How would you treat a Stage I DLBCL invading the mandible?

If a patient had an early-stage DLBCL of the oropharynx (e.g., tonsil) with minimal mandibular invasion, who was otherwise low risk by the IPI, then I think 3 cycles of R-CHOP followed by consolidation RT (30 Gy) would be quite reasonable. If the disease was bulky or if there was significant bone involvement, then I would recommend additional cycles of chemoimmunotherapy (6 would be reasonable) with consolidation RT (30 Gy). Surgery is generally not utilized as a therapeutic modality in lymphoma...