Are you de-escalating treatment for favorable risk Stage I-II DLBCL patients to 4 cycles of R- CHOP with 2 additional rituximab cycles?

In general I could see this being an option in select patients (not localized stage II or patients who have a contraindication to XRT) but for the most part these patients in my practice are not treated with 6 cycles of R-CHOP. I treat most patients with Stage I and localized stage II with 3 cycles ...

I find the data from FLYER quite compelling, and for appropriately selected patients see this regimen as a standard of care in early stage DLBCL, reducing both short and long term toxicity from radiotherapy without compromising outcomes.

It depends completely on the response to 4 cycles of R-CHOP and its tolerance. I would certainly consider this as an option.Thx, RAB

I find Dr. Matasar's answer totally compelling since it is based on randomized data. The value of post-chemotherapy radiation, even in bulky residual disease, is questionable. However, most of these patients are in CR.

Furthermore, I do not think radiation to any localized regions is without consequ...