Challenging Cases in Lymphoma - Modern RT for the CAR-T and Advanced Imaging Era
A session of challenging cases in lymphoma with a panel of expert radiation oncologists, including one in private practice, and a lymphoma medical oncologist is presented: (1) Refractory CNS lymphoma – primary or secondary, with plans for, or having completed CAR T-cell therapy. The patient case is detailed with MRI imaging. Discussion focuses on WBRT vs. focal RT and dose/fractionation, with particular considerations to long-term outcomes with PFS and neurocognitive sequelae of RT. (2) Bridging RT prior to CAR T in a patient with rapidly progressive refractory high-grade B-cell lymphoma with plans for CAR T-cell therapy. Discussion focuses on dose/fractionation/field size with consideration to the site of lymphoma, apheresis and timeline to RT. Presenters also review what to do with a very compressed timeline to CAR T, such as < 1 week, and need to control the lymphoma. Presenters discuss how to salvage RT and alternatives/adjunctive therapy to RT after CAR T if pertinent to the selected case. (3) Primary mediastinal B-cell lymphoma with Deauville 4 response after 6 cycles of da-EPOCH-R. Presenters review the data behind false positivity of PET/CT following this systemic therapy, and how that influences when to treat vs. when to closely watch with short-interval re-imaging. (4) Hodgkin lymphoma patient who fits RAPID criteria (such as stage IIA in supraclavicular and upper mediastinum) with disease in a male above cardiac tissue increase PFS with chemo/RT, vs. chemotherapy alone approach. Technique of DIBH to further distance cardiac tissue is reviewed.
- Introduction to CAR T-cell Therapy and Case 1
Chirayu G. Patel, MD, MPH and P. Connor Johnson, MD
- Introduction to Bridging RT and Case 2
Michael J. Yunes, MD and Chelsea C. Pinnix, MD, PhD
- Case 3 - Hodgkin Lymphoma
Rachel Abrams Rabinovitch, MD, FASTRO
- Case 4 - Primary Mediastinal B-cell Lymphoma
P. Connor Johnson, MD and Chirayu G. Patel, MD, MPH
This activity is available from July 11, 2023, through 11:59 p.m. Eastern time on July 10, 2025.
This activity was originally recorded at the 2022 ASTRO Annual Meeting.
The activity is designed to meet the interests of medical oncologists, radiation oncologists and residents.
Upon completion of this activity, participants should be able to:
- Explain the factors that may influence radiation dose, fractionation and field size in the bridging and salvage radiation for CAR T-cell therapy.
- Balance the goals and toxicity of radiation therapy in patients with refractory CNS lymphoma undergoing CAR T-cell therapy.
- Critically evaluate end-of-chemotherapy PET/CT for patients with primary mediastinal B-cell lymphoma and determine when to provide RT vs. closely observe the patient with a Deauville 4 response.
Chirayu G. Patel, MD, MPH, is employed by Massachusetts General Hospital and receives compensation from McCarthy Bouley Barry + Morgan and Best Doctors.
Chelsea C. Pinnix, MD, PhD, is employed by the University of Texas MD Anderson Cancer Center. Dr. Pinnix receives research grant funding from Merck and Co, owns stock in Neumentum Inc., and holds a leadership position as Vice President of the Association for Directors of Radiation Oncology Programs (ADROP).
Michael J. Yunes, MD, is employed by Baystate Health Systems, Inc and receives compensation from Elekta.
Rachel Abrams Rabinovitch, MD, FASTRO, is employed by the University of Colorado.
P. Connor Johnson, MD, is employed by Massachusetts General Hospital and receives compensation from AstraZeneca, ADC Therapeutics, and Seagen.
The person(s) above served as the developer(s) of this activity. Additionally, the Education Committee had control over the content of this activity. All relevant relationships have been mitigated.
The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council of Continuing Medical Education to provide continuing education to physicians.
ASTRO is awarded Deemed Status by the American Board of Radiology to provide SA-CME as part of Part II Maintenance of Certification.
- 1.25 AMA PRA Category 1 Credit™The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
- 1.25 Certificate of AttendanceThis activity was designated for 1.25 AMA PRA Category 1 Credit™.
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The course and its materials will only be available on the ASTRO website until July 10, 2025, regardless of purchase date. At the expiration of the qualification, participants will no longer have access to the course or its materials. ASTRO reserves the right to remove a course before the end of its qualification period.
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