Topline  Presentation Points

Evolution of radiation (RT) in diffuse large B-cell lymphoma (DLBCL) 

An Evolving Question 

  • Does radiotherapy provide benefit to patients with DLBCL? 
  • What is the incremental benefit of RT to patients with DLBCL with immunochemotherapy?  
  • What is the incremental benefit of RT to patients with DLBCL with complete metabolic response? 

State of the Evidence 

  • Most trials designed to address duration of chemotherapy, rather than benefit of RT 
    • Many trials not based on modern treatment practice 
    • Lack of chemoimmununotherapy 
    • Lack of functional imaging 
    • Old RT doses and techniques 
    • Incomplete local control data 
  • Heterogenous patient population 
    • What is the incremental benefit of RT in the era of chemo-immunotherapy?

Clinical Considerations 

      • Bulky Disease  
        • In Elderly Patients 
        • In Young Patients 
      • Bony Disease 
      • Primary Mediastinal B-Cell 
      • Can PET guide our decision on when to use combined modality treatment?
        • PET in Early-Stage Disease LYSA/GOELAMS 02-03 Trial (France)
          (Lamy et al:Blood. 2018 Jan 11; 131(2): 155–156) 
        • PET-Directed RT: Elderly Patients with Bulk

          (Pfreundschuh M, et al. J Clin Oncol 2017; 35 (15_suppl): 7506.)
      • Applying these trials to practice 

           New Frontiers: Relapsed and Refractory 

        • Bridging Radiotherapy with CAR T 
          • Disease stabilization and symptom control 
          • Decrease CAR T-cell toxicity 
          • Improve local control, and outcomes from CAR T