Radiation Oncology   

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...

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...

The said patient has been on Imatinib for 2.5 years and is In MMR. Last rt-PCR was 0.04.

In this case, initial tumor was 9.5 cm craniocaudal but hardware spans the entire femur.

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...

Does this change depending on stage?

What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?

Which systemic agents would you recommend holding during RT?

What dose/fractionation?

If re-irradiation, what dose would you use?

In situations when we are waiting for insurance clearance or due to other logistical reasons. 

Plasmacytoma of 6th rib s/p resection. Negative multiple myeloma work-up.

If the patient cannot tolerate methotrexate or further chemotherapy, how effective is radiation therapy (e.g. WBRT) in rendering the patient disease-f...

Would chemotherapy be preferred over RT? 

NCCN only recommends palliative ISRT for non-transplant eligible patients with refractory/relapsed DLBCL

 The dosing in the literature has a huge range.  

If so, what dose and fractionation would you recommend?

What would be your RT volumes and dose?

Would you move straight to second-line systemic therapy or first attempt consolidative ISRT/boost, or employ both? Assume node is biopsy-proven. 

Would your recommendation change based on grade and/or location (weight-bearing vs non weight-bearing bone)? 

Would your recommendations change if the mass were significantly smaller, say 1-2 cm, and was completely excised with negative margins?  

In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients. 

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 canc...

How do you approach systemic therapy options? What are your recommended volumes?  

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?&...

Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?

For instance, if the tissue came back SLL, Waldenstrom's, follicular lymphoma, or even nodular lymphocyte-predominant Hodgkin lymphoma, would any or a...

For example, in a young patient where standard fields would be very large and you want to minimize toxicity

What if it is a young patient?

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...

 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...

At what point would you recommend transfusion? At what point would you stop radiation?

The patient received R-EPOCH followed by consolidative RT (36 Gy in 18 fractions) approximately one year ago and was subsequently salvaged with RICE.

There seems to be a wide variety of palliative doses used in clinical practice (8 Gy x 1, 2 Gy x2, and 20 Gy in 10 fx).  Do you have a preferred ...

If so, what dose would you recommend? 

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...

How do you decide between WBRT, maintenance chemotherapy, or stem cell transplantation? 

The unfavorable risk factors for stage I-II Classic Hodgkin's Lymphoma differ depending on the cooperative group (GHSG, EORTC, NCCN), which criteria d...

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...

Do the potential late effects offset any benefit of mediastinal XRT in a young patient with bulky disease?

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...

How would your dose and/or volume change if the patient refuses chemotherapy?

Any experience treating patients prone with openings for both breasts, no minimize breast overlap with axilla and mediastinum?

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...

The patient has no bone marrow involvement.

Some specific questions: Would you recommend repeat biopsy to confirm residual disease? How would your recommendations vary if the patient had pre...

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...

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...

Is your scoring based on SUV uptake vs the subjective interpretation of the radiologist? How do you go about reconciling Deauville scoring when there ...

Would you follow an algorithm such as the one proposed by Hall et al? How do you decide between intrathecal chemotherapy vs systemic therapy with HD-...

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...

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...

If they are symptomatic do you relax that time interval? Do you ever consider partial brain radiation instead of whole brain to minimize neurotoxicity...

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...

Prior trials of systemic therapy including alkylating agents and rituximab have failed and the patient is medically inoperable with no history of Hepa...

The staging bone marrow biopsy was negative. The staging manual simply states "bone involvement is identified using appropriate imaging studies."...

Would you use a similar dose and fractionation as gastric MALT (30Gy in 1.5 Gy fractions)?

Should prechemo PET positive disease from bowel or other structures be carved out? 

Do you generally always boost the scalp and/or soles even if those sites are not involved with disease?  

Would you consider observation following surgical resection with negative margins? Would you recommend WBRT and/or ISRT? What would be your preferred ...

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...

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...

Would you use 10 Gy in 1 Gy per fraction as mentioned in a litterature review in Pubmed?

What factors influence your choice to treat as well as dose and target?

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...

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...

I have a patient with low volume disease of Castleman's disease with cervical lymphadenopathy and tonsillar hyperplasia that is suspicious but not bio...

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...

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...

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...

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 ...

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...

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?

What dose and volumes would you use?

PET/CT/bone marrow biopsy negative for evidence of distant disease. Following 4 cycles of combination chemotherapy with no evidence of progressive dis...

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...

We often see young women with favorable, early stage disease in the mediastinum who have had a complete response to chemotherapy. With current smaller...

How have the results of the UK RAPID study (Radford et al NEJM 2015) changed your practice?  

Specifically, is there still a role for dd RCHOP followed by ICE, or do you recommend DA-R-EPOCH for all patients?

What is the best evidence to support or refute this?

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...

If a patient had recently completed R-EPOCH x 6 cycles, would you change your dose for a low grade follicular lymphoma?

Is surgery an adequate treatment for Stage IE DLBCL of the cervix? 

If the mesentery is widely involved with small lesions would this change your management? What if the patient was symptomatic? 

When treating with radiation therapy, what dose-fractionation do you typically utilize?

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...

In what situations would you feel comfortable omitting RT to bulky disease in stage III/IV Hodgkin's lymphoma?

With the field moving more toward ISRT/ INRT, and conformal radiation, would you generate separate PTV for initial nodal involvements that are within ...

If so, what data should be presented to insurance companies to cover the cost?

What dose do you recommend?

When nodal regions not amenable to biopsy but are enlarged without significant SUV uptake, should they be treated as involed and recieve RT?

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...

Is there a preferred low dose splenic irradiation regimine?

When radiation therapy is utilized, what should the radiation therapy treatment fields include and what imaging studies should be completed to assist ...

If so, should involved site radiation thearpy (ISRT) or involved field radiation therapy (IFRT) be used for the radiation therapy treatment fields? Wo...

Are the results of AHOD0031 practice changing?

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...

In drawing the lung blocks approximately 1 cm in from the chest wall, diaphragm and mediastinum, should the blocks stop underneath the clavicle o...

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...

Specifically for marginal zone or follicle center?

Is it necessary to treat the whole orbit or is conformal treatment ok? 

After a nerve sparing parotidectomy, would you offer postoperative radiotherapy? If so, what volume and dose? Would it change your management if the p...

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...

Would you prescribe to a higher dose? Treat with wider margins? Encourage the use of systemic therapy?

Hoskin et al (Lancet Oncology 2014) suggest 24Gy/12fx is more effect RT dose compared to 4Gy.

Is there a benefit to IMRT when we treat to relatively low doses (as compared to squamous cell cancers of the head and neck)?

Or is it more appropriate for certain sites/stages/histologies?

Specifically, for a diffuse large B cell lymphoma of the femur?

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.