How would you manage a Stage IV NLPHL that has residual hypermetabolic disease involving the bilateral neck/SCV following RCHOP x 4 cycles?

Nodular lymphocyte predominant Hodgkin lymphoma is an unusual disease, developing in ~450 patients each year in the United States. While the WHO classification still categorizes this entity as a Hodgkin lymphoma subtype, the International Consensus Classification refers to this disease as "nodular l...

4 cycles of R-CHOP may not be enough to see the full effect of the systemic treatment.

I would rather complete systemic therapy with a total of 6 cycles of R-CHOP first and then irradiate any residual lesions.