Castleman disease

[manbeast8]

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Hello everyone,
I was recently referred a 26 year old female patient with unicentric castleman disease, hyaline vascular type, HIV and Hep B negative. She has a 6cm mass in the upper right mediastinum, deemed unresectable. She underwent Rituxan x 4 cycles with minimal response and now she’s seeing me for radiotherapy. Patient is asymptomatic. Treatment options in my opinion include radiotherapy versus observation. The patient is very anxious and desires treatment. Thoughts on dose? Would you even treat her? Limited data says to go to 40-50 Gy

 

[nkmiami]

Hello everyone,
I was recently referred a 26 year old female patient with unicentric castleman disease, hyaline vascular type, HIV and Hep B negative. She has a 6cm mass in the upper right mediastinum, deemed unresectable. She underwent Rituxan x 4 cycles with minimal response and now she’s seeing me for radiotherapy. Patient is asymptomatic. Treatment options in my opinion include radiotherapy versus observation. The patient is very anxious and desires treatment. Thoughts on dose? Would you even treat her? Limited data says to go to 40-50 Gy

yes, it is relatively radioresistant for lymphoma- I have seen failures and nasty paraneoplastic syndromes and would push to the higher edge of that range.

 

[OTN]

I've done it before- 45-50 Gy is what I would recommend. Tumor shrinkage was VERY slow for my patient, but it did occur and he's doing much better now 3 years out. His was in the bilateral cervical chains.

 

[Radiator20]

26yo in the thorax, potentially with reasonable prognosis if this lesion gets controlled. Wonder if worth considering referral for consideration of protons, if feasible? Doubt it would matter much for acute toxicity, but she has a lot of time to live out late toxicity and second malignancy risk...

 

[OTN]

If you have a hard time sparing the heart and breasts it might be reasonable to consider protons. Depending on where you're located, my group has protons + IGRT and does telemedicine consults. I could always have them take a look if needed.

 

[manbeast8]

If you have a hard time sparing the heart and breasts it might be reasonable to consider protons. Depending on where you're located, my group has protons + IGRT and does telemedicine consults. I could always have them take a look if needed.

Thanks everyone. Referring to local proton center