![]() ![]() The first study to enroll patients with advanced DLBCL was the LNH-98.5 trial conducted by the Groupe d’Etude des Lymphomes de l’Adulte (GELA). Perhaps no treatment to date has had a more profound impact on the prognosis of patients with advanced DLBCL than the incorporation of rituximab into combination chemotherapy regimens. ![]() Only the addition of rituximab to standard CHOP chemotherapy has led to consistent and meaningful improvements in outcomes for patients with advanced DLBCL. Phase II and randomized trials have evaluated different strategies, including delivery of more cycles of chemotherapy, dose-dense chemotherapy, alternative drug combinations, high-dose chemotherapy followed by autologous stem cell transplant (HDT/ASCT), and optimal incorporation of immunotherapy. A variety of treatment approaches have been explored in an attempt to improve outcomes. The primary modality for advanced-stage DLBCL is combination chemoimmunotherapy, now most commonly R-CHOP. In this review, we will first briefly summarize prior attempts to improve outcomes in advanced DLBCL using systemic therapy approaches, and then we will highlight the potential role of RT in advanced DLBCL. Patients with advanced disease have inferior clinical outcomes compared with those with localized presentations. Stage is an important prognostic factor in DLBCL. The other half of patients diagosed with DLBCL in the United States present with advanced disease managed primarily with systemic therapy. Now, 80% to 90% of patients with early-stage DLBCL remain disease-free after treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and consolidation RT. Radiation remains an integral part of the treatment of localized disease, having been shown to decrease the risk of relapse after chemotherapy, and it is currently designated as a category 1 treatment option by the National Comprehensive Cancer Network. Over time, treatment evolved to incorporate chemotherapy and rituximab, both of which led to lower relapse rates and improved survival. As with many lymphomas, radiation therapy (RT) was historically the cornerstone of treatment for localized disease, achieving high complete response (CR) rates and long-term freedom from relapse in 40% to 45% of patients. Approximately 50% of such patients present with stage I/II disease. More than 20,000 patients are diagnosed with DLBCL each year in the United States. Introductionĭiffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL), comprising 30% to 40% of all cases. In these settings consolidation RT is highly efficacious at achieving local disease control and improving overall outcomes. Consolidation RT has been shown to improve outcomes for patients with advanced DLBCL generally, and in specific instances including initially bulky disease, bone involvement, or in the setting of a partial response to systemic therapy. There is a growing body of retrospective and prospective data, however, suggesting a benefit for consolidation radiation therapy (RT) in select patients with advanced DLBCL. Efforts to improve upon R-CHOP-including more chemotherapy cycles, dose-dense chemotherapy, alternative drug combinations, high-dose chemotherapy with autologous stem cell transplant, and maintenance rituximab-have generally proved unsuccessful. The cornerstone of treatment is a combination of chemotherapy and immunotherapy, most commonly R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). ![]() Approximately half of patients will present with advanced (stage III/IV) disease. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. ![]()
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