How would you manage a stage IE DLBCL of the stomach, non-germinal center type by IHC, and Ki-67 of 70%, but negative for double/triple hit by FISH?

Nijland et al., PMID 29083044.

This shows that you can use either option, 3 cycles RCHOP+ XRT or 6 cycles RCHOP with no difference in relapse or DFS.

My bias would be to treat with 6 cycles of RCHOP as I look at DLBCL as a systemic disease and risk for systemic relapse even with early presentation.

If...