Chemotherapy alone for localized diffuse large B-cell lymphoma

Approximately 25% to 30% of patients with diffuse large B-cell lymphoma (DLBCL) present with limited-stage disease, typically defined as those with nonbulky (<10 cm) Ann Arbor stage I or II disease, without B-symptoms and with sites that can be encompassed within a radiation field. A variety of treatment approaches have been used, which have largely relied on the administration of systemic therapy followed by involved-field radiation therapy (IFRT) to all sites of disease. The use of IFRT has been associated with improved local control, but a significant impact on long-term outcome has not been demonstrated. Although the inclusion of IFRT may allow for an abbreviated course of chemotherapy to be administered, this benefit must be weighed against the potential for radiation-induced acute and delayed toxicity. With the advent of improved systemic therapy, the routine use of IFRT in all patients with limited-stage DLBCL seems no longer justifiable. A tailored-therapy approach, with choice of treatment guided by patient performance status and chemotherapy tolerance, sites of disease involvement, clinical risk factors, and early treatment response would seem rational. Ultimately, greater biologic insight into the heterogeneity of DLBCL will likely result in a personalized treatment approach that relies more on biologic characteristics than stage of disease.