Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is the appropriate treatment for marginal zone lymphoma of the parotid following surgery?
Definitive radiation therapy is the standard treatment for a patient with an uncomplicated case of localized marginal zone lymphoma of the parotid gland. The CTV would encompass the entire gland and the total dose would be 24 Gy. Occasionally patients will be diagnosed with MZL after parotidectomy, ...
Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?
It probably is. Although not proven by randomized trial/s in pediatric patients, the practice is accepted in adults. In children where long term morbidity of radiation therapy is of greater concern, it would not be unreasonable to use involved nodal field in combination with chemotherapy.
Is it preferable to simulate pediatric Hodgkin's lymphoma patients with arms up or akimbo?
We will be moving towards involved site radiotherapy for pediatric Hodgkin lymphoma. Consequently, you may want to match the simulation with the set up of their pre-treatment PET/CT scan (arms up vs arms down). This will allow you to have more certainty regarding the location of axiallary and subpec...
What is the difference between involved node and involved site irradiation?
In both involved node and involved site (ISRT), prechemotherapy GTV determines the CTV. However, ISRT accommodates cases in which optimal prechemotherapy imaging is not available to the radiation oncologist. In ISRT, clinical judgment in conjunction with the best available imaging is used to contour...
Is it time to start incorporating involved site irradiation for all lymphomas?
Involved site radiation is becoming the new standard therapy for lymphomas and the goal is to incorporate the ISRT concept broadly. ISRT evolved to update field design guidelines to take into account 3D imaging rather than base field design on bony anatomy which is the way we designed fields in the ...
Can you observe low grade follicular lymphoma if the involved node(s) have been surgically removed?
There are certainly circumstances where observation for limited stage, low grade follicular lymphoma is warranted. I would not rely on surgical resection alone for cure however. Occasionally surgery can be curative in Stage I extranodal MALT lymphoma.
Is IMRT preferred over 3D conformal RT for lymphoma of the head and neck?
If, based on the location of the node, we can spare the parotid gland more then we would do. The dose response curve for parotid salivary function is sigmoidal and not an all or none phenomenon, which is to say that the mean dose of 15Gy better than 25Gy which is better than 35Gy. As these patients ...
In treating with total body irradiation, how should the lung blocks be drawn and what dose should the lung receive?
I draw lung blocks 1 cm. insde the edge of peripheral lung including apex of the lung . The doses are usally 5% less than the prscribed doses to central axis . The typical TBI schedule as a conditioning regimen for BMT is 150 cGy BID for 1200 cGy . Bharat
What is the treatment volume for primary breast lymphoma?
This is a rare presentation for DLBCL. In most instances tumor fairly small and lumpectomy can be performed and usually has been before dx is established. Post chemo I usually rx whole breast to 30gy. One could argue against RT theoretically if lumpectomy with neg margins has been performed but it i...
When do you recommend consolidative XRT for patients with advanced stage (III-IV) DLBCL who achieve CR to chemoimmunotherapy?
The cornerstone of therapy for advanced DLBCL is chemoimmunotherapy (R-CHOP). Efforts to improve upon this with systemic therapy have been largely unsuccessful (dose-dense chemotherapy, maintenance R, more intensive chemotherapy, high-dose chemotherapy and autologous SCT, etc.). There are increasing...