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What is Mantel radiation therapy for - and explain in detail?
(A) (Hodgkins lymphoma) (1227 - 28 CSDT 13th) (306 - S.Das 7th)Mantel field radiation - is a type of extended field radiation administered occasionally in hodgken's lymphoma.Radiation is delivered to a large area of the neck, chest and armpits to cover all the main lymph node areas in the upper half of the body. A part of the lung, heart and the shoulder are shielded from the radiation beam to reduce the side effects. The term 'mantel' is derived from the name of a garment much like a cloak. Used many years back. The shape of the radiation field resembles the shape this cloak.HODGKIN LYMPHOMA:* Disease of young adults.* Incidence appears to be highter with a lower member of siblings, early birth order, sibling with Hodgkin's disease, decreased number of playmates, certain HLAs single family swellings, and patients who have under gone tonsillectomy.* Nuclear proteins of Epstein Barr Virus have been detected in about 40% of classical Hodgkin lymphoma.* Most common presentation is nontender palpable lymphadenopathy in the neck.* Pel-Ebstein Fever - Fevers persists for days to weeks, followed by afebrile intervals and then recurrence of the fever.* Occasionally unusual presentation - severe unexplanined itching, (Erythema nodosum and icthyosiform atrophy) Paraneoplastic cerebellar degeneration, nephrotic syndrome, immune hemolytic anemia and thrombocytopenia, hypercalcemia and pain in lymph nodes on alcohol ingestion.* Diagnosis based on Read Sternberg cells.* PET and Gallium scans are most useful to document remissions.TREATMENT:* Patients with localized Hodgkin's disease are cured >90deg% of the time.* Most widely used treatment ABVD (doxorubicin, becomycin, vinblastine and decarbacine).* Most serious late side effects - Acute leukemia, cardiac injury, hypothyroidism, Lhermitte's syndrome,Infertility.MANTEL CELL LYMPHOMA (928 - H 18lh)* Makes up ~ 6% all non Hodgkins lymphoma.* Characteristic chromosomal translocation t (11:14) between the immunoglobulin heavy chain gene on chromosome 14 and the bcl-1 gene on chromosome 11 and regularly over express the bcl-1 protein, also known as cyclin-Dl.* Mantle cell and small lymphocytic lymphoma share a characteristic expression of CD5.* Most common presentation is palpable lymphadenopathy.* Median age is 63 years and men are affected four times as commonly as women.* Approximately 70% of patient will be stage IV at the time of diagnosis. With frequent bone marrow and peripheral blood involvement.* GI involvement - lymphomatous polyposis in the large intestine.* Current therapy is combination chemotherapy followed by radiotherapy.