Treatment of Lymphoma in the Neck Lymph Nodes

Diagnosis and Staging

The European Society for Medical Oncology recommends diagnosis requires an excisional lymph node biopsy providing adequate tissue for histopathological examination and immunohistochemistry 3, 4
Core biopsies may be appropriate only in patients requiring emergency treatment, as stated by the European Society for Medical Oncology 3, 4
Staging workup should include a contrast-enhanced CT scan of neck, chest, and abdomen, according to the National Comprehensive Cancer Network 5, 6
PET-CT is preferred for accurate staging, as recommended by the European Society for Medical Oncology 5
Bone marrow biopsy is not required if PET-CT is performed, as stated by the European Society for Medical Oncology 1, 5
Complete blood count, ESR, and comprehensive blood chemistry including LDH should be included in the staging workup, as recommended by the European Society for Medical Oncology 6
Screening for hepatitis B, hepatitis C, and HIV is recommended, as stated by the European Society for Medical Oncology 1, 6

For stage IA NLPHL without risk factors, involved-site radiotherapy (ISRT) at 30 Gy alone is standard treatment, as recommended by the European Society for Medical Oncology 1, 2
For classical HL, combined modality therapy with abbreviated chemotherapy followed by involved-field radiation is standard, according to the National Comprehensive Cancer Network 6
Four cycles of ABVD followed by 30 Gy involved-field radiotherapy is standard for intermediate stage HL, as recommended by the European Society for Medical Oncology 6
PET-guided treatment approaches may allow omission of radiotherapy in selected patients with complete metabolic response, though this remains investigational, as stated by the European Society for Medical Oncology 1, 2
Six to eight cycles of ABVD or BEACOPPescalated is recommended for advanced stage HL, as stated by the European Society for Medical Oncology 1, 7
Consolidative radiotherapy may be considered for sites of initial bulky disease, as recommended by the European Society for Medical Oncology 1, 7

Six to eight cycles of R-CHOP given every 21 or 14 days is the standard treatment for CD20+ Large B-cell NHL, as recommended by the European Society for Medical Oncology 3, 4
Treatment strategies should be stratified according to International Prognostic Index (IPI) and patient factors, as stated by the European Society for Medical Oncology 3, 4
R-CHOP has shown promising results in retrospective studies for CD20+ NLPHL, as reported by the European Society for Medical Oncology 1, 2

High-dose chemotherapy followed by autologous stem cell transplantation is the standard of care for relapsed/refractory HL, as recommended by the European Society for Medical Oncology 7
Salvage regimens like DHAP, IGEV, or ICE can be used before high-dose chemotherapy and autologous stem cell transplantation, as stated by the European Society for Medical Oncology 7
Brentuximab vedotin is an option for patients failing autologous stem cell transplantation, as recommended by the European Society for Medical Oncology 7
Nivolumab and pembrolizumab are approved for patients with disease recurrence after high-dose chemotherapy, autologous stem cell transplantation, and brentuximab vedotin therapy, as stated by the European Society for Medical Oncology 7

Interim response evaluation should be conducted during treatment to exclude disease progression, as recommended by the European Society for Medical Oncology 1, 7
PET-CT is preferred for response assessment in FDG-avid lymphomas, as stated by the National Comprehensive Cancer Network 5
Follow-up should include history, physical examination, and laboratory analysis every 3 months for the first half year, every 6 months until the fourth year, and once a year thereafter, as recommended by the European Society for Medical Oncology 1, 7
CT scans should be used to confirm remission status, then only as clinically indicated, as stated by the European Society for Medical Oncology 1, 7
Regular thyroid function monitoring is recommended if the neck was irradiated, as stated by the European Society for Medical Oncology 3, 4, 7

With modern treatment strategies, 80-90% of Hodgkin lymphoma patients achieve permanent remission and can be considered cured, as reported by the European Society for Medical Oncology 1, 2
Prognosis for NHL varies based on subtype, stage, and risk factors, with R-CHOP providing significant improvement in outcomes for B-cell lymphomas, as stated by the European Society for Medical Oncology 3, 4