When do you recommend consolidative XRT for patients with advanced stage (III-IV) DLBCL who achieve CR to chemoimmunotherapy?

The cornerstone of therapy for advanced DLBCL is chemoimmunotherapy (R-CHOP). Efforts to improve upon this with systemic therapy have been largely unsuccessful (dose-dense chemotherapy, maintenance R, more intensive chemotherapy, high-dose chemotherapy and autologous SCT, etc.). There are increasing data that consolidation RT in advanced DLBCL is efficacious. The includes institutional series as well as randomized studies. In particular, the UNFOLDER and RICOVER studies demonstrated a benefit fo...

In 31 years of practice, I have never seen a case with III-IV presentations and limited disease extent in which all sites of disease can be safely encompassed. Even if they existed, I believe no data exists to support RT in this setting, either as an addition to systemic therapy, or instead of systemic therapy.