Planned? Don’t talk about—planned?!

How many times have you been referred a non-bulky, early stage diffuse large B-cell lymphoma (DLBCL) with residual disease after full R-CHOP? Yet you somehow never see these patients without residual disease. It’s worth noting the NCCN offers a decision point based on whether radiation was “planned” or not—with inclusion of radiation as the only category 1 rec. Forget PET-directed, PET-reactive therapy is what we’re more typically left delivering. NCTN S1001 was billed as a trial of PET-directed therapy for patients with non-bulky, stage I/II DLBCL. Patients received 3 cycles of R-CHOP and interim PET. iPET(-) patients received 1 more cycle of R-CHOP while iPET(+) patients received involved-field RT followed by ibritumomab tiuxetan radioimmunotherapy. Among 128 patients on trial, 11% were iPET(+) and received radiation therapy, which is roughly 11% more than usual. At 5 years, rates of progression-free (87%) and overall (89%) survival were similar between iPET(-) and iPET(+) patients. TBL: Having achieved the best results to date, radiation should be included as part of PET-directed therapy for non-bulky, early-stage DLBCL. | Persky, J Clin Oncol 2020