![]() As EFS included RT given for residual masses (which do not always represent disease), applicability in the PET era is not straightforward. This study reported a 16% increase in event-free survival (EFS) ( P =. 3 In the R-CHOP era, the only randomized trial of RT for bulky DLBCL, “UNFOLDER,” was not PET-guided and has been reported only in abstract form. “Proof of principle” for the efficacy of RT was provided by Eastern Cooperative Oncology Group-1484, a randomized trial in which RT following CHOP increased PFS by 16%. The benefit of adjuvant RT for bulky/advanced DLBCL has been debated for 2 decades. This is particularly important given the very poor outcome of relapsed DLBCL post –R-CHOP, even in the chimeric antigen receptor T-cell era. 2 With 25% of EOT PET-negative patients experiencing treatment failure, potentially effective adjuvant therapies, including RT, remain a relevant consideration. Although the 83% 3-year TTP for PET-negative patients was good, an eventual progression rate of at least 25% was observed (Figure 1A in Freeman et al), consistent with previous reports of a 70% to 75% progression-free survival (PFS) for EOT PET-negative patients. However, this recommendation requires careful consideration, particularly as this was not a randomized trial addressing that question. Based on the 83% 3-year TTP and subset analyses showing near identical outcomes for patients with or without bulky disease (>10 cm), or with or without skeletal disease at diagnosis, the authors recommend that RT should be routinely avoided for such patients. ![]() This study provides a robust benchmark for outcomes of EOT PET-negative patients after R-CHOP without adjuvant radiation. ![]()
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