Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What dose do you feel comfortable treating the entire circumference of an extremity to before you are concerned about chronic toxicity?
The doses for lymphoma will depend on the histology , use of chemotherapy , response to chemotherpy . I am comfortable in giving 3600cGy at 180 cGy per fraction .
For patients with stage 1A-E extra nodal marginal zone lymphoma that has been completely excised, would you still consider radiation?
Not if it has been excised completely
Is there a role for radiation therapy after chemotherapy for localized anaplastic large cell lymphoma?
Hard to answer this question as posed. ALCL when localized is primarily confined to skin. Treatment of choice in this circumstance is RT alone, generally 40 gy in conventional fractions. ALCL not primarily in the skin is a systemic disease best rx'd with chemo, rarely localized. For the latter, I wo...
What is the best management of a lacrimal gland MALToma?
Ocular MALT can occur in the conjunctiva, lacrimal gland or retroorbital tissue. Although chlamydia can cause this, treatment with antibiotics without documenting infection has not been reported to have a significant response rate. Even in patients who test positive for DNA, I have seen mixed respon...
How would you treat a pediatric patient with Stage IVB Hodkin lymphoma who still has persistent PET+ disease after dose-escalated chemotherapy?
ISRT per Hodgson et al PRO 2015 to 21 Gy then boost the PETavid disease to 30Gy (Deauville 3) perhaps 36 Gy (Deauville 4).
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?
There are multiple small series showing good a salvage rate with radiation therapy with acceptable morbidity for patients who have failed prior MTX. The outcome is dictated by age and extent of disease and accordingly one can plan for a palliative or definitive dose.
What is an appropriate dose for nodular lymphocyte predominant, stage 1 Hodgkin lymphoma following nodal excision?
We would treat to 30 Gy and treat somewhat more than involved site, as patients receive RT alone. This means treating more like involved region which, in this case, would probably be the ipsilateral groin nodal region.See the attached recent update from German group:http://jco.ascopubs.org/content/e...
What is the role of radiation treatment of stage IA ALK negative anaplastic large cell lymphoma?
It would be helpful to know the site of origin. Most stage I ALCL alk neg would be in the skin, in which case RT is the treatment of choice with little role for chemotherapy. Stage I ALCL, other then skin, would be quite rare with no data to guide us, except that we know response to chemotherapy for...
How would you treat Classic Hodgkin's lymphoma when the nodal sites are non-contiguous?
The question has insufficient information. I'm going to assume that the patient had chemotherapy with a PET/CT complete response. Based on that assumption, then the general principles are that if the sites of involvement are > 5 cm, that you should have multiple treatment fields, but if they are les...
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?
I'm not aware of any published data for HL. There is a phase I-II study on low-grade B-cell lymphoma: "In situ vaccination with a TLR9 agonist induces systemic lymphoma regression: a phase I/II study" by Brody et al (J Clin Oncol. 2010 Oct 1;28(28):4324-32) that used a dose of 2 Gy x 2. There is an ...