocol analysis, n=392) |
748 |
Summary of UK NCRI RAPID study |
749 |
EORTC/ LYSA/ FIL H10 (#20051): study design |
750 |
EORTC/LYSA/FIL H10 Trial |
751 |
Slide Number 32 |
752 |
Conclusions for FDG PET in Early HL |
753 |
Slide Number 34 |
754 |
Which Patients with Stage I-II Hodgkin Lymphoma for Contemporary Combined Modality Therapy in PET era ? |
755 |
Conclusions |
756 |
Illidge early stage indolent lymphomas |
757 |
Slide Number 1 |
757 |
Slide Number 2 |
758 |
Slide Number 3 |
759 |
Slide Number 4 |
760 |
Slide Number 5 |
761 |
Hypothesis: Is more dose better? |
762 |
Reduced dose radiotherapy for NHL : A randomised phase III trialLowry L, Smith P, Qian W, Falk S, Benstead K, Illidge T, Linch D, Robinson M, Jack A, Hoskin P. Radiother Oncol. 2011 Jun 9. |
763 |
Indications for Radiotherapy |
764 |
Acute RT Toxicity |
765 |
Local Control at 1 month |
766 |
Slide Number 11 |
767 |
Slide Number 12 |
768 |
Slide Number 13 |
769 |
Slide Number 14 |
770 |
Slide Number 15 |
771 |
Radiotherapy alone for stage I-III low grade follicular lymphoma: long-term outcome and comparison of extended field and total nodal irradiation.Guckenberger M Radiat Oncol 2012 Jun 24;7:103. |
774 |
Radiotherapy alone for stage I-III low grade follicular lymphoma: long-term outcome and comparison of extended field and total nodal irradiation.Guckenberger M Radiat Oncol 2012 Jun 24;7:103. |
775 |
Radiotherapy alone for stage I-III low grade follicular lymphoma: long-term outcome and comparison of extended field and total nodal irradiation.Guckenberger M Radiat Oncol 2012 Jun 24;7:103. |
776 |
Slide Number 21 |
777 |
Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Should RT alone remain standard of care ? |
778 |
Conclusions |
781 |
Illidge Immunotherapy 300816 |
782 |
Slide Number 1 |
782 |
Slide Number 2 |
783 |
Outline of talk |
784 |
The normal immune system |
785 |
Cancer Immunotherapy |
786 |
Rituximab – Anti-CD20 mAb and NHL |
787 |
Slide Number 7 |
788 |
Outline of talk |
789 |
Slide Number 9 |
790 |
Is there a relationship between immune activation and tumour response after RT ? |
791 |
Slide Number 11 |
792 |
Slide Number 12 |
793 |
Is there a relationship between immune activation and tumour response after RT ? |
794 |
Slide Number 14 |
795 |
Exploiting Immune Checkpoints Inhibitors : key to progress in developing therapeutics |
796 |
Slide Number 16 |
797 |
Slide Number 17 |
798 |
Rationale for Targeting PD1/PD-L1 Pathway in Cancer |
799 |
Outline of talk |
800 |
Slide Number 20 |
801 |
Is there a relationship between immune activation and tumour response after RT ? |
802 |
Slide Number 22 |
803 |
Slide Number 23 |
804 |
Slide Number 24 |
805 |
Scheduling of RT and anti-PD-L1 combination determines outcome |
806 |
Outline of talk |
807 |
Slide Number 27 |
808 |
Anti-PD1 in Hodgkin Lymphoma |
809 |
Anti-PD1 - Nivolumab Mechanism of Action |
810 |
Initial Responses and response durationAnsel et al N Engl J Med 2015; 372:311-319 |
811 |
Select Treatment-Related Adverse Events |
812 |
Select Treatment-Related Adverse Events |
813 |
Treatment-Related Serious Adverse Events |
814 |
Slide Number 34 |
815 |
Progression-Free Survival |
816 |
Overall Survival |
817 |
Summary |
818 |
CheckMate 205: Study Design, Cohort B Engert et al 2015 |
819 |
Treatment Status |
820 |
Response Rates |
821 |
Progression-Free and Overall Survival |
822 |
Adverse Events |
823 |
Summary |
824 |
Phase 1b KEYNOTE-013 KEYTRUDA® (Pembrolizumab), Anti-PD-1 Therapy, in Relapsed/Refractory Classical Hodgkin Lymphoma |
825 |
Phase 1b KEYNOTE-013 KEYTRUDA® (Pembrolizumab) Anti-PD-1 Therapy, in Relapsed/Refractory Classical HL |
826 |
PD-1 Blockade with Pembrolizumab in Patients with Classical Hodgkin Lymphoma after Brentuximab Vedotin Failure: Safety, Efficacy, and Biomarker AssessmentPhilippe Armand, et al Blood 2015 126:584 |
827 |
PD-1 Blockade with Pembrolizumab in Patients with Classical Hodgkin Lymphoma after Brentuximab Vedotin Failure: Safety, Efficacy, and Biomarker AssessmentPhilippe Armand, et al Blood 2015 126:584 |
828 |
PD-1 Blockade with Pembrolizumab in Patients with Classical Hodgkin Lymphoma after Brentuximab Vedotin Failure: Safety, Efficacy, and Biomarker AssessmentPhilippe Armand, et al Blood 2015 126:584 |
829 |
Conclusions |
830 |
Slide Number 51 |
831 |
Acknowledgements |
832 |
Questions |
833 |
Imaging for lymphoma 2016 - Mikhaeel |
834 |
Slide Number 1 |
834 |
Imaging in the Management of Lymphoma |
835 |
Outline |
836 |
Imaging in Modern RT for Lymphoma |
837 |
Recent advances in RT based on imaging |
838 |
The Lugano Classification - 2014 |
839 |
The Lugano Classification - 2014 |
840 |
What is new?(compared to 2007) |
841 |
PET/CT as standard imaging for staging |
842 |
Which lymphomas are FDG avid? |
843 |
Bone Marrow Assessment |
844 |
Slide Number 12 |
845 |
Slide Number 13 |
846 |
Slide Number 14 |
847 |
Interpretation of DIFFUSE marrow uptake |
848 |
Slide Number 16 |
849 |
Slide Number 17 |
850 |
Splenic Involvement |
851 |
Simplified Ann Arbor |
852 |
Prognostic value of Initial Bulk |
853 |
Stage & Bulk in prognostic indices |
854 |
Recommendations for Bulk |
855 |
Maximum Tumour Dimension (MTD) |
856 |
Max Tumour Dimension (147 DLBCL pts) |
857 |
MTD best cut-off to predict PFS |
858 |
Metabolic tumour volume |
859 |
MTV Cut-off |
860 |
Slide Number 28 |
861 |
Combining baseline MTV with early response |
862 |
Slide Number 30 |
863 |
Response assessment |
864 |
What is new?(compared to 2007) |
865 |
Change from IHP to Deauville |
866 |
Escalation |
867 |
Slide Number 35 |
868 |
Score 3 |
869 |
Score 4 & 5 |
870 |
Slide Number 38 |
871 |
Challenges with quantitation |
872 |
Recommendation: Quantitation for Response |
873 |
Revised criteria for response assessment |
874 |
Slide Number 42 |
875 |
Slide Number 43 |
876 |
Slide Number 44 |
877 |
Slide Number 45 |
878 |
Slide Number 46 |
879 |
Slide Number 47 |
880 |
Slide Number 48 |
881 |
Recommendation: Residual metabolic activity |
882 |
HL |
883 |
6 ABVD |
884 |
3 months post chemo + IFRT |
885 |
Slide Number 53 |
886 |
Recent advances in RT based on imaging |
887 |
CT-based planning |
888 |
3D CT based planning |
889 |
FDG-PET for target definition |
890 |
FDG-PET pitfalls |
891 |
Slide Number 59 |
892 |
Impact of PET on target definition |
893 |
Effect of PET on TV definition |
894 |
Slide Number 62 |
895 |
How often does PET detect more nodes? |
896 |
Impact of PET on target volume |
897 |
Slide Number 65 |
898 |
Terezakis 2014 - methods |
899 |
Results - Comparison of volumes |
900 |
PET Resolution & Detection limit |
901 |
Clinical examples |
902 |
non-FDG-avid areas in a mass |
903 |
non-FDG-avid LNsStage 1 NLP R axilla |
904 |
Slide Number 72 |
905 |
Skip areas – Stage 2 cHL |
906 |
PMR after chemo – residual mass + a focus of residual activitycHL > ABVDx6 |
907 |
4D-CT |
908 |
Recent advances in RT based on imaging |
909 |
Treatment verificationThe past |
910 |
TreatmentverificationThe present |
911 |
Deep Inspiration Breath Hold |
912 |
Real-time Position Management (RPM) |
913 |
VisionRT / AlignRT® |
914 |
Slide Number 82 |
915 |
Importance of IGRT for DIBH |
916 |
Conclusions -1 |
917 |
Conclusions -2 |
918 |
Slide Number 86 |
919 |
Nodular Lymph Predom Hodgkin - Mikhaeel |
920 |
Slide Number 1 |
920 |
Nodular Lymphocyte Predominant HLRole of Radiotherapy |
921 |
Incidence |
922 |
Characteristics |
923 |
Slide Number 5 |
924 |
Characteristics (2) |
925 |
Characteristics (3) |
926 |
Slide Number 8 |
927 |
Slide Number 9 |
928 |
Prognostic score |
929 |
Slide Number 11 |
930 |
Slide Number 12 |
931 |
Diagnostic work up |
932 |
Management |
933 |
Outcome of RT in early stage |
934 |
Slide Number 16 |
935 |
Slide Number 17 |
936 |
Slide Number 18 |
937 |
Slide Number 19 |
938 |
CMT / Chemo for early stage |
939 |
Slide Number 21 |
940 |
BCCCA study |
941 |
Surgical resection + Observation |
942 |
Summary of treatment of limited stage NLP |
943 |
Radiotherapy |
944 |
Slide Number 26 |
945 |
Slide Number 27 |
946 |
Slide Number 28 |
947 |
Radiotherapy (cont.) |
948 |
Key points |
949 |
Thank you |
950 |
rel-ref agg NHL 2016- Mikhaeel |
951 |
Slide Number 1 |
951 |
Aggressive Nodal NHLRT for Relapsed / Refractory Disease |
952 |
Outline |
953 |
(1) Persistent PET positivity after Primary Chemo |
954 |
Slide Number 5 |
955 |
Slide Number 6 |
956 |
Dorth et al |
957 |
Slide Number 8 |
958 |
Slide Number 9 |
959 |
Slide Number 10 |
960 |
Slide Number 11 |
961 |
Slide Number 12 |
962 |
Halasz et al |
963 |
Slide Number 16 |
964 |
Slide Number 17 |
965 |
Slide Number 18 |
966 |
PET +ve Post chemo |
967 |
Slide Number 21 |
968 |
(2) Peri-transplant RT |
969 |
2 Facts about ASCT salvage |
970 |
Slide Number 24 |
971 |
Slide Number 25 |
972 |
Role of Peri-transplant RT |
973 |
Slide Number 27 |
974 |
Slide Number 28 |
975 |
Timing of peri-transplant RT |
976 |
Choice |
977 |
(3) Transplant-ineligible patients & Relapse after transplant |
978 |
How radical should RT be? |
979 |
Non transplant eligible |
980 |
What can RT achieve in refractory HG-NHL? |
981 |
Salvage RT for relapsed / chemorefractory disease |
982 |
Slide Number 37 |
983 |
Slide Number 38 |
984 |
Slide Number 39 |
985 |
Palliative low dose RT |
986 |
Key points |
987 |
Ricardi_Bone Lymphoma |
988 |
Slide Number 1 |
988 |
Extranodal lymphomas: Bone |
989 |
Slide Number 3 |
990 |
Slide Number 4 |
991 |
Slide Number 5 |
992 |
Slide Number 6 |
993 |
Slide Number 7 |
994 |
Slide Number 8 |
995 |
Slide Number 9 |
996 |
Slide Number 10 |
997 |
Slide Number 11 |
998 |
DLBCL: combined modality treatment |
999 |
Slide Number 13 |
1000 |
Slide Number 14 |
1001 |
Slide Number 15 |
1002 |
Slide Number 16 |
1003 |
Slide Number 17 |
1004 |
Slide Number 18 |
1005 |
Slide Number 19 |
1006 |
Slide Number 20 |
1007 |
Slide Number 21 |
1008 |
Slide Number 22 |
1009 |
Slide Number 23 |
1010 |
Slide Number 24 |
1011 |
Slide Number 25 |
1012 |
Slide Number 26 |
1013 |
Slide Number 27 |
1014 |
Slide Number 28 |
1015 |
Slide Number 29 |
1016 |
Slide Number 30 |
1017 |
Slide Number 31 |
1018 |
Slide Number 32 |
1019 |
Ricardi_Early stage DLBCL |
1020 |
Slide Number 1 |
1020 |
Aggressive nodal non Hodgkin lymphoma The role of radiation therapyEarly Stage |
1021 |
Slide Number 3 |
1022 |
Slide Number 4 |
1023 |
DLBCL is different from HL |
1024 |
Slide Number 6 |
1025 |
SWOG Contributions: Limited Stage DLBCL |
1026 |
Slide Number 8 |
1027 |
Slide Number 9 |
1028 |
Slide Number 10 |
1029 |
Slide Number 11 |
1030 |
Slide Number 12 |
1031 |
Slide Number 13 |
1032 |
Slide Number 14 |
1033 |
Slide Number 15 |
1034 |
Slide Number 16 |
1035 |
Slide Number 17 |
1036 |
Slide Number 18 |
1037 |
Slide Number 19 |
1038 |
Slide Number 20 |
1039 |
Is there (still) a role for Radiation Therapy in DLCL? |
1040 |
Slide Number 22 |
1041 |
Slide Number 23 |
1042 |
Slide Number 24 |
1043 |
Slide Number 25 |
1044 |
Slide Number 26 |
1045 |
Slide Number 27 |
1046 |
Slide Number 28 |
1047 |
Slide Number 29 |
1048 |
Role of Radiotherapy to Bulky Disease in Elderly Patients With Aggressive B-Cell Lymphoma (n=1,222) |
1049 |
Role of Radiotherapy to Bulky Disease in Elderly Patients With Aggressive B-Cell Lymphoma |
1050 |
Slide Number 32 |
1051 |
Slide Number 33 |
1052 |
To irradiate or not to irradiate ? |
1053 |
Slide Number 35 |
1054 |
PET-oriented RT: BCCA experience |
1055 |
DLCL 10 IPI = 0 bulk, 1 and/or bulk (7.5 cm) (less favourable according MInT) |
1056 |
Slide Number 38 |
1057 |
Background |
1058 |
Slide Number 40 |
1059 |
Combined modality OR chemotherapy alonein early stage DLCL |
1060 |
Slide Number 42 |
1061 |
Slide Number 43 |
1062 |
Slide Number 44 |
1063 |
Slide Number 45 |
1064 |
Slide Number 46 |
1065 |
Slide Number 47 |
1066 |
Slide Number 48 |
1067 |
Slide Number 49 |
1068 |
Slide Number 50 |
1069 |
Slide Number 51 |
1070 |
Slide Number 52 |
1071 |
Slide Number 53 |
1072 |
Slide Number 54 |
1073 |
Ricardi_HL |
1074 |
Slide Number 1 |
1074 |
Radiation therapy for cHL:volumes, doses and techniques |
1075 |
Slide Number 3 |
1076 |
Slide Number 4 |
1077 |
RT in classical Hodgkin Lymphoma |
1078 |
Responsibilities of the radiation oncologist |
1079 |
Early Stage classical Hodgkin Lymphoma |
1080 |
Slide Number 8 |
1081 |
From IFRT to INRT/ISRT |
1082 |
Slide Number 10 |
1083 |
Treatment Volume Principles |
1084 |
Slide Number 12 |
1085 |
Slide Number 13 |
1086 |
Slide Number 14 |
1087 |
Slide Number 15 |
1088 |
Slide Number 16 |
1089 |
Slide Number 17 |
1090 |
Slide Number 18 |
1091 |
Slide Number 19 |
1092 |
Slide Number 20 |
1093 |
Slide Number 21 |
1094 |
Slide Number 22 |
1095 |
Slide Number 23 |
1096 |
Slide Number 24 |
1097 |
Slide Number 25 |
1098 |
Slide Number 26 |
1099 |
Slide Number 27 |
1100 |
Slide Number 28 |
1101 |
Slide Number 29 |
1102 |
Slide Number 30 |
1103 |
Slide Number 31 |
1104 |
Slide Number 32 |
1105 |
Optimal radiation doses |
1106 |
Slide Number 34 |
1107 |
Slide Number 35 |
1108 |
Slide Number 36 |
1109 |
Slide Number 37 |
1110 |
Slide Number 38 |
1111 |
Slide Number 39 |
1112 |
Slide Number 40 |
1113 |
Advanced conformal RT in lymphoma |
1114 |
Slide Number 42 |
1115 |
IMRT vs 3D-CRT in lymphoma |
1116 |
Slide Number 44 |
1117 |
IMRT in lymphoma RT |
1118 |
Dose constraints in lymphoma RT |
1119 |
Slide Number 47 |
1120 |
Slide Number 48 |
1121 |
Modern RT in lymphoma |
1122 |
Slide Number 50 |
1123 |
Key is the shape of the dose-response relationshipfor radiation-induced carcinogenesis... |
1124 |
However, recent epidemiology suggests that the risks are not small at large doses |
1125 |
May IMRT be optimized taking into account secondary cancers risk? |
1126 |
Slide Number 54 |
1127 |
Slide Number 55 |
1128 |
Slide Number 56 |
1129 |
Slide Number 57 |
1130 |
Slide Number 58 |
1131 |
Slide Number 59 |
1132 |
Which technique is preferable? |
1133 |
Which technique is preferable? |
1134 |
Slide Number 62 |
1135 |
Slide Number 63 |
1136 |
Slide Number 64 |
1137 |
Slide Number 65 |
1138 |
Slide Number 66 |
1139 |
Slide Number 67 |
1140 |
Slide Number 68 |
1141 |
Ricardi_Indolent NHL |
1142 |
Slide Number 1 |
1142 |
Radiation Therapy for Indolent Nodal non Hodgkin Lymphoma Volumes, doses and techniques |
1143 |
Slide Number 3 |
1144 |
Slide Number 4 |
1145 |
Modern RT in Indolent Lymphoma |
1146 |
Slide Number 6 |
1147 |
Slide Number 7 |
1148 |
Slide Number 8 |
1149 |
Slide Number 9 |
1150 |
Slide Number 10 |
1151 |
Slide Number 11 |
1152 |
Radiation therapy as primary treatment |
1153 |
Slide Number 13 |
1154 |
Slide Number 14 |
1155 |
Slide Number 15 |
1156 |
Slide Number 16 |
1157 |
|
1158 |
Slide Number 18 |
1159 |
Slide Number 19 |
1160 |
Reduced dose radiotherapy for NHL : A randomised phase III trialLowry L, Smith P, Qian W, Falk S, Benstead K, Illidge T, Linch D, Robinson M, Jack A, Hoskin P. Radiother Oncol. 2011 Jun 9. |
1161 |
Slide Number 21 |
1162 |
Slide Number 22 |
1163 |
Slide Number 23 |
1164 |
INDOLENT LYMPHOMAS: Overall Survival |
1165 |
Slide Number 25 |
1166 |
Slide Number 26 |
1167 |
Slide Number 27 |
1168 |
Slide Number 28 |
1169 |
Slide Number 29 |
1170 |
Slide Number 30 |
1171 |
Slide Number 31 |
1172 |
Slide Number 32 |
1173 |
Slide Number 33 |
1174 |
Slide Number 34 |
1175 |
Response to very low dose RT is variable |
1176 |
Slide Number 36 |
1177 |
Dose constraints in lymphoma RT |
1178 |
Which technique is preferable? |
1179 |
Slide Number 39 |
1180 |
Modern RT in indolent nodal lymphoma |
1181 |
Ricardi_Lung lymphoma |
1182 |
Slide Number 1 |
1182 |
Lung Lymphoma |
1183 |
Background |
1184 |
Slide Number 4 |
1185 |
Slide Number 5 |
1186 |
Clinical presentation |
1187 |
Background |
1188 |
Diagnosis |
1189 |
Slide Number 9 |
1190 |
StagingAnn Arbor system modified by Ferraro |
1191 |
Treatment |
1192 |
Slide Number 12 |
1193 |
Surgical approach |
1194 |
Surgical approach |
1195 |
Slide Number 15 |
1196 |
Slide Number 16 |
1197 |
Slide Number 17 |
1198 |
Slide Number 18 |
1199 |
Slide Number 19 |
1200 |
Slide Number 20 |
1201 |
Radiotherapy |
1202 |
Slide Number 22 |
1203 |
Slide Number 23 |
1204 |
Slide Number 24 |
1205 |
Slide Number 25 |
1206 |
Slide Number 26 |
1207 |
Slide Number 27 |
1208 |
Slide Number 28 |
1209 |
Conclusions |
1210 |
Conclusions |
1211 |
Slide Number 31 |
1212 |
Slide Number 32 |
1213 |
Modern RT for lung lymphoma |
1214 |
Ricardi_Myeloma |
1215 |
Slide Number 1 |
1215 |
Myeloma: Solitary & Disseminated |
1216 |
Multiple myeloma |
1217 |
Multiple myeloma |
1218 |
Slide Number 5 |
1219 |
Slide Number 6 |
1220 |
Slide Number 7 |
1221 |
Clinical presentation, diagnosis and staging |
1222 |
Slide Number 9 |
1223 |
Slide Number 10 |
1224 |
Slide Number 11 |
1225 |
Treatment |
1226 |
Slide Number 13 |
1227 |
Slide Number 14 |
1228 |
Role of Radiotherapy in MM |
1229 |
Slide Number 16 |
1230 |
Slide Number 17 |
1231 |
Slide Number 18 |
1232 |
Slide Number 19 |
1233 |
Slide Number 20 |
1234 |
Slide Number 21 |
1235 |
Slide Number 22 |
1236 |
Slide Number 23 |
1237 |
Slide Number 24 |
1238 |
RT for Multiple Myeloma @ University of Torino |
1239 |
Systemic radiotherapy in MM:TBI and HBI |
1240 |
Solitary plasmacytoma |
1241 |
Slide Number 28 |
1242 |
Slide Number 29 |
1243 |
Slide Number 30 |
1244 |
Slide Number 31 |
1245 |
Slide Number 32 |
1246 |
Slide Number 33 |
1247 |
Slide Number 34 |
1248 |
Slide Number 35 |
1249 |
Slide Number 36 |
1250 |
Slide Number 37 |
1251 |
Slide Number 38 |
1252 |
Slide Number 39 |
1253 |
Ricardi_Orbital Lymphoma |
1254 |
Slide Number 1 |
1254 |
Extranodal lymphomas:Orbital (ocular adnexal) lymphoma |
1255 |
ENL: Most common sites |
1256 |
Slide Number 4 |
1257 |
Slide Number 5 |
1258 |
Slide Number 6 |
1259 |
Slide Number 7 |
1260 |
Slide Number 8 |
1261 |
Extranodal Lymphomas of Mucosa-associated Lymphoid Tissue |
1262 |
Slide Number 10 |
1263 |
Slide Number 11 |
1264 |
Slide Number 12 |
1265 |
Slide Number 13 |
1266 |
Slide Number 14 |
1267 |
Slide Number 15 |
1268 |
Slide Number 16 |
1269 |
Slide Number 17 |
1270 |
Slide Number 18 |
1271 |
Slide Number 19 |
1272 |
Slide Number 20 |
1273 |
Slide Number 21 |
1274 |
Slide Number 22 |
1275 |
Slide Number 23 |
1276 |
Slide Number 24 |
1277 |
Slide Number 25 |
1278 |
Slide Number 26 |
1279 |
Slide Number 27 |
1280 |
Slide Number 28 |
1281 |
Slide Number 29 |
1282 |
Slide Number 30 |
1283 |
Slide Number 31 |
1284 |
Slide Number 32 |
1285 |
Slide Number 33 |
1286 |
Slide Number 34 |
1287 |
Slide Number 35 |
1288 |
Slide Number 36 |
1289 |
Slide Number 37 |
1290 |
Slide Number 38 |
1291 |
Slide Number 39 |
1292 |
Slide Number 40 |
1293 |
Slide Number 41 |
1294 |
Slide Number 42 |
1295 |
Slide Number 43 |
1296 |
Slide Number 44 |
1297 |
Slide Number 45 |
1298 |
Role of radiation oncologist, Lena Specht |
1299 |
Skin, Lena Specht |
1319 |
Splenomegaly, Lena Specht |
1346 |
Thyroid - Mikhaeel |
1352 |
Slide Number 1 |
1352 |
Thyroid Lymphoma |
1353 |
Incidence |
1354 |
Pathogenesis |
1355 |
Histological types |
1356 |
Clinical Presentation |
1357 |
Staging |
1358 |
Imaging |
1359 |
Slide Number 9 |
1360 |
Biopsy |
1361 |
FNAC |
1362 |
Role of Surgery |
1363 |
Treatment |
1364 |
Slide Number 14 |
1365 |
QUESTIONS? |
1366 |
Welcome, Lena Specht |
1367 |
Slide Number 1 |
1367 |
WELCOME |
1368 |
Slide Number 3 |
1369 |
Slide Number 4 |
1370 |
Multidisciplinary course |
1371 |
From ESTRO |
1372 |
What is your specialty? |
1373 |
How long in practice? |
1374 |
Where do you practice? |
1375 |
For those who have brought cases for the case discussion sessions |
1376 |
Yahalom ESTRO HL Salvage 2016 |
1377 |
RT for relapsed and refractory HL |
1377 |
39 year old woman presented with abdominal pain -November 2013 |
1378 |
39 yo woman in CR after ABVD X6 for HL |
1379 |
Slide Number 4 |
1380 |
Slide Number 5 |
1381 |
High-Dose Therapy Salvage of Hodgkin Lymphoma Enhanced by RT: 30 Years of Experience |
1382 |
HL: the numbers |
1383 |
Recent Trends-increasing the role of RT in salvage of HL |
1384 |
MSKCC Salvage Program- Always Emphasizing RT |
1385 |
MSKCC HL- Salvage with Transplantation Program |
1386 |
Salvage Therapy of Hodgkin Lymphoma – Why RT? |
1387 |
Integrating Radiotherapy - Rationale |
1388 |
Integrating Radiotherapy- Concerns |
1389 |
Integrating Radiotherapy - Options |
1390 |
Integrating Radiotherapy - Preferred |
1391 |
Phase I/II Trial of TLI vs High-Dose Chemotherapy Salvage Regimen |
1392 |
Slide Number 19 |
1393 |
Management of Relapsed HL |
1394 |
Advantages of Integrated RT in High-Dose Therapy Regimen |
1395 |
MSKCC Clinical Research Programof Salvage for Hodgkin Lymphoma1985-2015 |
1396 |
Protocol Generation (1-85/86, 2-94, 3-98, 4-04/06) |
1397 |
Protocol Generation (1-85/86, 2-94, 3-98, 4-04/06) |
1398 |
Overall Survival |
1399 |
Multivariate Analysis |
1400 |
Response to Salvage Therapy |
1401 |
≥ Grade 3 Toxicity |
1402 |
Second Malignancies |
1403 |
Summary |
1404 |
NEW DIRECTIONS IN SALVAGE: MSKCC STUDIES |
1405 |
Slide Number 32 |
1406 |
PET-adapted therapy with BV followed by augICE |
1407 |
EFS according to treatment and PET status |
1408 |
ATHERA Study- Lancet 2015 |
1409 |
Study Design and Key Eligibility Criteria |
1410 |
Slide Number 37 |
1411 |
Slide Number 38 |
1412 |
A Phase II Study of Pembrolizumab and Involved Site Radiation Therapy (ISRT) for Early Stage Relapsed or Primary Refractory Hodgkin Lymphoma |
1413 |
Hypothesis |
1414 |
PD-L1/L2 amplification is associated with poor prognosis in HL |
1415 |
Pembrolizumab is highly effective in heavily pre-treated HL patients |
1416 |
Aims |
1417 |
Slide Number 44 |
1418 |
Anti-PD-1 works in HL…but how? |
1419 |
Summary |
1420 |
Future Predictions for HL Salvage |
1421 |
Yahalom Gastric MZL |
1422 |
Slide Number 1 |
1422 |
Marginal Gastric Zone Lymphoma:Role of RT |
1423 |
Slide Number 3 |
1424 |
Slide Number 4 |
1425 |
Slide Number 5 |
1426 |
RT of Gastric Lymphomas |
1427 |
Involved-field Radiotherapy for H. pylori-independent Gastric Marginal Zone (MALT) Lymphoma: 23 years of experience with 131 patients1991-2012 at MSKCC |
1428 |
Patient Characteristics |
1429 |
Diagnostic/Staging Workup |
1430 |
H. Pylori |
1431 |
Chemotherapy |
1432 |
Radiotherapy |
1433 |
Response to RT |
1434 |
Stomach relapse after RT |
1435 |
Slide Number 15 |
1436 |
Slide Number 16 |
1437 |
Slide Number 17 |
1438 |
Slide Number 18 |
1439 |
Principles of RT of Stomach |
1440 |
Principles of Gastric Lymphoma RT (1) |
1441 |
Principles of Gastric Lymphoma RT (2) |
1442 |
Gastric Anatomy |
1443 |
Slide Number 23 |
1444 |
RT of Stomach: Pre Planning Studies |
1445 |
RT of Stomach: simulation |
1446 |
RT of Stomach: volumes |
1447 |
Treatment Planning |
1448 |
3D-CRT vs. IMRT |
1449 |
Treatment Planning Goals |
1450 |
DVH: 3D-CRT vs. IMRT |
1451 |
Respiratory Motion |
1452 |
Respiratory Motion |
1453 |
Respiratory Motion |
1454 |
Respiratory Motion |
1455 |
Conclusions |
1456 |
Yahalom- HL RT for advanced ESTRO 2016 V.1.1 |
1457 |
The Diminishing and Selective Role of RT inAdvanced-stage Hodgkin Lymphoma (HL) |
1457 |
Who is an “advanced-stage” patient? |
1458 |
The Evolution of Consolidation RT in Advanced-Stage HL |
1459 |
The Evolution of Consolidation RT in Advanced-Stage HL |
1460 |
Slide Number 5 |
1461 |
FDG-PET interim assessment Deauville criteria or 5 point scale |
1462 |
Non-Adaptive Regimens:How RT was added or tested? |
1463 |
Slide Number 8 |
1464 |
Slide Number 9 |
1465 |
Slide Number 10 |
1466 |
Slide Number 11 |
1467 |
EORTC Study relevance concerns |
1468 |
Slide Number 13 |
1469 |
Slide Number 14 |
1470 |
Slide Number 15 |
1471 |
Slide Number 16 |
1472 |
Slide Number 17 |
1473 |
Slide Number 18 |
1474 |
Slide Number 19 |
1475 |
Slide Number 20 |
1476 |
Slide Number 21 |
1477 |
RT in GHSG BEACOPP Studies (1) |
1478 |
RT in GHSG BEACOPP Studies (2) |
1479 |
Slide Number 24 |
1480 |
Slide Number 25 |
1481 |
Slide Number 26 |
1482 |
Patient Characteristics/PET 2 Results |
1483 |
PET 2 Negative-Post randomization |
1484 |
PET 2 Positive |
1485 |
Conclusions: Authors |
1486 |
Slide Number 31 |
1487 |
Overview: 4 Cohorts |
1488 |
13-034 Cohort 1 Study Design |
1489 |
Clinical Trial Flowchart |
1490 |
No significant pulmonary toxicity |
1491 |
High rates of Interim PET-negativity |
1492 |
Promising Preliminary Efficacy |
1493 |
Overview: 4 Cohorts |
1494 |
Cohorts 2-4: Definition of disease bulk |
1495 |
13-034 Cohort 2 Study Design, N=29 |
1496 |
13-034 Cohort 3 Study Design, N=29 |
1497 |
Consolidation Volume Radiotherapy / Residual Site Radiotherapy |
1498 |
13-034 Cohort 4 Study Design |
1499 |
Phase III Frontline HL (ECHELON-1) |
1500 |
Slide Number 45 |
1501 |
Slide Number 46 |
1502 |
When RT should be considered in “advanced-stage”? |
1503 |
Yahalom Primary CNS Lymphoma |
1504 |
Slide Number 1 |
1504 |
Primary CNS Lymphoma (PCNSL) |
1505 |
Definitions |
1506 |
Primary CNS Lymphoma (PCNSL) |
1507 |
Primary CNS Lymphoma:A unique lymphoma entity |
1508 |
PCNSLEpidemiology |
1509 |
PCNSLEpidemiology |
1510 |
PCNSL in “immunocompetent” hosts |
1511 |
Primary CNS Lymphoma |
1512 |
PCNSLSymptoms |
1513 |
Slide Number 11 |
1514 |
Slide Number 12 |
1515 |
Slide Number 13 |
1516 |
PCNSLExtent of Disease |
1517 |
Primary CNS Lymphoma |
1518 |
PCNSL: A unique treatment challenge |
1519 |
PCNSL Baseline Evaluation |
1520 |
PCNSLCT Appearance |
1521 |
PCNSLMRI Appearance |
1522 |
The debated role of RT consolidation |
1523 |
RTOG 83-15 WBRT alone |
1524 |
Slide Number 22 |
1525 |
MSKCC (1986): MTX-WBRT-ARAc |
1526 |
Slide Number 24 |
1527 |
Slide Number 25 |
1528 |
Slide Number 26 |
1529 |
Neurotoxicity by Age |
1530 |
Sites of PCNSL |
1531 |
Slide Number 29 |
1532 |
PCNSL - Neurotoxicity |
1533 |
PCNSL- Neurotoxicity |
1534 |
Slide Number 32 |
1535 |
Slide Number 33 |
1536 |
Slide Number 34 |
1537 |
Slide Number 35 |
1538 |
Hypothesis |
1539 |
Chemotherapy Schedule |
1540 |
RT Schedule |
1541 |
Slide Number 39 |
1542 |
Slide Number 40 |
1543 |
Slide Number 41 |
1544 |
Slide Number 42 |
1545 |
70 year old lady with severe headachesStereotactic biopsy- Diffuse large B-Cell Lymphoma |
1546 |
Randomized on RTOG-MSKCC protocol to receive low-dose RT after CR to R-MPV |
1547 |
RT Dose- 23.4 Gy (1.8 Gy X13) |
1548 |
Role of RT in PCNSL |
1549 |
Salvage of chemotherapy alone failures (MSKCC) |
1550 |
Salvage of chemotherapy alone failures (MGH) |
1551 |
RT in PCNSL: Field design |
1552 |
Slide Number 50 |
1553 |
RT in PCNSL: Dose |
1554 |
Slide Number 52 |
1555 |
RT in PCNSL – Take home |
1556 |
Yahalom- RT for relapsed indolent |
1557 |
Slide Number 1 |
1557 |
RT for relapsed indolent lymphomas |
1558 |
General Treatment Options |
1559 |
Field Design Concept |
1560 |
RT Dose for Palliation |
1561 |
Slide Number 6 |
1562 |
STUDY DESIGN |
1563 |
INDOLENT LYMPHOMAS: Local Control |
1564 |
INDOLENT LYMPHOMAS: PFS |
1565 |
INDOLENT LYMPHOMAS: Overall Survival |
1566 |
Slide Number 11 |
1567 |
Slide Number 12 |
1568 |
Slide Number 13 |
1569 |
Slide Number 14 |
1570 |
Slide Number 15 |
1571 |
Slide Number 16 |
1572 |
FoRT: A phase III multi-centre randomised controlled trial of low dose radiotherapy for follicular and marginal zone lymphoma |
1573 |
Slide Number 18 |
1574 |
Slide Number 19 |
1575 |
Slide Number 20 |
1576 |
Slide Number 21 |
1577 |
Slide Number 22 |
1578 |
Slide Number 23 |
1579 |
Slide Number 24 |
1580 |
Slide Number 25 |
1581 |
Whom to Boom-Boom? |
1582 |
Response to very low dose RT is variable |
1583 |
Slide Number 28 |
1584 |
Database creation: Low grade lymphomas treated with 2 Gy x 2 |
1585 |
Initial response predicts local progression free survival |
1586 |
Slide Number 31 |
1587 |
Slide Number 32 |
1588 |
Whole transcriptome profiling with FFPE extracted RNA samples |
1589 |
Whole transcriptome profiling with FFPE extracted RNA samples |
1590 |
Increased expression in CR vs. PR/NR |
1591 |
Decreased expression in CR vs. PR/NR |
1592 |
Slide Number 37 |
1593 |
CR vs. PR/NR Gene Pathways |
1594 |
Conclusions |
1595 |
Future Directions |
1596 |
Thank you! |
1597 |
Yahalom- TBI and BMT |
1598 |
Slide Number 1 |
1598 |
TBI and local RT in the conditioning regimen of BMT of Leukemia |
1599 |
Radiation therapy for leukemia |
1600 |
Cranial irradiation for CNS leukemia |
1601 |
Hematopoietic stem cell transplant (HSCT) |
1602 |
Types of HSCT |
1603 |
Types of HSCs/grafts |
1604 |
Process of HSCT |
1605 |
Total body irradiation as part of conditioning |
1606 |
Indications for HSCT |
1607 |
Biology of TBI |
1608 |
TBI effects on blood |
1609 |
Acute toxicity of TBI |
1610 |
Prophylactic anti-emetics for TBI |
1611 |
Late toxicity of TBI and HSCT |
1612 |
Secondary Malignant Neoplasms after TBI and HSCT |
1613 |
TBI: Techniques |
1614 |
TBI: Simulation Films |
1615 |
TBI: Technique |
1616 |
TBI: Technique (patients <40 cm tall) |
1617 |
TBI: Technique (patients >40 cm tall) |
1618 |
TBI: MSKCC Standing AP/PA Technique |
1619 |
TBI: MSKCC Chest Wall Compensation |
1620 |
TBI: MSKCC Standing AP/PA Technique |
1621 |
TBI: Duke Pediatric Setup |
1622 |
TBI: MSKCC Techniques |
1623 |
TBI: Prescription |
1624 |
TBI is associated with better survival |
1625 |
TBI associated with less veno-occlusive disease (liver complications) |
1626 |
TBI associated with better outcomes in ALL & AML, but not MM |
1627 |
TBI used in non-myeloablative regimens for various diseases |
1628 |
Slide Number 32 |
1629 |
CASE - Aleman case HL_100816_tp |
1630 |
Slide Number 1 |
1630 |
Dutch HL case 29-year old male patient |
1631 |
Dutch HL case |
1632 |
Dutch HL case |
1633 |
Dutch HL casePost biopsy CT-scan |
1634 |
Dutch HL casePost biopsy PETCT-scan |
1635 |
Dutch HL casePost biopsy PETCT-scan |
1636 |
Dutch HL case |
1637 |
Dutch HL case |
1638 |
Dutch HL casePost biopsy PETCT-scan |
1639 |
A bone marrow biopsy was performed, but was this indicated? |
1640 |
What would be your next step? |
1641 |
Dutch HL case |
1642 |
Which treatment would you give? |
1643 |
Slide Number 15 |
1644 |
Dutch HL case |
1645 |
Dutch HL case - IMRT plan |
1646 |
Dutch HL case - IMRT plan |
1647 |
Dutch HL case - continued |
1648 |
Dutch HL case PETCT 92014 |
1649 |
Which systemic treatment would you give for this localized recurrence 6 months after finishing primary treatment? |
1650 |
Would you give consolidation RT to right axilla? |
1651 |
Transplant BRAVE study |
1652 |
Transplant BRAVE study |
1653 |
Dutch HL case - continued |
1654 |
Slide Number 26 |
1655 |
CASE - Aleman case NHL breast_050915_tp |
1656 |
Slide Number 1 |
1656 |
Case extranodal NHL woman born 1973 |
1657 |
Treatment anno 1996 for 23-year old woman with stage IE DLBCL breast? |
1658 |
Case extranodal NHL woman born 1973 |
1659 |
Case extranodal NHL woman born 1973 |
1660 |
Case extranodal NHL woman 1973 |
1661 |
What would be your next step? |
1662 |
Case extranodal NHL woman born 1973 |
1663 |
Case extranodal NHL woman born 1973 |
1664 |
What is the stage? |
1665 |
How would you treat this patient? |
1666 |
RT dose in case of metabolic CR after 3 R-CHOP? |
1667 |
Case extranodal NHL woman born 1973 |
1668 |
Case extranodal NHL woman born 1973 |
1669 |
Case extranodal NHL woman born 1973 |
1670 |
CASE - Aleman case_duodenal NHL_04091515_tp |
1671 |
Slide Number 1 |
1671 |
Case extranodal NHL woman born 1981 |
1672 |
Case extranodal NHL woman born 1981 |
1673 |
What would you do? |
1674 |
Target volume radiotherapy? |
1675 |
In case of RT what dose would you give? |
1676 |
Case extranodal NHL woman born 1981 |
1677 |
Case extranodal NHL woman born 1981 |
1678 |
CASE - Davies_ESTRO_Extra nodal case_Sept 2016 |
1679 |
Slide Number 1 |
1679 |
Female 67 |
1680 |
Slide Number 3 |
1681 |
What therapy would you offer? |
1682 |
Slide Number 5 |
1683 |
IELSG 32 |
1684 |
Slide Number 7 |
1685 |
The addition of thiotepa and rituximab to MTX-ARAC (MATRIX) is associated with significantly improved CRR and ORR. |
1686 |
Positive effect was observed in all three IELSG risk groups |
1687 |
Preliminary results suggest a positive effect of these drugs on PFS |
1688 |
Addition of Rituximab + Thiotepa have a positive impact on OS |
1689 |
There is a good response to therapy. Residual changes on imaging. CR(u)ECOG 0 nowWhat next? |
1690 |
CASE - Davies_ESTRO_PMBL case_Sept 2016 |
1691 |
Slide Number 1 |
1691 |
Primary Mediastinal B-Cell Lymphoma |
1692 |
Female 32 years old |
1693 |
Slide Number 4 |
1694 |
Slide Number 5 |
1695 |
Slide Number 6 |
1696 |
Clinical Characteristics |
1697 |
Slide Number 8 |
1698 |
Slide Number 9 |
1699 |
Slide Number 10 |
1700 |
Which immunochemotherapy would you offer? |
1701 |
Slide Number 12 |
1702 |
Slide Number 13 |
1703 |
Slide Number 14 |
1704 |
Slide Number 15 |
1705 |
Slide Number 16 |
1706 |
Slide Number 18 |
1707 |
Slide Number 19 |
1708 |
Slide Number 20 |
1709 |
Slide Number 21 |
1710 |
Slide Number 22 |
1711 |
Assuming confined to mediastinum...what is your RT plan? |
1712 |
Slide Number 24 |
1713 |
Slide Number 25 |
1714 |
Slide Number 26 |
1715 |
Visual analysis: the 5-point scale (Deauville criteria, 2009) |
1716 |
Slide Number 28 |
1717 |
Slide Number 29 |
1718 |
Slide Number 30 |
1719 |
ESMO Guideline |
1720 |
Summary: PMBL |
1721 |
CASE - Illidge - 2 case studies indolent lymphoma 010915 - TP |
1722 |
Case studies and interactive questions in Indolent lymphomas |
1722 |
Follicular lymphoma nodal case presentation |
1723 |
45 year old man with retroperitoneal mass |
1724 |
45 year old man with retroperitoneal mass |
1725 |
How would you treat this 45 year old man with retroperitoneal mass ? |
1726 |
How would you treat this 45 year old man with retroperitoneal mass ? |
1727 |
What ISRT does would you use to treat this retroperitoneal mass ? |
1728 |
Case study orbital lymphoma |
1729 |
Case study orbital lymphoma |
1730 |
Case study orbital lymphoma |
1731 |
RTP scan for bilateral orbital lymphoma |
1732 |
Staging confirms disease localised to orbits only – How would you treat ? |
1733 |
What radiotherapy technique would you use ? |
1734 |
Staging confirms disease localised to orbits only – what dose of RT? |
1735 |
CASE - Mikhaeel - Agg NHL case - TP |
1736 |
Slide Number 1 |
1736 |
Aggressive Nodal NHLCase discussion |
1737 |
Clinical History |
1738 |
Diagnosis: |
1739 |
Staging and prognostic factors |
1740 |
Slide Number 6 |
1741 |
MDM & treatment planIPI = 1, stage 2A bulky |
1742 |
Points for discussion |
1743 |
Slide Number 9 |
1744 |
Further management |
1745 |
Points for discussion |
1746 |
Change of RCHOP in DLBCL |
1747 |
Slide Number 13 |
1748 |
Further management |
1749 |
Points for discussion |
1750 |
Timing of peri-transplant RT |
1751 |
MDM decision |
1752 |
Slide Number 18 |
1753 |
RT |
1754 |
Slide Number 20 |
1755 |
Slide Number 21 |
1756 |
Slide Number 22 |
1757 |
Slide Number 23 |
1758 |
CASE - Ricardi_Clinical Case HL |
1759 |
Slide Number 1 |
1759 |
Slide Number 2 |
1760 |
Slide Number 3 |
1761 |
Slide Number 4 |
1762 |
Slide Number 5 |
1763 |
Slide Number 6 |
1764 |
Slide Number 7 |
1765 |
Slide Number 8 |
1766 |
Slide Number 9 |
1767 |
Which salvage therapy? |
1768 |
Which salvage therapy? |
1769 |
Slide Number 12 |
1770 |
Slide Number 13 |
1771 |
Slide Number 14 |
1772 |
Slide Number 15 |
1773 |
Slide Number 16 |
1774 |
Slide Number 17 |
1775 |
Slide Number 18 |
1776 |
Further therapy needed? |
1777 |
Slide Number 20 |
1778 |
Slide Number 21 |
1779 |
Case 1, inguinal FL, Lena Specht |
1780 |
Slide Number 1 |
1780 |
Case 1: Follicular lymphoma in inguinal lymph nodes |
1781 |
48 year old male, March 2012 |
1782 |
Staging PET/CT: CS IA (right groin) |
1783 |
How would you treat this patient ? |
1784 |
Contouring for ISRT |
1785 |
Treatment plan |
1786 |
After radiotherapy |
1787 |
PET/CT |
1788 |
Excisional biopsy of enlarged PET+ lymph node |
1789 |
How would you treat this patient now? |
1790 |
Contouring for ISRT |
1791 |
Treatment plan |
1792 |
After second radiotherapy |
1793 |
Case 2, lung MALT, Lena Specht |
1794 |
Slide Number 1 |
1794 |
Case 2; Marginal zone lymphoma in left lung |
1795 |
60 year old female from Greenland, February 2014 |
1796 |
Staging |
1797 |
PET/CT in deep inspiration breath hold |
1798 |
How would you treat this patient? |
1799 |
Contouring for ISRT in deep inspiration breath hold |
1800 |
Treatment plan |
1801 |
After radiotherapy |
1802 |
Case 3, maxillary DLBCL, Lena Specht |
1803 |
Slide Number 1 |
1803 |
Case 3: DLBCL in left maxilla |
1804 |
87 year old male, December 2014 |
1805 |
Staging |
1806 |
PET/CT: CS IEA |
1807 |
How would you treat this patient? |
1808 |
Treatment |
1809 |
Contouring for ISRTpre-chemo PET+ volume (left) and post-chemo CTV (right) |
1810 |
Contouring for ISRTpre-chemo PET+ volume (left) and post-chemo CTV (right) |
1811 |
Contouring for ISRTpre-chemo PET+ volume (left) and post-chemo CTV (right) |
1812 |
Treatment plan |
1813 |
After chemo-radiotherapy |
1814 |
Case 4, tonsillar mantle cell lymphoma, Lena Specht |
1815 |
Slide Number 1 |
1815 |
Case 4: Mantle cell lymphoma in right tonsil and neck |
1816 |
70 year old male, May 2014 |
1817 |
Staging: CS IIA |
1818 |
Staging CT-scan |
1819 |
How would you treat this patient? |
1820 |
Treatment |
1821 |
Contouring for ISRT pre-chemo GTV, post-chemo CTV |
1822 |
Treatment plan |
1823 |
After chemo-radiotherapy |
1824 |
Case 5, nasopharyngeal DLBCL, Lena Specht |
1825 |
Slide Number 1 |
1825 |
Case 5: DLBCL in right nasopharynx |
1826 |
70 year old male, June 2014 |
1827 |
Staging |
1828 |
PET/CT: CS IEA |
1829 |
How would you treat this patient |
1830 |
Treatment |
1831 |
Contouring for ISRT pre-chemo PET+ lymphoma and post-chemo CTV |
1832 |
Contouring for ISRT pre-chemo PET+ lymphoma and post-chemo CTV |
1833 |
Treatment plan |
1834 |
After chemo-radiotherapy |
1835 |