Non-Hodgkin’s lymphoma: diagnosis and management

Recommendation ID: NG52/3
Question: Radiotherapy in first-line treatment of diffuse large B-cell lymphoma:- In people presenting with diffuse large B-cell lymphoma and sites of bulky disease, are outcomes improved by radiotherapy to those sites following a full course of chemotherapy?
Any explanatory notes (if applicable): Why this is important:- The role of radiotherapy to sites of original bulky disease in treating diffuse large B-cell lymphoma is uncertain. Some clinical teams will consider radiotherapy in this setting while others will not because of concerns about morbidity and late effects of treatment. In a recent randomised trial of chemotherapy in people over 60 years old with diffuse large B-cell lymphoma, people having radiotherapy were identified and compared with a cohort having no radiotherapy. Significant improvements in event-free, progression-free and overall survival were seen in the group having radiotherapy. These results have encouraged some teams to reconsider radiotherapy for bulky diffuse large B-cell lymphoma. A definitive randomised trial is needed to address this question.
Outcomes of interest include overall survival, disease-free survival, progression-free survival, treatment-related mortality, treatment-related morbidity, health-related quality of life, patient satisfaction, patient preference and overall response rate (complete or partial remission).

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Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	31/07/2016