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Radiation Oncology

Hematology   

Questions discussed in this category

What dose and fractionation do you use to palliate mycosis fungoides lesions?
There seems to be a wide variety of palliative doses used in clinical practice (8 Gy x1, 2 Gy x2, and 20 Gy in 10 fx). Do you have a preferred dose? D...
1 Answer available
Would you consider a patient with DLBCL to have CNS involvement if no brain lesion is seen on imaging, CSF flow cytometry is negative, but PCR is positive for MYD88 and KMT2D mutations?
1 Answer available
For patients with Stage IIIB or IV HD flowing Bv-AVEPC with initial large mediastinal adenopathy, how can we avoid ISRT?
Per the NCCN guideline for HR HD, if treated per OEPA-COPDAC, you can omit ISRT. This patient received treatment per AHOD1331, which recommends ISRT f...
2 Answers available
Is there a risk of increased side effects with combined radiation and ibrutinib therapy?
Would you change your radiation therapy treatment dose or volume if you needed to treat a chloroma? If a patient had a separate cancer (e.g., skin can...
5 Answers available
For a patient with ENKTL nasal type (nose/sinus involvement) who has hepatic toxicity with pegasparaginase but a CR after 2 cycles of chemotherapy with a plan for "sandwich" radiotherapy - what, if any, chemotherapy would you resume after completion of radiation?
I am not sure there is much efficacy for a regimen that does not include asparaginase. The patient received 2 cycles of P-GemOx, then was admitted for...
2 Answers available
Would you offer lung SBRT in a patient with Pulmonary Langerhans Cell Histiocytosis (PLCH)?
1 Answer available
How would you approach a patient with vitreoretinal lymphoma without CNS or systemic involvement?
What would be your RT volumes and dose?
2 Answers available
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
4 Answers available
What dose and fractionation would you deliver to the sole of the foot in a patient with multifocal cutaneous DLBCL that is resistant to systemic therapy?
2 Answers available
What dose and fields would you use to treat a low grade CNS lymphoma that presents as an isolated single mass in the brain?
The patient has a history of a lymphoplasmacytic lymphoma with a CR after chemotherapy but presented with a large frontal lobe mass that was biopsied ...
2 Answers available
What radiation dose would you use to treat a symptomatic osseous lesion secondary to AL-amyloidosis?
2 Answers available
In the post Covid era, could the ILROG hypofractionated regimens (published as "emergency guidelines" for lymphoma) be considered as standard of care for ISRT?
For example, would you offer 4 Gy x 5 fx (vs 24 Gy/12 fx) in a patient with isolated recurrent follicular lymphoma of the breast after RCHOP and maint...
1 Answer available
Would you consider splenic radiation in stage IV CD5+ DLBCL involving the bone marrow in patients who initially presented with symptomatic splenomegaly, anemia, and thrombocytopenia but achieved complete response on PET after 6 cycles of R-miniCHOP?
2 Answers available
In a patient with amyloidosis and abnormal liver function but child Pugh A, would you still proceed with SABR for a liver metastasis?
1 Answer available
How would you manage a gastric MALT patient with anemia and peri-gastric and abdominal retrocaval nodal involvement?
Would you offer palliative (4 Gy) radiation therapy to the stomach mass vs. definitive doses (24 - 30 Gy) encompassing all of the disease? 
1 Answer available
How are you utilizing vibratory devices for reducing pain associated with injection or procedures?
In which situations or patient populations do you find this useful? How is it sterilized?
3 Answers available
How would you manage a pre-menopausal woman with extranodal marginal zone lymphoma confined to the bladder wall?
Given pelvic RT is likely to induce ovarian dysfunction/menopause, would you consider systemic options?
2 Answers available
Does the use of A+AVD versus ABVD affect your decision for consolidation RT for bulky Hodgkin lymphoma?
1 Answer available
How would you manage a primary dural low-grade lymphoma?
Would you consider observation following surgical resection with negative margins? Would you recommend WBRT and/or ISRT? What would be your preferred ...
2 Answers available
How would you optimally manage a small solitary plasmacytoma of the alveolar ridge, including minimizing the risk of dental toxicity?
1 Answer available
Would you treat the mandible if the patients has osteonecrosis from zoledronic acid but also multiple myeloma in this region, biopsy proven?
1 Answer available
What would your radiation field be for a 7.5 cm DLBCL involving the tibia (with pretibial soft tissue involvement) after CR to R-CHOP x6?
Complete response was achieved after cycle 3. What extent of bone would you include?
1 Answer available
How would you approach treatment in a patient with Fanconi anemia and glioblastoma?
1 Answer available
How do you manage acute keratoconjunctivitis following total skin electron therapy (TSET)?
1 Answer available
How do you approach CNS prophylaxis in patients with DLBCL?
Would you follow an algorithm such as the one proposed by Hall et al., PMID 29940062?How do you decide between intrathecal chemotherapy vs systemic th...
1 Answer available
Do you routinely offer consolidation RT to sites of previous bulky disease in stage III and IV Hodgkin's lymphoma who have a complete metabolic response on restaging PET/CT following 6 cycles of ABVD?
In what situations would you feel comfortable omitting RT to bulky disease in stage III/IV Hodgkin's lymphoma?
1 Answer available
Would you recommend consolidative radiation therapy for advanced stage bulky Hodgkin's lymphoma with a delayed complete response after 6 cycles of A-AVD chemotherapy?
Initial tumor size:18 cm. Partial response was achieved after cycle 2 and cycle 6 of chemotherapy. Complete response (Deauville 2, size: 6 cm) was ach...
1 Answer available
Would you recommend radiation to a painful rib fracture in a patient with multiple myeloma on systemic therapy with ongoing response to treatment?
Is there benefit to radiation on top of systemic therapy?
5 Answers available
Would you offer XRT as bridging for all patients with limited pre CAR-T disease or as consolidation for only those with residual PET-avidity on day+30 post CAR-T?
1 Answer available
Would you offer consolidative scrotal RT for patients with bilateral testicular lymphoma involvement s/p bilateral orchiectomy and chemotherapy?
Would your management be different in node + vs. node - patients? What would be your radiation volume and dose?
1 Answer available
Is there an optimal salvage radiation dose for relapsed post-CART disease?
1 Answer available
Would you offer bridging radiation before or after leukapheresis?
Are you concerned about cases where radiation has to be started urgently before leukapheresis?
1 Answer available
How soon after CAR T-cell therapy can salvage radiation be delivered?
3 Answers available
What is your approach to cancer patients who inquire about alternative or complementary treatments?
8 Answers available
What is the best treatment management of low grade early stage follicular lymphoma of the mesentery?
If the mesentery is widely involved with small lesions would this change your management? What if the patient was symptomatic? 
1 Answer available
How will you manage a patient with symptomatic secondary CNS involvement from DLBCL not eligible for HD-MTX?
Would you offer WBRT + boost vs WBRT vs focal treatment/SRS.
2 Answers available
Which patients with relapsed/refractory NHL are appropriate for pre-CAR-T bridging radiation therapy?
2 Answers available
Is there an optimal bridging radiation dose for aggressive B-cell NHL undergoing CAR T-cell therapy?
What influences your decision to proceed with palliative vs. definitive, and standard vs. hypofractionation dosing regimens?
2 Answers available
What hypofractionated radiotherapy dose regimen is acceptable for plasmacytoma?
1 Answer available
Do you recommend postoperative radiation for spinal cord compression DLBCL?
Do you give RT before or after systemic therapy?
1 Answer available
What is the role of radiation therapy in recurrent Rosai-Dorfman disease after surgical resection, which manifests as many cutaneous lesions on the arms and buttocks?
Does the fact that the patient is on methotrexate alter your choice?
2 Answers available
For patients with solitary plasmacytoma of the ureter undergoing definitive XRT (40-50 Gy), what dose constraint do you use for the ureter?
3 Answers available
How do you treat a stage IE DLBCL of the breast?
How many cycles of systemic therapy is recommended? is XRT needed and what XRT dose is recommended?
1 Answer available
How do you manage grade 1-3A Follicle Center Lymphoma of the lower female genital tract, presenting with a cervical mass?
How do you pursue fertility preservation in younger females with this presentation?
1 Answer available
How do you follow patients with Bronchus Associated Lymphoid Tissue Lymphoma treated with 2 Gy x 2 fractions?
1 Answer available
When utilizing ISRT for Hodgkin lymphoma, what volumetric expansions (ITV and PTV) are appropriate on top of the CTV that includes the original pre-systemic therapy disease?
How would these expansions differ based on the anatomic site being treated?
1 Answer available
When do you recommend consolidative XRT for patients with advanced stage (III-IV) DLBCL who achieve CR to chemoimmunotherapy?
What XRT dose do you use? Does the location of the disease (e.g., mediastinum) affect your decision when taking toxicity into account? would you offer...
2 Answers available
In patients with early-stage follicular lymphoma undergoing definitive RT, do you approach grade 3a disease any differently than grade 1-2 (radiation dose, fields/margins, systemic therapy)?
1 Answer available
Would you offer radiation therapy for extramedullary testicular masses in the setting of multiple myeloma?
 Is this considered a sanctuary site from systemic therapy?
2 Answers available
What is the most convenient and reproducible setup for simulation and treatment of the contralateral testis in a primary testicular lymphoma? 
This is an adult patient that is status-post orchiectomy and R-CHOP now requiring prophylactic contralateral testicular radiation. Would you recommend...
1 Answer available
How can oncologists be more collaborative with palliative care physicians?
How can these interactions be improved? 
1 Answer available
How would you approach radiation therapy for indolent T-cell lymphoproliferative disorder of the gastrointestinal tract?
1 Answer available
What is the role of CNS prophylaxis in a healthy patient in their 60s with a large DLBCL of the cranium/dura with brain parenchymal invasion?
Good performance score, 7 cm in size, CSF cytology is negative, MRI complete spine is negative. Would you consider any additional systemic therapy mod...
2 Answers available
Would you consider radiation therapy before chemotherapy in a patient with stage I-II high-grade B-cell lymphoma presenting with a large necrotic skin lesion?
Elderly patient with large fungating necrotic breast mass positive for high grade BCL and a solitary hypermetabolic ipsilateral axillary node. Medical...
3 Answers available
If blood counts are being checked during concurrent chemoradiation, is there a number at which point you would recommend a radiation treatment break?
For example, concerning throbocytopenia or neutropenia during anal cancer treatment with concurrent mitomycin/5FU, or other pelvic malignancies treate...
3 Answers available
What is your approach to treating early stage EBV-positive diffuse large B-cell lymphoma of the elderly after a CR to systemic therapy?
This is a recently described entity with poor prognosis, so even with a CR after RCHOPx6 cycles, is your bias to push for ISRT due to EBV being poor p...
1 Answer available
What dose constraints do you use when treating gastric MALT or DLBCL with radiation therapy?
2 Answers available
For a patient with diffuse large B-cell lymphoma of the testicle, do you irradiate the contralateral testicle alone or do you recommend radiation to the lymphatics and remaining testicle?
1 Answer available
How would you approach a patient with low grade follicular lymphoma (stage IE) of the breast who presents with local recurrence 1 year s/p lumpectomy?
She was on surveillance after lumpectomy. No prior radiation therapy. What dose/fractionation?
2 Answers available
What is your simulation setup and dose fractionation for DLBCL of the hand with Deauville 4 residual disease following R-CHOP?
1 Answer available
What is the recommended radiation treatment volume for a patient with orbital DLBCL who achieved a CR to chemotherapy?
When would you treat the entire orbit versus partial orbit? One patient has medial rectus involvement and another has only conjunctival involvement. I...
1 Answer available
Would you stop hydroxyurea for thrombocytosis in a prostate patient receiving radiation?
1 Answer available
Would you require biopsy of both orbits or is unilateral biopsy adequate for a patient with suspected bilateral orbital MALT lymphoma?
Imaging studies (MRI and PET) show bilateral disease
2 Answers available
Do you hold histone deacetylase (HDAC) inhibitors for patients receiving palliative radiation therapy for cutaneous lymphomas?
If so, how long before/after radiation?
1 Answer available
How would you approach an early stage II unfavorable Hodgkins lymphoma following 6 cycles ABVD with persistent Deauville 5 with negative biopsy?
iPET2 and iPET4 showed Deauville 5 response. CT biopsy after 4 cycles was negative. Patient is currently scheduled for 2 additional cycles of ABVD.
1 Answer available
How would you approach a bulky 9 cm DLBCL of the axilla following an excisional biopsy to negative margins?
Would you treat as bulky or non-bulky? Is ISRT indicated? Biopsy was performed because there was concern for soft tissue sarcoma. 
1 Answer available
For primary CNS lymphoma, when do you refer for whole brain radiation therapy (WBRT)?
My experience has been that patients can be neurologically devastated years out from WBRT. In Medical Oncology practice at my institution, we do not r...
1 Answer available
How do you define bulky disease for Hodgkin's lymphoma which is outside the mediastinum?
Do you use a cutoff of 10 cm? Do you measure the size of the largest node or measure the largest conglomerate or measure the total length of the entir...
1 Answer available
In patients with CML on imatinib and newly diagnosed breast cancer now requiring radiation therapy, should we hold imatinib?
The said patient has been on Imatinib for 2.5 years and is In MMR. Last rt-PCR was 0.04.
3 Answers available
How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?
1 Answer available
Would you include the entire hardware as part of ISRT for a patient with Stage IE DLBCL of the distal femur treated with upfront prophylactic nailing for impending fracture, who had a CR to chemotherapy?
In this case, initial tumor was 9.5 cm craniocaudal but hardware spans the entire femur.
1 Answer available
How do you manage real-time release of pathology and radiology results to oncology patients following enaction of the CURES act?
1 Answer available
Would you offer consolidation RT to a young woman with bulky mediastinal DLBCL who achieved early and persistent CR to RCHOP on PET?
2 Answers available
For primary MZL of the breast, do you do whole breast to 24 Gy or ISRT?
2 Answers available
What radiation dose do you typically use for relapsed DLBCL following 6 cycles of R-CHOP?
1 Answer available
When consolidating DLBCL with radiotherapy, do you treat all originally involved sites, or just initially bulky and partial responder sites?
Does this change depending on stage?
1 Answer available
Are there best practices or data regarding the use of open notes among oncology patients?
What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?
2 Answers available
What would be a reasonable radiation approach and dose for a patient with multiple myeloma with brain involvement?
1 Answer available
How would you approach a patient with early-stage orbital MALT lymphoma with high proliferative index?
2 Answers available
For multiple myeloma patients with vertebral lesions requiring palliative radiation (e.g. 20-30 Gy in 10fx), do you treat concurrently with modern systemic myeloma agents such as lenalidomide and bortezomib?
Which systemic agents would you recommend holding during RT?
3 Answers available
Is it reasonable to treat a solitary plasmacytoma of the lung parenchyma with SBRT?
What dose/fractionation?
1 Answer available
How would you manage an in-field small volume recurrence of early-stage favorable Hodgkin Lymphoma treated previously with 2 cycles of ABVD and 20Gy?
If re-irradiation, what dose would you use?
2 Answers available
Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?
2 Answers available
For lymphoma, how long after chemotherapy can you wait to start consolidative radiation therapy?
In situations when we are waiting for insurance clearance or due to other logistical reasons. 
1 Answer available
How would you approach a resected solitary osseous plasmacytoma?
Plasmacytoma of 6th rib s/p resection. Negative multiple myeloma work-up.
1 Answer available
What is your approach to a patient with an advanced stage diffuse large B-cell lymphoma treated with chemotherapy alone (with a PET CR) who then develops an isolated CNS relapse?
If the patient cannot tolerate methotrexate or further chemotherapy, how effective is radiation therapy (e.g. WBRT) in rendering the patient disease-f...
1 Answer available
What is the role for consolidative ISRT for patients with stage III follicular lymphoma following a good response to systemic therapy?
1 Answer available
How would you approach a patient with gastric MALT lymphoma who has CREST syndrome?
Would chemotherapy be preferred over RT? 
2 Answers available
In what situations would you offer salvage radiotherapy for relapsed/refractory DLBCL?
NCCN only recommends palliative ISRT for non-transplant eligible patients with refractory/relapsed DLBCL
1 Answer available
What radiation dose and fractionation is appropriate for hairy cell leukemia presenting as an isolated skeletal lesion, where systemic treatment is not recommended?
 The dosing in the literature has a huge range.  
1 Answer available
Is there a role for radiation therapy in the treatment of a lymphoproliferative disorder involving the orbit?
If so, what dose and fractionation would you recommend?
4 Answers available
How would you approach early stage unfavorable classical Hodgkin lymphoma with metabolic CR apart from a single residual positive node after 6 cycles of ABVD?
Would you move straight to second-line systemic therapy or first attempt consolidative ISRT/boost, or employ both? Assume node is biopsy-proven. 
1 Answer available
Would you require pre-RT dental evaluation and clearance for a patient who is being treated with ISRT to Waldeyer's ring/BOT area to 30 - 36Gy?
1 Answer available
What would you recommend for a stage I follicular lymphoma of the bone?
Would your recommendation change based on grade and/or location (weight-bearing vs non weight-bearing bone)? 
1 Answer available
Would you offer RT to a patient with a stage I low grade follicular lymphoma in the groin/upper thigh (7 cm) s/p complete excision with negative margins?
Would your recommendations change if the mass were significantly smaller, say 1-2 cm, and was completely excised with negative margins?  
1 Answer available
What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?
In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients. 
1 Answer available
Does your treatment approach for NK/T cell lymphoma of the nasal cavity differ depending on the volume and extent of disease?
How do you approach systemic therapy options? What are your recommended volumes?  
2 Answers available
What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?
2 Answers available
How would you manage a patient with Stage IVB DLBCL with refractory disease in the retroperitoneum and spleen after 6 cycles of RCHOP?
Would you offer refractory doses (40-50 Gy) to the RPnodes and send for splenectomy? Or would you offer refractory doses to both RP nodes and spleen?&...
3 Answers available
How do you counsel patients who are candidates for a clinical trial regarding their options?
Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?
2 Answers available
For incidentally found stage I indolent non-Hodgkin's lymphoma in young patients, which subtypes would more strongly warrant a consideration for curative-intent radiation?
For instance, if the tissue came back SLL, Waldenstrom's, follicular lymphoma, or even nodular lymphocyte-predominant Hodgkin lymphoma, would any or a...
1 Answer available
Would you consider just treating radiographic residual disease (as opposed to all original sites of disease involvement, per ILROG guidelines) in a patient with bulky early-stage Hodgkin's lymphoma of the mediastinum?
For example, in a young patient where standard fields would be very large and you want to minimize toxicity
1 Answer available
Is there any role for post chemotherapy (R CHOP x 6) radiation therapy after a splenectomy for a stage IE diffuse large B-cell lymphoma involving only the spleen?
What if it is a young patient?
1 Answer available
What would you recommend for a patient with bilateral conjunctival MALT (without systemic disease)?
In this scenario, is systemic treatment better given bilateral involvement? In a patient who has already had cataract surgery and is not at risk for c...
1 Answer available
How would you treat a stage IE diffuse large B-cell lymphoma of the adrenal gland in an elderly patient who is not a candidate for systemic therapy?
2 Answers available
What CTV margins do you use for indolent advanced stage lymphoma treated with palliative radiation alone?
1 Answer available
Would you forgo consolidation radiotherapy for a patient with stage 1EA diffuse large B cell lymphoma of the stomach who presented with a perforated ulcer?
1 Answer available
What dose do you use to palliate multiple myeloma in a vertebral body?
 Does your dose recommendation change if a patient has cord compression or has undergone surgery? There is a range of doses in the ILROG guidelin...
5 Answers available
What is the role of RT for a patient with double-hit DLBCL and a single site of relapse who can no longer tolerate chemotherapy?
1 Answer available
What is the role of radiation in a patient with stage IV DLBCL with bilateral testicular involvement?
1 Answer available
How do you manage thrombocytopenia when radiating the spleen?
At what point would you recommend transfusion? At what point would you stop radiation?
1 Answer available
How would you approach re-irradiation to a localized DLBCL of the lower extremity?
The patient received R-EPOCH followed by consolidative RT (36 Gy in 18 fractions) approximately one year ago and was subsequently salvaged with RICE.
1 Answer available
Would you recommend prophylactic cranial irradiation (PCI) for a teenager with a T cell acute lymphoblastic leukemia in remission?
If so, what dose would you recommend? 
1 Answer available
How long would you wait after a cycle of IT MTX to treat a spinal lesion causing cord compression in a patient with stage IV DLBCL?
1 Answer available
How do you determine whether to treat a young adult with stage IA Hodgkin Lymphoma with the adult or pediatric treatment paradigm?
At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...
2 Answers available
How do you decide on the modality of consolidative treatment after a CR in primary CNS lymphoma patients treated with a high-dose methotrexate regimen?
How do you decide between WBRT, maintenance chemotherapy, or stem cell transplantation? 
2 Answers available
How do you assess whether an early-stage Hodgkin's patient is unfavorable?
The unfavorable risk factors for stage I-II Classic Hodgkin's Lymphoma differ depending on the cooperative group (GHSG, EORTC, NCCN), which criteria d...
1 Answer available
Do you have preferred regimens for young patients (<30 y/o) with early stage DLBCL?
Guidelines indicate RCHOPx3 +RT as category I and RCHOP x 6 below that; long term f/u for SWOG 8736 showed similar PFS and OS. Do you have and approac...
1 Answer available
What volumes do you treat for ISRT for extranodal DLBCL?
For a stage IAE DLBCL (in this case, of the oral cavity) that was completely excised, s/p R-CHOP, is the ISRT target volume just the preop volume plus...
1 Answer available
Would you offer consolidative RT to a patient with early stage, non-bulky, high-grade non-Hodgkin's lymphoma of the orbit after 6 cycles of RCHOP + IT chemotherapy?
1 Answer available
Would you recommend scrotal RT in a patient with stage IV primary testicular lymphoma with CNS involvement after CR to RCHOP and MTX?
1 Answer available
What dose and volume would you treat in a patient with diffuse large B-cell lymphoma confined to the stomach after complete response to R-CHOP?
How would your dose and/or volume change if the patient refuses chemotherapy?
1 Answer available
What positions and immobilization strategies do you use to minimize breast and heart dose when treating axillary and mediastinal nodes in young women with large breasts who require consolidative radiation (ISRT) for Hodgkins lympoma?
Any experience treating patients prone with openings for both breasts, no minimize breast overlap with axilla and mediastinum?
1 Answer available
Would you recommend consolidative radiation therapy to an isolated frontal dural MALT lymphoma after complete response to chemotherapy?
1 Answer available
In a patient with Waldenstrom's macroglobulinemia doing well and feeling better on ibrutinib & rituximab, but with a rising IgM, do you switch treatment or continue?
1 Answer available
What is the role of consolidative RT to initially bulky sites (>8cm) in a patient with stage III triple hit lymphoma who has tolerated only 4 cycles of DA-EPOCH-R?
The patient is not a transplant candidate due to multiple co-morbidities. Some of the sites in question have had a complete response and other have ha...
3 Answers available
What dose and fractionation would you recommend for a localized primary bone marginal zone lymphoma?
The patient has no bone marrow involvement.
1 Answer available
What is your approach for bulky stage I primary mediastinal B-cell lymphoma in a patient with a positive post-chemotherapy PET-CT (residual mass and Deauville 5)?
Some specific questions: Would you recommend repeat biopsy to confirm residual disease? How would your recommendations vary if the patient had pre...
2 Answers available
Which imaging modalities and schedule do you use to follow stage I-II follicular lymphoma that was treated with radiotherapy alone?
1 Answer available
Would you offer chestwall RT after capsultectomy+explant for an implant-related ALCL?
If the breast was previously radiated 15 years ago, would that change your decision?  If there was residual lymphoma on cytology of a chronic se...
1 Answer available
What would you recommend for a stage I diffuse large B cell lymphoma (IPI 0-1) involving a single lymph node that is completely removed with an excisional biopsy?
Would you recommend RCHOP x 3-6 or RCHOP x 3 + ISRT?  If you end up doing ISRT, would your target be any different than the principles that guide...
1 Answer available
What factors do you consider when interpreting post treatment PET Deauville scores for patients treated with chemotherapy for classical Hodgkin Lymphoma?
Is your scoring based on SUV uptake vs the subjective interpretation of the radiologist? How do you go about reconciling Deauville scoring when there ...
1 Answer available
What dose/fractionation do you like to use for palliation of bulky LAD from CLL/SLL?
1 Answer available
What is the role of salvage radiation therapy in patients with locally recurrent Hodgkin lymphoma after an autologous stem cell transplant?
1 Answer available
Can post op RT be omitted in a surgically repaired pathological fracture site in multiple myeloma if the patient will receive systemic therapy?
1 Answer available
How would you manage a patient with a MALT lymphoma (H. Pylori negative) found incidentally in the surgical specimen at the time of sleeve gastrectomy?
Repeat EGD and additional biopsies of the stomach were all negative for MALT lymphoma and H. Pylori. A CT of the C/A/P was done showing no evidence of...
1 Answer available
What stage is bilateral orbital/conjunctival NHL (limited only to the bilateral orbit/conjunctiva)?
2 Answers available
How do you manage classical early stage Hodgkin lymphoma patients when an ESR is not checked as part of their workup?
For example, would you go ahead with 20 Gy of ISRT if medical oncology has already treated a stage I-IIA patient with 2 cycles of ABVD meeting all oth...
1 Answer available
How long after high-dose IV methothrexate for chemo-refractory CNS lymphoma do you wait before giving brain radiation?
If they are symptomatic do you relax that time interval? Do you ever consider partial brain radiation instead of whole brain to minimize neurotoxicity...
1 Answer available
How would you manage a patient with primary CNS lymphoma who is not a candidate for high-dose methotrexate?
In a patient who absolutely cannot receive chemotherapy due to impaired performance status, what dose would you use for WBRT and what dose would you u...
1 Answer available
How would you treat a patient with a refractory primary splenic marginal zone lymphoma with symptomatic splenomegaly (20 cm) and a mild pancytopenia?
Prior trials of systemic therapy including alkylating agents and rituximab have failed and the patient is medically inoperable with no history of Hepa...
1 Answer available
In staging Hodgkin's lymphoma, would you identify a PET+ bony focus as disease when there are no associated bone changes on CT and a biopsy was not obtained?
The staging bone marrow biopsy was negative. The staging manual simply states "bone involvement is identified using appropriate imaging studies."...
1 Answer available
What volume and dose would you use for a Stage I MALT lymphoma of the lung?
Would you use a similar dose and fractionation as gastric MALT (30Gy in 1.5 Gy fractions)?
2 Answers available
What CTV margins should be used with early stage favorable Hodgkin's Lymphoma in the illiac chain if they had a complete response on PET after 2 cycles of ABVD?
Should prechemo PET positive disease from bowel or other structures be carved out? 
1 Answer available
Do you recommend using DIBH for young adults with Hodgkin lymphoma who require mediastinal RT?
1 Answer available
In which patients with early-stage favorable Hodgkin's lymphoma, if any, would you consider omitting consolidation RT after ABVD chemotherapy?
2 Answers available
What is your standard dose for total skin irradiation in a mycosis fungoides patient?
Do you generally always boost the scalp and/or soles even if those sites are not involved with disease?  
1 Answer available
Would you offer scrotal radiation to a patient with a stage IIE bilateral testicular DLBCL treated with a bilateral orchiectomy and chemotherapy?
The patient had a bilateral orchiectomy (pathology demonstrated no invasion of the tunica) followed by R-CHOP x 6 and IT Mtx with a PET CR in a para-a...
2 Answers available
What is an appropriate dose for definitive radiation of a stage IE EBV+ polymorphic B-cell lymphoproliferative disorder?
The patient is a 75 yo immunocompetent man who has a history of inverted papilloma of the sinuses and presented with a new lesion in the right maxilla...
1 Answer available
What is the best dose to treat splenomegaly with pancytonenia in the setting of myelofibrosis?
Would you use 10 Gy in 1 Gy per fraction as mentioned in a litterature review in Pubmed?
1 Answer available
What are your radiotherapy recommendations for a unilateral primary intraocular large B-cell lymphoma following high-dose methotrexate and rituximab?
What factors influence your choice to treat as well as dose and target?
1 Answer available
Would you treat a patient with definitive local XRT without systemic therapy if he/she presents with pathology showing a PTCL NOS from a small (1.5 cm) lesion of the skin of the chin?
The patient does have significant weight loss, drenching night sweats, but no evidence of other involved sites on PET, thorough skin exam, and has nor...
1 Answer available
When would you consider treating a testicular relapse with definitive radiation in a child with ALL?
1 Answer available
What is an appropriate dose for nodular lymphocyte predominant, stage 1 Hodgkin lymphoma following nodal excision?
In the case of an excised groin node with no residual disease and no chemotherapy in a young adult patient, how large should the fields be? Is it requ...
1 Answer available
For multiple myeloma, is 8 Gy in 1 fraction an appropriate palliative dose, although this histology was excluded from trials examining a single fraction?
1 Answer available
What dose of radiotherapy do you use for low volume Castleman's disease?
I have a patient with low volume disease of Castleman's disease with cervical lymphadenopathy and tonsillar hyperplasia that is suspicious but not bio...
1 Answer available
How do you manage patients with primary refractory Hodgkin lymphoma?
If a patient has an increase in PET avidity between the PET/CT done after 2 cycles of ABVD and after completion of chemo, how would you proceed? Would...
1 Answer available
How do you follow patients after radiation treatment for orbital MALT lymphoma?
Does your follow-up differ depending on the dose you used (e.g. boom boom vs. 24 Gy)?  Do you routinely image?  If so, do you use MRI or PET...
1 Answer available
Do you prefer a chemo-radiation combination or chemotherapy followed by sequential radiation approach for early stage NK/T-cell lymphoma?
1 Answer available
For Hodgkin lymphoma patients with initial splenic involvement, do you ever include the pre-chemotherapy involved spleen as part of your consolidative ISRT treatment after a CR?
If the patient had a CR by PET/CT after 2 cycles of ABVD and received 6 cycles of ABVD would you recommended consolidating only the bulky disease and ...
2 Answers available
For a MALT of the eyelid, do you treat the entire conjunctiva reflection as well, or just the eyelid?
What technique do you use (IMRT vs direct electrons w bolus)?  The ILROG paper on extranodal NHL says "For tumors confined to the conjunctiva or...
1 Answer available
Can RT to non-bulky sites be omitted in an early stage (stage I or II) classical Hodgkin's lymphoma case with a CR by PET/CT?
If a patient will receive a total of 4 cycles ABVD and has a CR by PET/CT after cycle 2, can RT be omitted to non-bulky sites to avoid toxicity?
1 Answer available
For elderly patients who cannot tolerate chemotherapy, is radiation alone an option for a stage IA favorable classical Hodgkin lymphoma?
What dose and volumes would you use?
1 Answer available
What is the role of radiation treatment of stage IA ALK negative anaplastic large cell lymphoma?
PET/CT/bone marrow biopsy negative for evidence of distant disease. Following 4 cycles of combination chemotherapy with no evidence of progressive dis...
2 Answers available
What dose/fractionation schedule should be used for adjuvant RT after surgical decompression of a spinal cord compression from multiple myeloma osseous lesions?
1 Answer available
For early stage indolent NHL (low grade follicular, MALT) involving midline structures of the head and neck (ie base of tongue, soft palate) how do you apply the concepts of ISRT?
For example: would you treat the entire Waldeyer's ring?  For a stage II patient who also has cervical lymph node involvement on one side, do you...
1 Answer available
What is the risk of breast cancer that you quote to young women with early stage Hodgkin's lymphoma receiving involved field/site radiation therapy?
We often see young women with favorable, early stage disease in the mediastinum who have had a complete response to chemotherapy. With current smaller...
1 Answer available
Should we continue to offer consolidative radiation for early stage, non-bulky Hodgkin's disease for individuals who have had a complete response (Deauville 1 or 2) after chemotherapy by PET?
How have the results of the UK RAPID study (Radford et al NEJM 2015) changed your practice?  
1 Answer available
What is your preferred approach to a patient with newly diagnosed primary mediastinal B-cell lymphoma in the upfront setting?
Specifically, is there still a role for dd RCHOP followed by ICE, or do you recommend DA-R-EPOCH for all patients?
1 Answer available
Does radiation improve bone health and allow for healing of a pathological fracture in a patient with multiple myeloma refusing surgery?
What is the best evidence to support or refute this?
1 Answer available
How would you define your radiation treatment volume for a primary diffuse large B-cell lymphoma of the L4 vertebral body that had a complete response to chemotherapy?
Would you include one vertebral body above and below the involved vertebral body? Is IMRT appropriate in order to reduce dose to small bowel? What oth...
1 Answer available
How would you manage a localized low grade follicular lymphoma diagnosed shortly after a patient had a CR to an aggressive treatment regimen for DLBCL?
If a patient had recently completed R-EPOCH x 6 cycles, would you change your dose for a low grade follicular lymphoma?
1 Answer available
Is it appropriate to treat a Stage IE DLBCL of the cervix with close followup if a CR is achieved after 4 cycles of R-CHOP followed by a hysterectomy omitting RT?
Is surgery an adequate treatment for Stage IE DLBCL of the cervix? 
1 Answer available
What is the recommended initial treatment for spinal cord compression due to non-Hodgkin lymphoma (e.g. diffuse large B-cell lymphoma)?
When treating with radiation therapy, what dose-fractionation do you typically utilize?
1 Answer available
When treating a patient with classic early stage diffuse large B-cell lymphoma (Stage I/II), when is it appropriate for patients to receive 3 versus 6 cycles of R-CHOP chemotherapy when the treatment is followed by ISRT?
The NCCN guidelines recommend all patients receive 3 cycles RCHOP followed by ISRT unless they have bulky disease greater than 7.5 cm. However, are th...
1 Answer available
Is there any data on an effective RT regimen (dose/fractionation) for inducing an abscopal effect using a PD-1 inhibitor in refractory Hodgkin's lymphoma?
1 Answer available
How would you treat Classic Hodgkin's lymphoma when the nodal sites are non-contiguous?
With the field moving more toward ISRT/ INRT, and conformal radiation, would you generate separate PTV for initial nodal involvements that are within ...
1 Answer available
Given the improved ability to spare heart, kidney and liver, should IMRT be the standard of care for gastric MALT lymphoma (despite the low dose needed to effectively treat these patients)?
If so, what data should be presented to insurance companies to cover the cost?
1 Answer available
When would you consider testicular RT prior to TBI for BMT?
What dose do you recommend?
1 Answer available
Would you irradiate all borderline suspicious lymph node regions on PET/CT in stage IIA nodular lymphocyte predominant Hodgkin's lymphoma treated with ISRT alone?
When nodal regions not amenable to biopsy but are enlarged without significant SUV uptake, should they be treated as involed and recieve RT?
1 Answer available
Should whole brain radiation therapy and orbital radiation therapy be administered in situations of ocular B-cell lymphoma recurrence 2 years after primary CNS lymphoma treated with intrathecal methotrexate and no prior cranial irradiation?
1 Answer available
How would you treat a pediatric patient with Stage IVB Hodkin lymphoma who still has persistent PET+ disease after dose-escalated chemotherapy?
After ABVE-PC X4 and Ifos/vinorelbine x 2 per AHOD 0831 (and is unable to have these sites biopsied), what dose would you treat to and what volume wou...
1 Answer available
What are your current recommendations for treatment of symptomatic splenomegaly in the setting of myelofibrosis when splenectomy is not an option?
Is there a preferred low dose splenic irradiation regimine?
1 Answer available
What is the best management of a lacrimal gland MALToma?
When radiation therapy is utilized, what should the radiation therapy treatment fields include and what imaging studies should be completed to assist ...
1 Answer available
Is there a role for radiation therapy after chemotherapy for localized anaplastic large cell lymphoma?
If so, should involved site radiation thearpy (ISRT) or involved field radiation therapy (IFRT) be used for the radiation therapy treatment fields? Wo...
1 Answer available
Do you omit consolidative RT in pediatric patients with intermediate risk, non-bulky Hodgkin lymphoma who have a rapid early response to chemotherapy?
Are the results of AHOD0031 practice changing?
1 Answer available
What is the role of radiation consolidation after chemotherapy for residual splenic involvement in follicular lymphoma?
1 Answer available
What dose do you feel comfortable treating the entire circumference of an extremity to before you are concerned about chronic toxicity?
When the disease (in this case, lymphoma) involves almost all of the entire muscle compartment of the distal lower extremity, what is a safe dose? I'm...
1 Answer available
In treating with total body irradiation, how should the lung blocks be drawn and what dose should the lung receive?
In drawing the lung blocks approximately 1 cm in from the chest wall, diaphragm and mediastinum, should the blocks stop underneath the clavicle o...
1 Answer available
Is there a role for consolidation radiation in a patient with stage I low grade follicular lymphoma treated with chemotherapy?
If a patient with stage I, low grade follicular lymphoma achieves a complete response after rituxan and treanda is there any role for consolidative ra...
1 Answer available
In Stage I-II primary mediastinal B-cell lymphoma (PMBL), bulky or non-bulky, is post-chemotherapy radiotherapy still standard in patients with a complete response to CHOP-R chemotherapy?
1 Answer available
What is the best radiation dose to treat primary cutaneous B cell lymphoma?
Specifically for marginal zone or follicle center?
1 Answer available
What is the best treatment volume and dose for a marginal zone orbital lymphoma?
Is it necessary to treat the whole orbit or is conformal treatment ok? 
1 Answer available
What is the appropriate treatment for marginal zone lymphoma of the parotid following surgery?
After a nerve sparing parotidectomy, would you offer postoperative radiotherapy? If so, what volume and dose? Would it change your management if the p...
1 Answer available
Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?
1 Answer available
What is the treatment volume for primary breast lymphoma?
In a patient with Stage IE DLBCL, is your treatment volume postchemo ISRT or whole breast? Would you consolidate if a lumpectomy was performed prior t...
1 Answer available
What is the appropriate RT dose for an advanced stage follicular lymphoma?
Hoskin et al (Lancet Oncology 2014) suggest 24Gy/12fx is more effect RT dose compared to 4Gy.
2 Answers available
Is IMRT preferred over 3D conformal RT for lymphoma of the head and neck?
Is there a benefit to IMRT when we treat to relatively low doses (as compared to squamous cell cancers of the head and neck)?
1 Answer available
Can you observe low grade follicular lymphoma if the involved node(s) have been surgically removed?
1 Answer available
Is it time to start incorporating involved site irradiation for all lymphomas?
Or is it more appropriate for certain sites/stages/histologies?
1 Answer available
What is the appropriate dose of radiation for a primary osseous non-Hodgkin's lymphoma?
Specifically, for a diffuse large B cell lymphoma of the femur?
1 Answer available
Is it preferable to simulate pediatric Hodgkin's lymphoma patients with arms up or akimbo?
It seems that with the arms up, you get better lung blocking but with arms akimbo, you might have a lower dose to the humeral head. 
1 Answer available
What is the difference between involved node and involved site irradiation?
1 Answer available


Papers discussed in this category

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Modern radiation therapy for nodal non-Hodgkin lymphoma-target definition and dose guidelines from the International Lymphoma Radiation Oncology Group.
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The New England journal of medicine, 2013-04-11
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