![]() ![]() Of 251 evaluable patients, 36 received an RT boost within 3 months of allo-HCT at our institution from 2001 to 2016. We evaluated the impact on survival of antithymocyte globulin conditioning (TLI-ATG) with radiation (RT) boost to high risk or residual disease before allogeneic hematopoietic cell transplant (allo-HCT) for adults with lymphoma (excluding mycosis fungoides and low-grade NHL other than SLL/CLL). In addition, a number of retrospective studies of peri-transplant radiotherapy to high-risk sites have been performed in HL and non-Hodgkin lymphoma (NHL), motivated by the observation that most relapses following transplant occur at the sites of initial disease relapse, though most of these studies focus on patients undergoing autologous-HCT. Similarly, in diffuse large B-cell lymphoma, radiotherapy may mitigate the impact of risk factors such as bulky disease, extranodal involvement, incomplete response to chemoimmunotherapy on PET, and may possibly be omitted for patients with PETnegative bulky disease. In advanced Hodgkin lymphoma (HL), radiotherapy may mitigate the impact of risk factors such as partial response to chemotherapy, original bulky disease or residual disease on CT, or PET-positive partial response to chemotherapy, and may be omitted in patients with initially bulky disease with complete remission (CR) on CT after chemotherapy or in patients with PET-negative partial remission. Further prospective randomized data are needed to confirm these findings. The current analysis supports the use of consolidative RT in early stage DLBCL given an OS benefit on multivariate analysis. On multivariate Cox regression analysis of OS controlling for IPI and extranodal disease, the addition of RT was associated with improved OS (hazard ratio of 0.4, P =. Five-year OS was 87% versus 67%, and 10-year OS was 67% versus 58%, numerically higher favoring RT (P =. 001) were significantly correlated with OS. 04) and National Comprehensive Cancer Network IPI (P <. On univariate analysis, extranodal disease (P =. Seventy-seven patients received chemoimmunotherapy alone, and 41 received chemoimmunotherapy plus RT. Kaplan-Meier survival analysis and a Cox proportional hazards model were used for overall survival (OS). Relevant clinical information was used to calculate National Comprehensive Cancer Network international prognostic index (IPI) scores. Patients with early stage I-II DLBCL from 1998 to 2017 were reviewed coinciding with our institutional utilization of rituximab with the standard regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone and PET-CT. We sought to retrospectively review modern patients with early stage I-II DLBCL treated with rituximab and staged by PET-CT to better define which patients benefit from consolidative RT. The benefit of radiation therapy (RT) becomes uncertain in the treatment of early stage diffuse large B-cell lymphoma (DLBCL) in the era of rituximab, positron emission topography (PET), and computed tomography (CT). This article presents a systematic overview of ISRT, updating key evidence and highlighting differences in the application of ISRT across the lymphoma clinical spectrum. In addition to imaging considerations, the optimal ISRT treatment volume also depends on disease histology, stage, nodal or extranodal location, and the type and efficacy of systemic therapy, which in turn influence the distribution of macroscopic and potential subclinical disease. Involved site radiation therapy (ISRT) was introduced by the International Lymphoma Radiation Oncology Group as a slightly larger treated volume, intended to allow for commonly encountered uncertainties. Limitations of baseline imaging, changes in patient position, and anatomic changes after chemotherapy may make this difficult in routine practice. The successful implementation of involved node radiation therapy requires optimal imaging and precise coregistration of baseline imaging with the radiation therapy planning computed tomography scan. Involved node radiation therapy for lymphoma was introduced with the aim of using the smallest effective treatment volume, individualized to the patient's disease distribution, to avoid the potentially unnecessary normal tissue exposure and toxicity risks associated with traditional involved field radiation therapy.
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