Renewed interest in the role of consolidative radiotherapy in advanced stage diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) represents the most common subtype of non-Hodgkin lymphoma (NHL) in the United States, and two-thirds of these patients will present with advanced stage (stage III-IV) disease. Although radiation therapy (RT) alone was the first curative therapy for limited stage DLBCL, the advancement of combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) with the addition of the anti-CD20 antibody rituximab became the cornerstone of current management. The role of consolidative RT as part of first-line therapy in the management of patients with advanced stage DLBCL remains unclear, and represents an area of controversy with considerable differences in patterns of practice across different institutions. Emerging data now challenge the National Comprehensive Cancer Network (NCCN) guidelines, and give support to the use of consolidative RT in patients with advanced stage DLBCL. This review summarizes the major studies as reflected in our current practice and provides further insight into future directions for randomized trials which would help better define the role of consolidative RT in such a cohort.