Adjuvant radiotherapy

Involved field radiotherapy is frequently give to bulky mediastinal disease after completion of combination chemotherapy. This improves DFS but has no effect on OS. Meta-analysis suggest an overall 11% improvement in DFS and that the benefits are greatest for NSHL histology (least for MCHL and LDHL), for mediastinal bulk rather than other bulky sites and that no benefit is gained in stage IV disease3. Late toxicity is increased. The lack of difference in overall survival was attributed to a greater number of second malignancies and poorer response and survival after relapse among patients who received combined modality therapy.

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