Hematologic Malignancies&nbsp;&nbsp;&nbsp;

Under what circumstances would you consider omitting radiation in patients with early stage, unfavorable (bulky) Hodgkin Lymphoma?

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...

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?

How do you approach pelvic radiation therapy for a patient with multiple myeloma who needs more intensive therapy (e.g., Dara-KRd or impending CAR-T) with a risk of cytopenias?

For example, a large iliac or sacral plasmacytoma causing symptoms. Both medical oncologists and radiation oncologists get nervous about RT-related cy...

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...

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...

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...

How would you approach a patient with vitreoretinal lymphoma without CNS or systemic involvement?

What would be your RT volumes and dose?

Is there any role for radiation in the treatment of stage II nasopharyngeal DLBCL involving bilateral nasopharynx and unilateral cervical nodal involvement but without bony or nerve involvement?

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

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?

How do you counsel patients with locally advanced malignancies who have ECOG 3-4?

How do you advise patients who strongly desire chemotherapy?

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 ...

What radiation dose would you use to treat a symptomatic osseous lesion secondary to AL-amyloidosis?

How do you incorporate radiation therapy in patients undergoing CAR T-cell therapy for DLBCL?

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...

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?

For patients with primary CNS lymphoma and less than a CR to chemotherapy, in what situation would you consider partial or focal radiation?

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?

Would you re-irradiate a spleen with increasing splenomegaly for a patient with myelofibrosis?

If a patient had a high dose of radiation to the spleen (10 Gy over 5 fractions) over a year ago but with increasing splenomegaly now, would you consi...

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?

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?

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

Does the use of A+AVD versus ABVD affect your decision for consolidation RT for bulky Hodgkin lymphoma?

How would you treat a stage IIA NS HD patient with bulky disease who refuses chemotherapy?

What field design and dosing is most appropriate? Would you use ISRT or a more extended field?

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 ...

How would you optimally manage a small solitary plasmacytoma of the alveolar ridge, including minimizing the risk of dental toxicity?

Would you treat the mandible if the patients has osteonecrosis from zoledronic acid but also multiple myeloma in this region, biopsy proven?

Are there any circumstances where you recommend early institution of systemic therapy for patients with solitary plasmacytoma?

Specifically, do you offer closer follow-up for certain patients after local radiation?

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?

When should vaccines be given if not received prior to the start of high dose radiation (40-50 Gy) to the spleen?

How do you manage acute keratoconjunctivitis following total skin electron therapy (TSET)?

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...

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...

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?

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...

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?

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?

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?

Is there an optimal salvage radiation dose for relapsed post-CART disease?

Would you offer bridging radiation before or after leukapheresis?

Are you concerned about cases where radiation has to be started urgently before leukapheresis?

How soon after CAR T-cell therapy can salvage radiation be delivered?

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?

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.

Which patients with relapsed/refractory NHL are appropriate for pre-CAR-T bridging radiation therapy?

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?

What hypofractionated radiotherapy dose regimen is acceptable for plasmacytoma?

Do you recommend postoperative radiation for spinal cord compression DLBCL?

Do you give RT before or after systemic therapy?

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?

For patients with solitary plasmacytoma of the ureter undergoing definitive XRT (40-50 Gy), what dose constraint do you use for the ureter?

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?

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?

How do you follow patients with Bronchus Associated Lymphoid Tissue Lymphoma treated with 2 Gy x 2 fractions?

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?

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...

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)?

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

Would you offer radiation therapy for extramedullary testicular masses in the setting of multiple myeloma?

Is this considered a sanctuary site from systemic therapy?

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...

How would you approach radiation therapy for indolent T-cell lymphoproliferative disorder of the gastrointestinal tract?

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...

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...

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...

What dose constraints do you use when treating gastric MALT or DLBCL with radiation therapy?

What is your target volume when treating lymphoid hyperplasia of the lacrimal gland with radiation therapy?

Would you cover the lacrimal gland alone or the entire orbit?

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?

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?

What is your simulation setup and dose fractionation for DLBCL of the hand with Deauville 4 residual disease following R-CHOP?

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...

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

What is the role of radiotherapy in cutaneous pseudolymphoma?

Are there particular indications you use for RT? i.e. multiply recurrent, refractory to other therapies, near critical structures, unresectable (or re...

Do you hold histone deacetylase (HDAC) inhibitors for patients receiving palliative radiation therapy for cutaneous lymphomas?

If so, how long before/after radiation?

How would you approach radiation treatment for a grade 3A follicular lymphoma that has recurred multiple times with one site of active disease?

What dose constraints, if any, would you use when administering TBI?

What if the patient has had a liver transplant?

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.

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.

How would you approach a young patient with stage I follicular lymphoma of the mesenteric lymph nodes?

What treatment margins/set-up/on-board imaging would you use?

How would you approach a patient with high-grade gastric lymphoma who achieved a CR following chemotherapy?

If radiation is indicated, what dose would you use?

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...

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...

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.

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.

How do you approach a patient with unfavorable stage II Hodgkin's lymphoma who achieved cCR after 6 cycles of systemic therapy but developed acute pericarditis with non-malignant effusion after 2 fractions of consolidative radiation therapy?

Signs/symptoms and echo/EKG consistent with pericardial effusion likely secondary to acute pericarditis

Would you offer consolidation RT to a young woman with bulky mediastinal DLBCL who achieved early and persistent CR to RCHOP on PET?

For primary MZL of the breast, do you do whole breast to 24 Gy or ISRT?

What radiation dose do you typically use for relapsed DLBCL following 6 cycles of R-CHOP?

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?

What would be a reasonable radiation approach and dose for a patient with multiple myeloma with brain involvement?

How would you approach a patient with a primary splenic DLBCL who has residual PET avid disease after 6 cycles of R-CHOP?

Would you consider radiation therapy? What dose/fractionation?

How would you approach a patient with early-stage orbital MALT lymphoma with high proliferative index?

What consolidative radiation volumes and dose would you use for plasmablastic lymphoma of the L maxilla s/p incisional biopsy and 6 cycles of EPOCH-R?

Would 5000 cGy ISRT be appropriate? Would you include the entire maxilla to 3000 cGy and cone down or just treat the post incisional biopsy site...

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?

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?

Do you recommend treating the entire extent of hardware for a femoral neck plasmacytoma with pathologic fracture requiring internal fixation?

If the plasmacytoma was originally limited to the femoral neck, is it necessary to cover the entire femur out of concern for marrow space involvement?

Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?

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.

How would you approach a resected solitary osseous plasmacytoma?

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

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...

What is the role for consolidative ISRT for patients with stage III follicular lymphoma following a good response to systemic therapy?

How would you approach a patient with gastric MALT lymphoma who has CREST syndrome?

Would chemotherapy be preferred over RT?

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

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.

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?

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.

Does multiple myeloma become more radioresistant post transplant?

When treating LUQ metastases, is there a cutoff dose to the spleen after which you would recommend post-splenectomy vaccinations to protect against overwhelming post-splenectomy infection?

Would you recommend RT for DLBCL of a pre-isthmus node incidentally found during thyroidectomy for papillary thyroid cancer?

If the patient has received RCHOPx3 and the post treatment PET is negative, what would your management be?

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?

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)?

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?

How should a patient with perforated H. pylori negative gastric MALT be managed?

Should systemic therapy or ISRT be utilized? Is there a risk for intrabdominal spread with perforation? If the ulcer is repaired by simple...

How would you treat a Stage I DLBCL invading the mandible?

Would you consider ISRT after 3 cycles of RCHOP, omit radiation and proceed to surgery after 6 cycles of RCHOP, or do something else?

What is the role of consolidative radiotherapy in a Stage IV triple hit lymphoma with partial response above and below diaphragm s/p 8 cycles of RCHOP?

Specifically, would you consolidate initially bulky sites or allow patient to proceed to next line systemic therapy / transplant?

Is there a role for orchiectomy in a patient with stage IV DLBCL who presents with a testicular mass?

The patient was started immediately on chemotherapy due to gastric bleed and scrotal irradiation is planned.

Can radiation therapy alone for localized recurrence of high-grade B-cell lymphoma be considered for those that previously received rituximab-based chemotherapy?

In particular, for frail patients to avoid toxicity or for those that do not want chemotherapy

How would you define bulky involvement of the tonsil in a patient with DLBCL?

The patient in question has Stage IIIA DLBCL with a CR after 6 cycles R-CHOP. When would you treat the involved tonsil?

How would you manage a patient with a 2 cm forehead subcutaneous lesion s/p excision found to be a diffuse large B-cell lymphoma germinal center?

PET/CT negative for any other sites of metastatic disease. Focal activity noted on PET (postop changes?). CSF negative. Bone marrow biopsy negative. 2...

What dose-fractionation scheme do you recommend for the treatment of leukemia cutis?

Does your recommendation change based on whether the patient has one or multiple lesions?

Would you recommend ISRT after salvage auto transplant for relapsed classical Hodgkin Lymphoma if the patient had Deauville 2 after ICEx2 prior to BEAM auto transplant and now has Deauville 1 imaging?

Would it being non-bulky and along the right heart border impact your decision making?

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?

Would you ever consider SRS as a salvage option as an alternative to whole brain radiation for secondary CNS lymphoma?

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?&...

How would you treat a stage I peripheral <3cm extranodal marginal zone lymphoma of the lung? Is SBRT appropriate? If so, what dose would you use?

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?

How do you perform geriatric assessment for cancer patients?

Do you use specific tools or take into account certain factors when considering treatment options for older adults?

Is there a role for RT in localized nodal relapse of stage IV follicular lymphoma with the goal of delaying the need for additional systemic therapy?

For example, in a patient treated with multiple systemic therapies over ~10 years, would it be reasonable to use radiation to a single asymptomatic si...

Is it safe to deliver definitive radiation for a solid tumor malignancy (ie H&N) concurrently with maintenance lenalidomide/Revlimid for multiple myeloma?

Do you routinely prescribe PCP prophylaxis for patients who will be on steroids long-term?

If so, what is your time threshold for when you'll start PCP prophylaxis--when you anticipate steroid courses greater than 1 week? 1 month? 3 months?&...

What RT fields would you recommend for a patient with early-stage diffuse large B-cell lymphoma who refuses or is unfit for systemic therapy?

Would you treat the involved site or involved field for definitive intent?

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

Can venetoclax and radiation be safely given concurrently?

How would you set up and treat a mycoses fungoides patient with symptomatic bilateral inner thigh, groin, and scrotal plaques?

This patient has previously been treated with low dose total skin electron therapy.

For a MALT lymphoma involving the preseptal orbit only, woud you treat the entire orbit or limit the CTV to the preseptal orbit?

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?

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...

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?

What CTV margins do you use for indolent advanced stage lymphoma treated with palliative radiation alone?

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?

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...

Is 2 Gy x 2 (or the "boom boom" regimen) appropriate for treating patients with low volume stage I MALT lymphoma?

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?

What RT dose would you use to treat a single site relapse of high risk multiple myeloma?

What is the role of radiation in a patient with stage IV DLBCL with bilateral testicular involvement?

How do you manage thrombocytopenia when radiating the spleen?

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

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.

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?

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?

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...

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?

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...

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...

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...

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?

Would you recommend scrotal RT in a patient with stage IV primary testicular lymphoma with CNS involvement after CR to RCHOP and MTX?

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?

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?

Would you recommend consolidative radiation therapy to an isolated frontal dural MALT lymphoma after complete response to chemotherapy?

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?

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...

What dose and fractionation would you recommend for a localized primary bone marginal zone lymphoma?

The patient has no bone marrow involvement.

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...

Which imaging modalities and schedule do you use to follow stage I-II follicular lymphoma that was treated with radiotherapy alone?

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...

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...

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 ...

What dose/fractionation do you like to use for palliation of bulky LAD from CLL/SLL?

What is the role of salvage radiation therapy in patients with locally recurrent Hodgkin lymphoma after an autologous stem cell transplant?

Can post op RT be omitted in a surgically repaired pathological fracture site in multiple myeloma if the patient will receive systemic therapy?

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...

What stage is bilateral orbital/conjunctival NHL (limited only to the bilateral orbit/conjunctiva)?

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...

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...

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...

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...

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."...

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)?

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?

Do you recommend using DIBH for young adults with Hodgkin lymphoma who require mediastinal RT?

In which patients with early-stage favorable Hodgkin's lymphoma, if any, would you consider omitting consolidation RT after ABVD chemotherapy?

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?

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...

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...

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?

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?

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...

When would you consider treating a testicular relapse with definitive radiation in a child with ALL?

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...

For multiple myeloma, is 8 Gy in 1 fraction an appropriate palliative dose, although this histology was excluded from trials examining a single fraction?

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...

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...

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...

Do you prefer a chemo-radiation combination or chemotherapy followed by sequential radiation approach for early stage NK/T-cell lymphoma?

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 ...

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...

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?

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?

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...

What dose/fractionation schedule should be used for adjuvant RT after surgical decompression of a spinal cord compression from multiple myeloma osseous lesions?

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...

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...

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?

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?

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?

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...

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?

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?

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?

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...

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?

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 ...

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?

When would you consider testicular RT prior to TBI for BMT?

What dose do you recommend?

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?

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?

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...

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?

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 ...

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...

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?

What is the role of radiation consolidation after chemotherapy for residual splenic involvement in follicular lymphoma?

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...

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...

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...

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?

What is the best radiation dose to treat primary cutaneous B cell lymphoma?

Specifically for marginal zone or follicle center?

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?

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...

Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?

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...

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.

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)?

Can you observe low grade follicular lymphoma if the involved node(s) have been surgically removed?

Is it time to start incorporating involved site irradiation for all lymphomas?

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

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?

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.

What is the difference between involved node and involved site irradiation?