Do you routinely recommend consolidative radiation to bulky site(s) in the setting of advanced stage DLBCL?

How radiation therapy (RT) should be incorporated into the management of patients with advanced DLBCL continues to be investigated. In the setting of widespread, non-bulky disease, when a complete response is achieved with systemic therapy, I don't recommend consolidation RT. Though controversial, I do generally recommend RT in the following three circumstances:

1. When the disease extent is limited, particularly with limited osseous disease. It is not uncommon in DLBCL to have a patient present with 2-3 sites of extranodal disease only without bone marrow involvement. Disease in the distal femur and proximal tibia constitutes stage IV disease. Given the localized distribution, however, it seems reasonable to consolidate with RT.

2. When a co...