Management of Young Women With Bulky Mediastinal HL
- The standard of care for patients with bulky mediastinal HL is combined modality therapy. This management approach poses special challenges in young women, because of potential short-term considerations (eg, the need to make decisions about fertility preservation) and long-term effects of therapy (the risk of cardiac disease and second cancers).
- In North America, cooperative group protocols often include patients with bulky stage I–II mediastinal disease together with advanced-stage patients, whereas in Europe additional prognostic factors are used to further risk-stratify patients into an early-stage–unfavorable category. The US Intergroup study ECOG 2496 suggests that for this subset two effective strategies are ABVD for 6 cycles followed by 36 Gy mediastinal radiation therapy (RT) and the Stanford V regimen for 12 weeks followed by 36 Gy involved-field RT.
- Current trials utilize risk-adapted designs based on interim PET scan, refinements of RT (including
reduction of field size and the use of protons), and incorporation of highly effective targeted agents, such as brentuximab vedotin, in frontline regimens.
- Ultimately it is critical to tailor therapy at an individual level in order to maintain high cure rates and minimize toxicity.