In a retrospective cohort of 68 DLBCL patients with partial metabolic response on interim PET after 4 cycles of R-CHOP, PET-directed residual site RT was associated with improved response and PFS.
29 patients received additional R-CHOP risk-adapted pRSRT:
• Deauville 4: 24 Gy
• Deauville 5: 40 Gy
Compared with no RT, pRSRT improved EOT CR:
• Overall: 72.4% vs 41.0%
• Deauville 5 subgroup: 83.3% vs 22.2%
PFS also favored pRSRT:
• 2-year PFS: 85.8% vs 52.9%
• 5-year PFS: 57.2% vs 44.1%
• Multivariable HR 0.26, p=0.018
No statistically significant OS difference was observed, with limited events and no deaths in the RT cohort. Toxicity was generally manageable, though one grade 4 bowel perforation occurred.
Although this cohort was treated in the R-CHOP era, the question remains highly relevant in the POLARIX/pola-R-CHP era: when residual PET-avid disease persists despite improved systemic therapy, PET-directed RT may still have a role as a selective consolidation strategy.
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