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8-16-Engert-chemotherapy.pdf 		1
Slide Number 1 		1
Chemotherapy of malignant lymphoma 		2
Slide Number 3 		3
Slide Number 4 		4
Slide Number 5 		5
Slide Number 6 		6
Slide Number 7 		7
Slide Number 8 		8
Slide Number 9 		9
Slide Number 10 		10
Slide Number 11 		11
Slide Number 12 		12
Slide Number 13 		13
Slide Number 14 		14
Slide Number 15 		15
Slide Number 16 		16
Slide Number 17 		17
HL treated with MOPP and ABVD Patients in advanced stages 		18
US Intergroup Trial E2496 ABVD vs Stanford V in Advanced Stages 		19
Slide Number 20 		20
Slide Number 21 		21
GHSG HD9 trial FFTF by treatment arm 		22
GHSG HD9 trial OS by treatment arm 		23
Slide Number 24 		24
Brentuximab Vedotin Mechanism of action 		25
ECHELON-1: Phase III Trial BV + AVD vs. ABVD in frontline advanced cHL 		26
Slide Number 27 		27
Slide Number 28 		28
Slide Number 29 		29
Slide Number 30 		30
Non Hodgkin lymphoma Subtypes 		31
Slide Number 32 		32
Slide Number 33 		33
Slide Number 34 		34
GELA LNH-98.5: Trial design 		35
GELA LNH-98.5 10-year follow-upOverall survival 		36
Standard Regimen for DLBCL Patients 		37
Results with R-CHOP in DLBCL 		38
How to further improve DLBCL 		39
Slide Number 40 		40
Slide Number 41 		41
Slide Number 42 		42
Slide Number 43 		43
Slide Number 44 		44
Slide Number 45 		45
Slide Number 46 		46
Slide Number 47 		47
International Hodgkin Symposium12.-15.10.2013, Köln, Gürzenich 		48
Aggressive NHL: Prognostic factors - aaIPI 		49
2016 0815-Engert-advanced stages 		50
Slide Number 1 		50
Treatment of advanced stage Hodgkin lymphoma 		51
Slide Number 3 		52
Hodgkin Lymphom – Historische PrognoseÜberleben von Hodgkin-Patienten in Köln 1960 bis 1967Alle Stadien, n=109 		53
Long-term Results of HL Patients in advanced Stages 		54
Slide Number 6 		55
Slide Number 7 		56
Hodgkin LymphomaCumulative relative survival of HL pts in Sweden 		57
Slide Number 9 		58
Slide Number 10 		59
Slide Number 11 		60
GHSG HD9 trial FFTF by treatment arm 		61
GHSG HD9 trial OS by treatment arm 		62
Slide Number 14 		63
HD12 pts with no bulk and no rest (PFS n=388) 		64
HD12 patients with bulk only (PFS; n=402) 		65
HD12 pts with bulk and rest (PFS n=613) 		66
Slide Number 18 		67
Reconstructed individual OS ABVD versus 6xBEACOPPesc 		68
TRM of BEACOPP escalated* Multivariate model 		69
ECHELON-1: Phase III Trial BV + AVD vs. ABVD in frontline advanced cHL 		70
BV: Increased Pulmonary Toxicity Phase I Combination of BV and ABVD 		71
Slide Number 23 		72
Slide Number 24 		73
Slide Number 25 		74
Slide Number 26 		75
Slide Number 27 		76
Slide Number 28 		77
Slide Number 29 		78
Slide Number 30 		79
Slide Number 31 		80
GHSG HD18 trial for advanced stages 		81
Slide Number 33 		82
Slide Number 34 		83
RATHL: Impact of BleomycinPFS for PET-negative patients (ITT) 		84
UK RATHL TrialPFS for PET-negative patients (ITT) 		85
Comparing RATHL and HD18PFS at 3 years 		86
Slide Number 38 		87
Slide Number 39 		88
Advanced stage HLSummary 		89
International Hodgkin Symposium12.-15.10.2013, Köln, Gürzenich 		90
2016 0815-Engert-R&R HL 		91
Slide Number 1 		91
Relapsed and refractoryHodgkin Lymphoma 		92
Slide Number 3 		93
Slide Number 4 		94
Slide Number 5 		95
Slide Number 6 		96
Relapsed Hodgkin Lymphoma Selected conventional salvage regimen 		97
HDR2: European Intergroup TrialRelapsed Hodgkin Lymphoma* 		98
Slide Number 9 		99
Slide Number 10 		100
Slide Number 11 		101
Slide Number 12 		102
Slide Number 13 		103
Brentuximab Vedotin (SGN-35) Mechanism of action 		104
Slide Number 15 		105
Random. Phase III (AETHERA)BV in HL pts after auto-TX 		106
Slide Number 17 		107
Slide Number 18 		108
Slide Number 19 		109
Slide Number 20 		110
Slide Number 21 		111
Slide Number 22 		112
Slide Number 23 		113
114
Slide Number 25 		115
Slide Number 26 		116
Slide Number 27 		117
Slide Number 28 		118
Slide Number 29 		119
International Hodgkin Symposium12.-15.10.2013, Köln, Gürzenich 		120
2016 0824 Engert_current approaches_slides 		121
Slide Number 1 		121
Current approaches and emerging therapies in the treatment of malignant lymphoma 		122
Slide Number 3 		123
Slide Number 4 		124
Slide Number 5 		125
Slide Number 6 		126
Slide Number 7 		127
Slide Number 8 		128
Slide Number 9 		129
Slide Number 10 		130
Slide Number 11 		131
Slide Number 12 		132
Slide Number 13 		133
Slide Number 14 		134
Slide Number 15 		135
Slide Number 16 		136
Slide Number 17 		137
Slide Number 18 		138
HL treated with MOPP and ABVD Patients in advanced stages 		139
US Intergroup Trial E2496 ABVD vs Stanford V in Advanced Stages 		140
Slide Number 21 		141
Slide Number 22 		142
GHSG HD9 trial FFTF by treatment arm 		143
GHSG HD9 trial OS by treatment arm 		144
Slide Number 25 		145
How can we improve BEACOPPescalated? 		146
Slide Number 27 		147
Brentuximab Vedotin Mechanism of action 		148
ECHELON-1: Phase III Trial BV + AVD vs. ABVD in frontline advanced cHL 		149
Slide Number 30 		150
Slide Number 31 		151
Slide Number 32 		152
Slide Number 33 		153
Non Hodgkin lymphoma Subtypes 		154
Slide Number 35 		155
Slide Number 36 		156
Slide Number 37 		157
GELA LNH-98.5: Trial design 		158
GELA LNH-98.5 10-year follow-upOverall survival 		159
Standard Regimen for DLBCL Patients 		160
Aggressive NHL: Prognostic factors - aaIPI 		161
Results with R-CHOP in DLBCL 		162
How to further improve DLBCL 		163
DLBCL: Higher dose regimen 		164
DLBCL: Salvage therapy 		165
DLBCL: Conclusions 		166
Slide Number 47 		167
Slide Number 48 		168
Slide Number 49 		169
Slide Number 50 		170
Slide Number 51 		171
Slide Number 52 		172
Slide Number 53 		173
Slide Number 54 		174
2016 0824-Engert-CMT 		175
Slide Number 1 		175
Combined Modality Treatment of Hodgkin Lymphoma 		176
Slide Number 3 		177
Hodgkin LymphomaCumulative relative survival of HL pts in Sweden 		178
Slide Number 5 		179
Slide Number 6 		180
Slide Number 7 		181
Slide Number 8 		182
Hodgkin Lymphoma Evolution of Radiotherapy 		183
Slide Number 10 		184
Slide Number 11 		185
Slide Number 12 		186
Slide Number 13 		187
Slide Number 14 		188
Slide Number 15 		189
HD10: Long-term outcome 		190
Slide Number 17 		191
Slide Number 18 		192
HD13: Progression-free survivalAll patients (ITT) 		193
HD13: Overall survivalAll patients (ITT) 		194
Slide Number 21 		195
Slide Number 22 		196
Slide Number 23 		197
Slide Number 24 		198
Slide Number 25 		199
HD11: Long-term Outcome 		200
Slide Number 27 		201
Slide Number 28 		202
Slide Number 29 		203
UK NCRI RAPID trialEarly stage HL 		204
H10 (#20051): study design 		205
H10 (#20051): study design 		206
UK RAPID; EORTC/LYSA H10 RT or no RT in PET-negative early stage HL 		207
Slide Number 34 		208
EORTC/GELA/IIL H10 StudyAccrual 2006 - 2011 		209
Slide Number 36 		210
Slide Number 37 		211
Slide Number 38 		212
New Antibodies and Moleculesin Malignant Lymphoma 		213
Brentuximab Vedotin (SGN-35) Mechanism of action 		214
Slide Number 41 		215
Phase II Pivotal Study of BVSafety (AEs in ≥20% of pts) 		216
Slide Number 43 		217
Slide Number 44 		218
Slide Number 45 		219
Slide Number 46 		220
Slide Number 47 		221
Slide Number 48 		222
Slide Number 49 		223
PD-1 Blockade in HLBackground 		224
Aleman case_duodenal NHL_020916_tp 		225
Slide Number 1 		225
Case extranodal NHL woman born 1981 		226
Case extranodal NHL woman born 1981 		227
What would you do? 		228
Target volume radiotherapy? 		229
In case of RT what dose would you give? 		230
Case extranodal NHL woman born 1981 		231
Case extranodal NHL woman born 1981 		232
Aleman_aggressive nodal NHL_RT volume dose and technique_draft_010916 		233
Slide Number 1 		233
Aggressive nodal NHL, the role of RT: volume, dose and technique 		234
Aggressive nodal NHL, the role of radiotherapy: volume, dose and technique 		235
Aggressive nodal NHL – early stageTarget volume 		236
Aggressive nodal NHL – early stageTarget volume 		237
Aggressive nodal NHL – advanced stageTarget volume 		238
Aggressive nodal NHL – refractory diseaseTarget volume 		239
Slide Number 8 		240
Slide Number 9 		241
30 Gy vs 40-45 Gy 		242
Slide Number 11 		243
Slide Number 12 		244
Palliative radiotherapy 		245
Slide Number 14 		246
Palliative radiotherapy 		247
Slide Number 16 		248
RT technical isssues 		249
Aggressive nodal NHL- early stagePrinciples of ISRT for Nodal Sites 		250
Slide Number 19 		251
Questions? 		252
Aleman_breast lyphoma_draft_290816 		253
Slide Number 1 		253
Extranodal lymphomas: Characteristics, the role of radiotherapy, volumes doses and techniques:Primary breast lymphoma 		254
Breast lymphoma 		255
Literature 		256
Primary diffuse large B-cell lymphoma of the breast:a study by the International Extranodal Lymphoma Study Group 		257
Primary diffuse large B-cell lymphoma of the breast:a study by the International Extranodal Lymphoma Study Group 		258
Primary diffuse large B-cell lymphoma of the breast:a study by the International Extranodal Lymphoma Study Group 		259
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 		260
Primary diffuse large B-cell lymphoma of the breast:a study by the International Extranodal Lymphoma Study Group 		261
Primary diffuse large B-cell lymphoma of the breast:a study by the International Extranodal Lymphoma Study Group 		262
Suggested algorithm for newly diagnosed PB-DLBCL 		263
Suggested algorithm for newly diagnosed PB-DLBCL 		264
Follicular and marginal zone primary breast lymphoma (PBL): results from International Extranodal Lymphoma Study Group 		265
Follicular and marginal zone primary breast lymphoma (PBL): results from International Extranodal Lymphoma Study Group 		266
15-year PFS and OS in follicular and marginal zone primary breast lymphoma 		267
15-year cause specific survival in follicular and marginal zone primary breast lymphoma 		268
Follicular and marginal zone primary breast lymphoma (PBL): results from International Extranodal Lymphoma Study Group 		269
Breast Implant–Associated Anaplastic Large-Cell Lymphoma 		270
Proposed TNM Staging for Breast Implant–Associated Anaplastic Large-Cell Lymphoma 		271
Breast Implant–Associated Anaplastic Large-Cell Lymphoma(retrospective analysis 87 patients) 		272
Breast Implant–Associated Anaplastic Large-Cell Lymphoma(retrospective analysis 87 patients) 		273
Breast Implant–Associated Anaplastic Large-Cell Lymphoma(retrospective analysis 87 patients) 		274
Radiotherapy 		275
Breast lymphoma 		276
Breast lymphoma 		277
49-year old woman with DLBCL right breast in CR after chemo 		278
Breast lymphoma 		279
Questions? 		280
Aleman_late effects after HL_2016_for participants 		281
Slide Number 1 		281
Long term toxicityLate effects after Hodgkin lymphoma: incidence and clinical implications 		282
Content 		283
Slide Number 4 		284
Survival after Hodgkin lymphoma 		285
HL treatment changes since 1965 		286
HL treatment changes since 1965 		287
Slide Number 8 		288
Causes of second cancers 		289
Causes of second cancers in relation to age 		290
Slide Number 11 		291
Slide Number 12 		292
Risks of Second Malignancy following HL combined results from 3 large studies* (n=9618) 		293
Survival outcome after a second malignancyn=1319 ; treatment period: 1969 and 1997; median fup 12 years. 		294
Survival outcome after a second malignancyn=1319 ; treatment period: 1969 and 1997; median fup 12 years. 		295
Relative risks of SMN by age at HL diagnosis 		296
Slide Number 17 		297
From mantle field to IFRT 		298
Slide Number 19 		299
Slide Number 20 		300
Slide Number 21 		301
Slide Number 22 		302
Literature on CRC risk after HL or childhood cancer and in A-bomb survivors 		303
Slide Number 24 		304
SIR & AER of CRC in 2,820 5-year Dutch HL survivors, diagnosed<51 years, treated1965-1995; median fup 21.5 years 		305
Risk of CRC by HL treatment 		306
Clinical implications 		307
Slide Number 28 		308
Slide Number 29 		309
Slide Number 30 		310
Slide Number 31 		311
Slide Number 32 		312
Solid tumor risk by follow up intervalDutch 5 year HL survivors treated 1965-2000 at age 15-51 years (n=3,905) 		313
Cumulative incidence any SMN by period 		314
Cumulative incidence of solid tumors by treatment period 		315
Cumulative incidence of leukemia (excluding MDS) 		316
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 		317
Conclusions 		318
Summary SMN 		319
Causes cardiovascular damage 		320
Slide Number 41 		321
Cardiovascular toxicity Differences in mechanisms 		322
Literature cardiovascular disease after HL 		323
Morbidity of cardiovascular disease (all events in 2524 5-year survivors of HL treated before age 51 between 1965-1995) 		324
HL treatment 		325
Nested case-control studies 		326
Nested case-control studies 		327
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 		328
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 		329
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 		330
Dose-response by tertiles of age at HL treatment 		331
Dose-associated cumulative incidence 		332
Established CVD Risk factors 		333
Established CVD Risk factors 		334
Conclusions ischemic heart disease after HL 		335
Cumulative incidence of all and first cardiovascular disease (in 2524 5-year survivors of HL treated before age 51 between 1965-1995) 		336
Heart failure after HL (1st event) 		337
Conclusions CVD after HL(literature and Dutch HL cohort) 		338
Anthracyclines 		339
Cardiovascular disease after therapy for HL: A detailed analysis of 9 collaborative EORTC-LYSA trials 		340
CVD after therapy for HL: A detailed analysis of 9 collaborative EORTC-LYSA trials 		341
Cardiovascular disease after therapy for HL: A detailed analysis of 9 collaborative EORTC-LYSA trials 		342
Cardiovascular disease after therapy for HL: A detailed analysis of 9 collaborative EORTC-LYSA trials 		343
Cardiovascular disease after therapy for HL: A detailed analysis of 9 collaborative EORTC-LYSA trials 		344
Optimize treatment ? 		345
Treatment optimization: 		346
Slide Number 67 		347
Limit risk of (treatment -related) side effectsPatient 		348
Slide Number 69 		349
Future 		350
Acknowledgements 		351
Aleman_testicular lymphoma_draft_290816 		352
Slide Number 1 		352
Extranodal lymphomas: Characteristics, the role of radiotherapy, volumes doses and techniques:Testicular lymphoma 		353
Testicular lymphoma 		354
Testicular lymphoma 		355
Slide Number 5 		356
Slide Number 6 		357
Slide Number 7 		358
Primary testicular diffuse large B-cell lymphoma displays distinct clinical and biological features for treatment failure in rituximab era: a report from the International PTL Consortium (n=280; 1993-2014) 		359
Primary testicular diffuse large B-cell lymphoma displays distinct clinical and biological features for treatment failure in rituximab era: a report from the International PTL Consortium (n=280; 1993-2014) 		360
Primary testicular diffuse large B-cell lymphoma displays distinct clinical and biological features for treatment failure in rituximab era: a report from the International PTL Consortium (n=280; 1993-2014) 		361
Prognostic factors for PFS in PTL 		362
Testicular lymphoma 		363
Testicular lymphomaProphylactic RT contralateral testicle 		364
Setup radiotherapy testicle 		365
Testicular lymphoma 		366
Testicular lymphoma 		367
Aznar_HemMal_2016_template 		368
Slide Number 1 		368
Deep inspiration breath hold in thoracic tumours: imaging and treatmentMarianne C Aznar 		369
At Rigshospitalet 		370
Lymphoma: a special case 		371
Fusing prechemo and planning images 		372
DIBH through the whole imaging chain 		373
Rigshospitalet (The Finsen Center) 		374
How to handle registration uncertainties ? 		375
Respiration monitoring 		376
CT + PET/CT 		377
Slide Number 11 		378
Slide Number 12 		379
Take home message (1) 		380
PET/CT acquisition in practice 		381
Methods: Image reconstruction 		382
Some problems at start-up !! 		383
Results: reduced respiration artifacts 		384
Registration for contouring 		385
Mediastinal lymphomaFree breathing vs. inspiration breath hold 		386
Breath hold decreases the exposure of healthy tissues 		387
Mean dose to lungs: 8.5Gy vs 12.8 Gy 		388
Benefit: inter-patient variation 		389
Benefit: over the whole group 		390
DIBH + VMAT/IMRT 		391
Combining DIBH and VMAT 		392
Take home message (2): treatment planning 		393
Position verification in DIBH 		394
Daily 2D images: fuse on spine, check sternum 		395
Can check heart position and lung inflation 		396
Some challenges with CBCT in DIBH 		397
Some possible compromises… 		398
A note about margins… 		399
Take home message (3): treatment delivery 		400
Conclusion 		401
Next frontiers? 		402
DIBH and proton therapy? 		403
TEDDI 		404
Acknowledgments 		405
Keep breathing  		406
Extra slides 		407
Slide Number 41 		408
Our experience with DIBH for breast cancer 		409
DIBH + IMRT/RA 		410
Fixed beam IMRT (sliding window)RPM integrated with linacBeam switches on and off automatically 		411
DIBH + RA 		412
What to choose: IMRT? DIBH or both? 		413
Results: Dose 		414
Results: Excess absolute risk (%) 		415
Results: Life years lost (y) 		416
Position verification in DIBH 		417
Summary and future work 		418
DIBH for lung cancer? 		419
Slide Number 53 		420
Slide Number 54 		421
Potential of DIBH in lung cancer 		422
Potential of DIBH in lung cancer 		423
Slide Number 57 		424
Slide Number 58 		425
Titles in Arial 		426
Slide Number 60 		427
Berthelsen - ESTRO Wien 2016 		428
Contouring workshop, Lena Specht 		461
Davies_ESTRO_MZL systemic therapies_sept 2016 		477
Slide Number 1 		477
Systemic approaches to early and advanced marginal zone lymphoma 		478
The faces of MZL 		479
Splenic Marginal Zone Lymphoma 		480
Slide Number 5 		481
Slide Number 6 		482
Slide Number 7 		483
Slide Number 8 		484
Rituximab 		485
Outcomes in patients with splenic marginal zone lymphoma and marginal zone lymphoma treated with rituximab with or without chemotherapy or chemotherapy alone 		486
Slide Number 11 		487
RESORT trial 		488
Slide Number 13 		489
Slide Number 14 		490
Slide Number 15 		491
Nodal MZL 		492
BR vs. R-CHOP as First Line Treatment in Patients with Indolent and Mantle Cell Lymphomas (MCL): Updated Results from the StiL NHL1 Study 		493
Slide Number 18 		494
Slide Number 19 		495
Slide Number 20 		496
Slide Number 21 		497
Slide Number 22 		498
Slide Number 23 		499
Extranodal MZL 		500
Slide Number 25 		501
Slide Number 26 		502
Slide Number 27 		503
Slide Number 28 		504
IELSG 19 		505
IELSG 19 		506
Slide Number 31 		507
Slide Number 32 		508
Lenalidomide 		509
The R2 regimen (Fowler at al. Lancet Oncol 2014) 		510
Slide Number 35 		511
Slide Number 36 		512
Toxicity of R2 		513
Exhausted T-cells 		514
Slide Number 39 		515
Slide Number 40 		516
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 		523
B-cell receptor signalling. ..Inhibit and spare the chemotherapy 		524
Slide Number 49 		525
Ibrutinib in B-cell lymphoma 		526
Toxicity 		527
Ibrutininb in Mantle cell 		528
Other inhibitors of PI3K 		529
Slide Number 54 		530
Slide Number 55 		531
Slide Number 56 		532
Slide Number 57 		533
Slide Number 58 		534
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 		538
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 		545
ESMO Guidelines 		546
Slide Number 10 		547
…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 		556
Slide Number 20 		557
Slide Number 21 		558
Slide Number 22 		559
Slide Number 23 		560
Slide Number 24 		561
Slide Number 25 		562
Baseline characteristics 		563
Toxicity 		564
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 		577
Slide Number 41 		578
Slide Number 42 		579
Slide Number 43 		580
Differential outcomes with DA-EPOCH-R 		581
Differential outcome in the relapsed setting 		582
But how to distinguish phenotype? 		583
Slide Number 47 		584
Slide Number 48 		585
Slide Number 49 		586
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
R-CVP versus R-CHOP versus R-FM as first-line therapy for advanced-stage follicular lymphoma: Final results of FOLL05 trial from the Fondazione Italiana Linfomi (FIL).Federico et al J Clin Oncol 2013 		681
R-CVP versus R-CHOP versus R-FM as first-line therapy for advanced-stage follicular lymphoma: Final results of FOLL05 trial from the Fondazione Italiana Linfomi (FIL).Federico et al J Clin Oncol 2013 		682
R-CVP versus R-CHOP versus R-FM as first-line therapy for advanced-stage follicular lymphoma: Final results of FOLL05 trial from the Fondazione Italiana Linfomi (FIL).Federico et al J Clin Oncol 2013 		683
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
Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial.Salles G et al Lancet. 2011 Jan 1;377(9759):42-51 		687
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
.Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University.Mac Manus MP, Hoppe RT J Clin Oncol 1996 Apr;14(4):1282-90. 		772
.Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University.Mac Manus MP, Hoppe RT J Clin Oncol 1996 Apr;14(4):1282-90. 		773
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
Treatment of limited stage follicular lymphoma with Rituximab immunotherapy and involved field radiotherapy in a prospective multicenter Phase II trial-MIR trial. Witzens-Harig M, et al BMC cancer. 2011; 11: 87 		779
Treatment of limited stage follicular lymphoma with Rituximab immunotherapy and involved field radiotherapy in a prospective multicenter Phase II trial-MIR trial. Witzens-Harig M, et al BMC cancer. 2011; 11: 87 		780
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
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