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Radiation Oncology

Pediatric Hematology/Oncology   

Questions discussed in this category

For patients with newly diagnosed brain metastases without a history of seizure activity, do you routinely start anti-seizure medication?
If so, how long do you continue medication and when do you discontinue? Does treatment with surgical resection versus radiation alone change your mana...
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 it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
4 Answers available
What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?
4 Answers available
How do you differentiate demoralization from depression during cancer treatment?
2 Answers available
Should I treat a patient who doesn't know she has cancer?
My patient’s family has asked that I don’t tell her that she has metastatic cancer because it will devastate her. I am planning on palliat...
4 Answers available
How do you counsel patients with locally advanced malignancies who have ECOG 3-4?
How do you advise patients who strongly desire chemotherapy?
4 Answers available
How do you approach a young patient with metastatic poorly differentiated thyroid cancer with rhabdoid/non-anaplastic features?
4 Answers available
How would you manage a patient less than 40 years old with an incidentally found LGG, IDH mutated, 1p19q intact, s/p STR?
Would you offer radiation and chemotherapy, vorasidenib, or observation?
4 Answers available
What cardiac surveillance would you do for an asymptomatic male patient with a remote history of mantle field radiation for Hodgkin's lymphoma?
1 Answer available
Would use of proton radiation versus photon radiation in neuroblastoma patients post autologous stem cell transplant reduce the risk of transplant associated-TMA?
1 Answer available
What radiation dose constraints should be used for the spinal cord in pediatrics?
Should they be context/disease specific?  Should the use of chemotherapy before/after, or during radiotherapy modify these tolerances? Contexts...
1 Answer available
Would you offer adjuvant radiation therapy in a young adult with NF1 who has a craniopharyngioma s/p STR?
Tumor measures 4 cm after STR. Is NF1 a contraindication for adjuvant RT?
2 Answers available
How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?
I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...
2 Answers available
What approach do you use when treating adult diffuse gliomas with H3-G34 mutations, now classified into their own category under the 2021 glioma guidelines?
Do you treat this similarly to IDH-Wildtype GBM with the STUPP regimen? Is there any role of less-intensive paradigms, such as 59.4 Gy/33 fx?
1 Answer available
How would you approach patients with primary cardiac sarcomas for adjuvant systemic treatment?
How do we approach patients with rare tumors given the paucity of data?
2 Answers available
How do you approach delivering ISRT to nodular lymphocyte predominant Hodgkin Lymphoma that has responded on FDG-PET/CT after chemotherapy?
Does the stage at diagnosis affect your decision?
1 Answer available
What are magic mouthwash alternatives that you would recommend?
There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?
9 Answers available
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
2 Answers available
Does the use of A+AVD versus ABVD affect your decision for consolidation RT for bulky Hodgkin lymphoma?
1 Answer available
What, if any, cardioprotective measures beyond dexrazoxane may be used to minimize cardiac risk during or after chemo- or radio-therapy?
Are there other measures, pharmocologic or adjunctive, that can be used or are under investigation to mitigate cardiotoxicity related to chemo- or rad...
2 Answers available
How do you approach treatment of sub-total resected ZFTA fusion ependymoma after radiation therapy in a young adult?
Do you recommend adjuvant chemotherapy after radiation treatment?
1 Answer available
What special considerations do you take when treating cancer patients with severe intellectual disabilities?
Have you been able to deliver standard of care treatment?
1 Answer available
How would you approach treatment in a patient with Fanconi anemia and glioblastoma?
1 Answer available
How do you approach and manage anorexia and appetite loss in people with advanced cancer?
How do you counsel patients and caregivers? Do you prescribe medications (''appetite stimulants'') with the goal to improve appetite even if they do n...
4 Answers 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
When would you consider radiation therapy for an optic pathway glioma in a pediatric patient?
1 Answer available
How do you approach fertility preservation in a young child with cancer?
What is the best way to counsel families in regards to their child's risk of infertility and need for fertility preservation?
2 Answers available
Which patients with relapsed/refractory NHL are appropriate for pre-CAR-T bridging radiation therapy?
2 Answers available
Do you recommend adjuvant radiotherapy for an adult patient with localized myxopapillary ependymoma, WHO Grade 2, status-post gross total resection?
2 Answers available
How do you manage symptomatic radiation necrosis not responsive to steroids?
How do you choose between Avastin, hyperbaric O2 and other therapies?
4 Answers available
Does your institution omit prophylactic cranial irradiation in high risk ALL patients greater than 3 years of age?
Does the St. Jude's Experience (NEJM 2009, PMID: 19553647) provide sufficient justification for routine omission in high risk patients?
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
How would you manage a patient with radiation pneumonitis who remains symptomatic on steroids?
2 Answers available
Do you recommend sperm banking for males prior to undergoing radiation?
Is it necessary to delay the start of radiation therapy for males planning on sperm banking for fertility preservation?
2 Answers available
What is your local control approach to localized relapse of Ewing sarcoma in a site that was previously unresectable and received definitive radiation?
1 Answer available
For pediatric Ewing sarcoma, what is the role of metastatic site consolidation?
What volume and dose do you treat a bone met that has completely responded to chemo?
1 Answer available
Is there evidence to support or argue against intermittent fasting for cancer patients?
3 Answers available
Why do we use dexamethasone for CNS edema and prednisone for pneumonitis?
Is this an artifact of what agent prior clinical trials used or something to do with the mechanism of action (i.e., less mineralocorticoid effect of d...
1 Answer available
What is the role of local control +/- whole lung irradiation in a patient with relapsed/refractory Ewing sarcoma to the hilum plus multiple lung nodules?
Patient initially achieved CR with VAC-IE with resolution of presumed lung mets and 100% necrosis in LLE primary tumor on BKA. Then was NED again afte...
2 Answers available
What are best practices for oncologists during the national platinum shortage?
Please specify how your institution is allocating resources now or will be soon.
13 Answers available
What are some alternatives to dexamethasone for brain edema in patients who are allergic, have an intolerance, or refuse the medication?
5 Answers available
What is your response to the question, "Is this terminal?"
How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?
8 Answers available
How would you treat an essential-like tremor secondary to tumor (e.g. glioma)?
Is your approach different than that to a primary essential tremor?
1 Answer available
How can oncologists be more collaborative with palliative care physicians?
How can these interactions be improved? 
1 Answer available
How do you clearly communicate to parents that the main purpose of a phase I trial is to find the best dose of a new drug with the fewest side effects rather than treating the patient's cancer?
There is evidence that parents do not adequately understand the purpose of phase I pediatric cancer trials (Cousino et al., PMID 23071225). 
1 Answer available
What is your treatment approach for a pediatric patient with uterine embryonal rhabdomyosarcoma found after removal of a prolapsing uterine mass, with no evidence of distant metastasis on imaging?
1 Answer available
How do you approach hormone replacement therapy for premenopausal patients following pelvic radiation therapy?
How is your approach different from or similar to those who undergo surgical menopause? 
1 Answer available
Does "preoperative rupture" always necessitate whole abdomen RT for Wilms' tumor?
What if the spillage is noted to be limited to the tumor bed, per the surgeon?
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 do you manage AEDs in patients with malignant brain tumors?
Do you ever add prophylactic Keppra (levetiracetam) for glioblastoma patients without a seizure history based on data such as this study (nature.com) ...
5 Answers 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
How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?
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
What is the role of radiotherapy in a newly diagnosed patient with parameningeal rhabdomyosarcoma w/ intracranial extension, a positive CSF but no extra-CNS metastases?
How do you sequence/integrate radiotherapy relative to high risk chemotherapy? When would you consider cranial/craniospinal radiotherapy? 
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
Is there an age cut off below you would not treat a keloid with radiation post surgical excision?
Assuming it has previously been treated with excision and steroid injections? Is it reasonable to treat a bothersome keloid in a pediatric patient aft...
6 Answers available
For post-operative radiation of resected high grade soft tissue sarcoma, how long of a delay do you tolerate before starting radiation?
This is particularly relevant for patients with extensive delays due to wound healing issues. 
1 Answer available
Should all pediatric CNS cases be referred to a proton center?
If not, how should you select those cases that should be referred?
4 Answers available
What is your follow up schedule after completion of RT for pediatric rhabdomyosarcoma?
When/how often do you order imaging?
2 Answers available
How would you approach local control in a patient with extra-osseous metastatic Ewing sarcoma of the kidney?
1 Answer available
What is the preferred radiation delivery technique for whole abdominal or flank RT in childhood cancers?
Is there a role for more advanced delivery techniques
2 Answers available
When do you offer adjuvant radiation therapy for high grade non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) in a skeletally mature teenager or young adult?
Individuals often cite ARST0332 to justify radiation omission in high grade R0 resections, but R0 was defined as > 5 mm margins.
1 Answer available
Would you recommend prophylactic retro-peritoneal RT in an adolescent with paratesticular rhabdomyosarcoma, s/p radical inguinal orchiectomy without a lymph node dissection?
If a staging RPLND is NOT performed, is there a role for prophylactically irradiating the lymph nodes, even in the setting of a negative PET/CT at dia...
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 young is too young to treat a child's keloid with radiation?
What dose/fractionation regimen is most appropriate?  -i.e. 12 Gy in 4 fractions, but would you modify that approach in a young patient? What i...
1 Answer available
How do you treat a primary pineal neoplasm of intermediate differentiation?
Would extent of surgical resection matter? Do these patients need CSI (like Pineoblastoma), just local radiation, or something in-between (say whole ...
2 Answers available
Would you give whole-abdomen RT for preoperative rupture of favorable histology Wilm's Tumor treated with induction chemotherapy followed by GTR?
The patient initially presented with an large renal tumor encasing the IVC and abutting the abdominal aorta. Given this, the patient received inductio...
1 Answer available
How do you approach treatment of a glioblastoma in pregnancy?
3 Answers available
How should dose homogeneity across bone be handled in pediatric patients?
To minimize the likelihood of asymmetrical growth, when is it of sufficient concern to necessitate altering planning objects? When planning paediatri...
2 Answers available
How would you treat osteosarcoma that has relapsed with unresectable pulmonary metastatic disease?
4 Answers 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
How do you manage cancer treatment-related cognitive change or "chemo brain?"
Are there any effective non-pharm or pharm interventions?
1 Answer available
How would you counsel a young female patient who refuses to use contraception during radiotherapy?
Would your counseling change if she reported a history of unplanned pregnancy? Is there any wording or waiver you might be able to use warning her of ...
1 Answer available
Is there a contraindication to orthodonture in an AYA after high dose head and neck radiation where the mandible got close to full dose (e.g., 60 Gy for nasopharyngeal carcinoma)?
1 Answer available
Do you offer whole lung radiation with metastatic recurrence of Wilm's Tumor (FH, no LOH 1p16q)?
What is the timing and role of surgery and RT at salvage for a lung recurrence?  Patient initially presented with lung metastases, but achieved ...
1 Answer available
Should special precautions be taken patients with Ehlers-Danlos syndrome receiving radiation therapy?
Would you have reservations in treating patients with breast, GI, or pelvic malignancies with radiation alone or concurrent chemoradiation?
2 Answers available
What are the current appropriate planning margins for Wilms tumor in lymph node negative cases?
How should the need for dose homogeneity be managed relative to the proximity of these target volumes to the spine?   Are AREN0321(HR), 0532(...
1 Answer available
How would you define the primary site GTV and CTV volumes in a high risk neuroblastoma patient who obtained a complete response to induction chemo?
1 Answer available
What is the radiation volume for M+ pure germinoma with brain only extra-ventricular mets and negative CSF/spine imaging?
Is chemotherapy recommended for M+ germinoma? CR to chemo; Spine MRI negative; CSF negative Is CSI required or whole brain radiation is sufficient f...
1 Answer available
What is the evidence/rationale for not treating neuroblastoma metastatic sites which are MIBG negative after induction chemo?
What if there is residual soft tissue disease?  Would you treat a distant metastatic site if only 1 or 2 metastatic sites total with gross residu...
1 Answer available
What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?
2 Answers available
For AYA patients with early-stage Hodgkin's lymphoma being treated with ABVD, how many cycles of chemotherapy do you administer, and when can radiation be avoided?
Have the RAPID or CALGB 5064 studies changed your treatment approach?
2 Answers available
What are the indications for RT for an alveolar FOX01 fusion positive, paratesticular rhabdomyosarcoma s/p radical inguinal orchiectomy and PLND showing pN0, group 1, stage 1 disease?
What volume and dose would you use?
1 Answer available
What dose do you treat the involved lymph node chain to in definitive radiation for rhabdomyosarcoma?
Do you cone down to gross residual (and stop elective nodal coverage) after 36Gy or 41.4Gy? Parameningeal group III, stage III alveolar rhabdo.
1 Answer 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
What is your hemoglobin transfusion threshold for asymptomatic pediatric solid tumor patients during radiation?
Does tumor type matter? Are there issues are associated with overcorrecting anemia during radiation?
1 Answer available
What is the volume and dose for a rhabdo bone met showing complete response to chemo?
ARST 1431 indicated: 30Gy (PTV2=GTV2); 25Gy (PTV1=CTV2+2mm) in 5 fractions. With complete response to chemo, how do you defined GTV2?
1 Answer available
How do you manage leptomeningeal disease in relapsed rhabdomyosarcoma?
FOXO1 translocation positive
1 Answer available
Do you block kidney to meet kidney constraint when treating Wilms with diffuse unresectable peritoneal implants?
AREN 0532 kidney constraint is whole kidney <14.4Gy and 50% kidney <19.8Gy. If treating whole abdomen to 21Gy for diffuse unresectable peritonea...
1 Answer available
What is the flank radiation dose for recurrent Wilms?
Is radiation always indicated? AREN 0532 specified 10.8Gy flank with 10.8Gy boost to gross residual in all recurrent Wilms patients. However, NWTS-5 ...
1 Answer available
What is the appropriate radiation volume for a stage III, group III unresectable embryonal rhabdomyosarcoma originating from the bladder?
When the original tumor extent is substantial (displaces normal abdominopelvic organs), but responds well to therapy (i.e. as of week 12) - How would ...
1 Answer available
How would you incorporate whole abdomen radiation therapy after cytoreduction in an AYA patient with desmoplastic small round cell tumor?
What if the patient had also received HIPEC prior?
1 Answer available
What is the utility and optimal timing of histologic conformation of NGGCT?
ACNS1123 classified patients as NGGCT if serum & CSF AFP >10 ng/mL or bHCG >100 mIU/ml irrespective of biopsy results & did not mandate ...
1 Answer available
Do you re-test patients who test positive for COVID-19 during or prior to starting cancer treatment?
There are mixed recommendations about re-testing vs simply waiting for a quarantine period prior to resuming therapy. 
2 Answers available
What bladder-filling protocol do you use when treating children with bladder neck rhabdomyosarcoma with definitive radiotherapy (VMAT)?
Are there other practical tips for improving the patient setup in this patient population to minimize potential acute and late effects?
2 Answers available
Is there a role for surgical resection in parameningeal rhabdomyosarcoma either at diagnosis or following initial therapy w/ VAC at week 12?
1 Answer available
What areas do you treat with RT for an intermediate or high risk pediatric Hodgkin Lymphoma with a slow early response?
Do you give RT to the entire extent of disease at presentation or just regions with slow early response? Is it necessary to irradiate all known extent...
1 Answer available
What is the radiation volume for unresected gross paraaortic lymph node in a Wilms patient?
Do you radiate the paraaortic chain to 10.8Gy then boost gross residual with 1cm block edge margin to 19.8Gy or simply treat the entire paraaortic cha...
1 Answer available
Do you routinely recommend proton therapy for whole ventricular radiation for intracranial germinoma after chemotherapy?
Do you treat in a response adjusted fashion as per ACNS1123 Stratum 2: 18-24 Gy whole ventricle with 12 Gy boost? Are there any situations where you d...
2 Answers available
What is your local therapy paradigm for unresectable pelvic EWS cases?
Is there a role for dose escalation? Would you recommend sequential or SIB? Is there more of a role for surgery vs. dose escalated RT in EWSR1-non-ET...
1 Answer available
How would you manage an unresectable central meningioma in a young patient with evidence of mild compression on the optic nerve and 4th ventricle involvement?
1 Answer available
How should young patients with rhabdomyosarcoma be managed in the absence of a clinical trial?
-Are there settings where group II disease does not need RT?-Are there additional genetic alterations in fusion negative RMS patients that can be used...
1 Answer available
When are increased flank doses beneficial in Stage III Wilms tumor?
What are the data supporting this?
2 Answers available
How would you treat a skull based chordoma in a pediatric patient?
If proton therapy is not available would you consider radiosurgery? How would your management differ if residual disease is present?
0 Answers available
Do you recommend salvage radiation therapy to limited recurrent Ewing's sarcoma bony lesions?
If you do what dose and fractionation do you recommend?
1 Answer available
How do you approach the pharmacologic management of cancer-related fatigue?
After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...
2 Answers available
What is the risk of secondary malignancy and/or conversion to MPNST for patients with NF-1 who undergo radiation?
 Is it higher than the average person?
1 Answer available
How would you approach therapy for a young, fit patient with alveolar rhabdomyosarcoma involving the anterior nasal vault/sinuses in the absence of available clinical trials?
Presented with mass projecting into right/left anterior ethmoid complex
1 Answer available
How do you counsel families of pediatric patients regarding risk of secondary malignancy or IQ changes with cranial radiation using photons?
Are there general ages that you refer to in terms of risk of secondary malignancy or points dropped for IQ over time after treatment, or particular he...
1 Answer available
How do you approach a patient with metastatic rhabdomyosarcoma complicated by sinusoidal obstruction syndrome (SOS) after neoadjuvant chemotherapy and radiation therapy?
Stage 4/group 4 due to dissemination in peritoneal fluid. Translocation negative; treated per intermediate risk protocol on study arm ARST1431 VAC/VI ...
1 Answer available
Would you consider salvage SRS in a young patient with locally recurrent ATRT?
If so, what dose would you consider in the setting of complete and incomplete repeat surgical resection? How would you sequence this with salvage sys...
1 Answer available
How should patients be selected for metastatic-site directed radiotherapy in rhabdomyosarcoma?
Should this be based off of the response? or the site of disease such as bone vs soft tissue?What data are there to dictate that the prior (response, ...
1 Answer available
When do you offer hyperbaric oxygen therapy to a pediatric brain tumor patient with radiation injury/necrosis?
1 Answer available
How do you approach the decision of whether and when to initiate therapy in patients who remain COVID-19 positive >2 weeks after infection but are asymptomatic from the virus?
E.g. a patient with progression of their primary cancer but still is testing COVID19+ over a month after infection?
5 Answers available
In the management of the primary site in high risk neuroblastoma, is there a role for a cone-down to residual disease (boost), following treatment of the post-chemo, pre-surgical extent to 21.6 Gy?
1 Answer available
Do you give post-operative radiation to Ewing sarcoma if there is poor histologic response to neoadjuvant therapy in a completely resected tumor?
1 Answer available
Are there any unique considerations for treating pediatric high grade glioma?
i.e. Should concurrent therapy be given?, Does MGMT matter? What are the current most promising therapeutic approaches? Should we always treat based o...
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
What is the role for adjuvant monoclonal antibody therapy with radiation for diffuse intrinsic pontine glioma?
Discuss the role of mAb in DIPG.
1 Answer available
Is there a Mednet app?
2 Answers available
What are your indications for radiotherapy in children with pleomorphic xanthoastrocytoma?
Would you manage this histology any differently relative to other low grade gliomas? Is a STR a definite indication for postoperative XRT?
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
Do you use hippocampal avoidance techniques when delivering PCI for high-risk leukemia?
1 Answer available
How do you decide the right time to transition to hospice?
Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...
4 Answers available
Can we use a linear accelerator to sterilize PPE?
5 Answers available
In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?
Acknowledging that there is no time for good trials yet in this setting
1 Answer available
How should you manage a coronavirus infected/suspected patient who is receiving radiotherapy and cannot interrupt or delay their cancer treatment?
How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...
7 Answers available
Is it feasible to treat craniospinal fields with new generation scanning beam-only proton machines?
Scanning beam only machines are being increasingly marketed, it could be problematic if you can't use them to treat the one site which is most appropr...
3 Answers available
What field and dose would you prescribe for a an extra-renal rhabdoid tumor of the pelvis?
The more recent NWTS trials do not include these tumors, since rhabdoid are recognized to not be similar to Wilms, and the AREN0321 does not provide s...
1 Answer available
How should you manage a pediatric oncology patient who has an ANC > 500 and a normal chest x-ray but is confirmed to be infected with COVID-19 and is immunosuppressed from chemotherapy?
Should the patient be admitted for observation which will risk exposing other immunocompromised patients to COVID-19, or should the patient be quarant...
1 Answer available
Should I wear gloves during a routine physical exam on an asymptomatic patient with no risk factors for COVID-19?
1 Answer available
Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?
1 Answer available
What techniques do you use to address fertility preservation in young female patients being treated with chemoradiation therapy for cancer in the pelvis?
How do you prevent early menopause in women? Please comment on freezing of eggs, oophopexy, supine vs prone position, vaginal dialator. 
4 Answers 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
How does the management of nasopharyngeal cancer in kids/young adults differ from adult patients?
-The data on induction for adult H&N ca has been mixed (excluded NPX) but recent data suggest a benefit for adult NPX. -Given that this is standa...
1 Answer available
What are indications for RT coverage of pleural cavity for margin positive resected Askin tumor after neoadjuvant chemotherapy?
When covering with radiation what dose and technique do you favor, electrons, IMRT, brachytherapy, protons?
1 Answer available
How would you manage a recurrent pineoblastoma following prior CSI?
Would you offer repeat CSI or favor chemotherapy?
1 Answer available
Would you offer whole abdominal irradiation to a pelvic recurrence of rhabdomyosarcoma with tumor rupture / spillage?
3 Answers available
Should post-op RT be delayed for children < 3yo after a GTR resection for a posterior fossa or supratentorial ependymoma?
1 Answer available
How do you approach isolated CNS recurrence in previously treated neuroblastoma?
Some emerging data of improved up front therapy shifting recurrence to CNS as sanctuary site, is focal RT approach (i.e. SRS) reasonable or is CSI a s...
1 Answer available
Is cardiac sparing whole lung IMRT acceptable for Wilms Tumor?
With the recent publication of multi-institutional trial data, should this now become standard of care?
1 Answer available
How would you manage an osteosarcoma patient with local disease only and an R0 resection who could not tolerate neoadjuvant chemotherapy?
Is there a role for adjuvant radiation? Other chemotherapy options?
1 Answer available
Is there a role for extended treatment volumes (elective nodal) in the definitive treatment of parameningeal rhabdomyosarcoma in a young adult?
Would the translocation status influence your decision? Are there specific subsites where elective radiotherapy likely offers a higher therapeutic rat...
1 Answer available
How do you approach local control in intermediate risk bladder rhabdomyosarcoma in very young (<24 months) children ?
Would you consider radical cystectomy equivelant in terms of local control and how do you balance morbidity of radiation with morbidity of non-organ p...
1 Answer available
What is the maximum number of metastatic sites you would treat with consolidative radiation for a patient with high-risk neuroblastoma?
1 Answer available
What are the anesthesia risks for pediatric patients undergoing radiation treatments, given it's repetitive use throughout the treatment course?
1 Answer available
Is NF1 an absolute contraindication to intracranial radiation in pediatric gliomas?
Comments regarding risk of Moyamoya
1 Answer available
When would you consider treating a testicular relapse with definitive radiation in a child with ALL?
1 Answer available
Is there a benefit to metastatic & primary site RT in RMS w/ persistent marrow disease?
In a patient with high risk rhabdomyosarcoma with significant marrow involvement (Stage IV), who has responded completely on imaging to all known site...
2 Answers available
How would you treat a pediatric embryonal rhabdomyosarcoma of the kidney with preoperative rupture s/p nephrectomy and getting VAC/VI chemotherapy?
Would you treat this with whole-abdomen RT with a boost? What dose would you recommend? This would be Stage 1, Group 2 (R1 resection), low risk; but l...
1 Answer available
Is there any mature data about cognitive outcomes in 12 Gy vs 18 Gy in the setting of prophylactic cranial irradiation for ALL in children?
1 Answer available
At what dose would you recommend future audiogram screening for pediatric patients treated with radiotherapy?
Is it recommended in every pediatric patient?  Are there any guidelines for organ-specific surveillance after XRT for children based on age, dose...
1 Answer available
How would you treat a solitary intracranial oligometastasis from Ewing's sarcoma that has been resected?
What fields would you use for adjuvant RT?  SBRT vs. whole brain?
1 Answer available
What is a standard field for LN+ paratesticular rhabdomyosarcoma (ie aorta + ivc + ipsi common iliac)?
For example, if there was a common iliac node, does external iliac nodal region also need to be included? When, if ever, do you include the exter...
1 Answer available
What is your approach when it comes to reirradiation for DIPG patients who have already received 54Gy upfront?
1 Answer available
Would you give post operative radiation for a pT1N0 parotid low grade mucoepidermoid carcinoma with positive margin on the facial nerve to an adolescent?
Would the risk of secondary malignancy affect the decision?
2 Answers available
For a recurrent medulloblastoma in the posterior fossa several years after initial standard risk therapy (23.4 Gy CSI), and in which the patient is still less than 18, how would you approach re-irradiation?
Assuming CSF is negative for neoplastic cells would you: Re-irradiate gross disease only? Re-irradiate posterior fossa only? Re-irradiate the entir...
2 Answers available
How do you manage an adult primary rhabdomyosarcoma of the lung/mediastinum?
Is there any role for consolidative RT/CRT to the lung and mediastinum after initial chemo? What dose and fractionation would be most appropriate for ...
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
Would it be appropriate to treat an adult with a pure germinoma at 1.8 Gy/ fraction instead of the pediatric dose of 1.5 Gy/ fx when treating with radiation alone to the whole ventricle (with cone down to primary)?
1 Answer available
Is it acceptable to do IFRT rather than whole posterior fossa boost for high risk medulloblastoma?
 If so in what circumstances and what margin is acceptable? ACNS 0331 recently showed no difference in outcomes when comparing IFRTboost vs ...
3 Answers available
Is there a role for hyperbaric oxygen treatment concurrent with radiotherapy in the treatment of pediatric glioblastoma?
1 Answer available
Do you boost residual lung disease after chemotherapy after whole lung irradiation for patients with Ewings, Rhabdomyosarcoma or Wilms?
Can you use SBRT for boost?
1 Answer available
For extremity rhabdomyosarcomas (hand) with positive epitrochlear and axillary lymph nodes, do you treat the lymph nodes or just the primary?
What is the risk of joint issues if you treat the epitrochlear nodes?
1 Answer available
What is the value and potential morbidity of second look surgery in patients with sub-totally resected ependymoma?
1 Answer available
When would you consider testicular RT prior to TBI for BMT?
What dose do you recommend?
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
Does the literature support a benefit for whole lung irradiation for high risk rhabdomyosarcoma with multiple lung metastases?
What if there is a CR to chemo? 
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
How do you determine whether to offer whole lung radiation to children with favorable histology Wilms, lung metastases, and a CR on chemo, without knowledge of 1p16q status, as per the AREN0533 protocol?
AREN0533 schema requires knowledge of 1p16q status, though this test is not available off-protocol. How does this affect management for patients treat...
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
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


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45 GyRBE for group III orbital embryonal rhabdomyosarcoma.
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Integrated genetic and epigenetic analysis defines novel molecular subgroups in rhabdomyosarcoma.
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