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. 

Topics:

1. Introduction to CAR T-cell Therapy and Case 1 
   Chirayu G. Patel, MD, MPH and P. Connor Johnson, MD 
2. Introduction to Bridging RT and Case 2
   Michael J. Yunes, MD and Chelsea C. Pinnix, MD, PhD
3. Case 3 - Hodgkin Lymphoma
   Rachel Abrams Rabinovitch, MD, FASTRO
4. 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.