Skip to main content

Advertisement

SpringerLink
Log in

The importance of radiotherapy on diffuse large B cell lymphoma treatment: a current review

  • Clinical
  • Published:
Cancer and Metastasis Reviews Aims and scope Submit manuscript

Abstract

Diffuse large B cell lymphoma is recognized as a heterogeneous group of hematological malignancies; two main subtypes germinal center B and activated B cells are well defined although 15 % of patients remain with unclassifiable disease. R-CHOP treatment has proven to provide very effective results in limited or advanced stage of the disease. However, treatment solely involving R-CHOP submits the patient to possible chemotherapy-induced toxicities, which may be avoided with the use of radiotherapy. Patients with early stage localized disease or who are particularly unresponsive to chemotherapy may be more suitable for mixed modality treatment with R-CHOP and consolidative radiotherapy. Although radiotherapy is being slowly phased out by other treatment strategies including chemotherapy and therapeutic drugs, it is still a highly important method of treatment. The different forms of radiotherapy can be used alongside these “new-age” treatment strategies to further improve prognostic outcomes and overall survival rates. The establishment of radiotherapy as a treatment strategy provides a highly beneficial prognostic advantage in early stage, localized disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ba, C. (2013). The role of radiation therapy in the treatment of stage I-II diffuse large B-cell lymphoma. Current Hematologic Malignancy Reports, 8(3), 236–242. doi:10.1007/s11899-013-0170-5.

    Article  Google Scholar 

  2. Campo, E., Swerdlow, S. H., Harris, N. L., Pileri, S., Stein, H., & Jaffe, E. S. (2011). The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood, 117(19), 5019–5032. doi:10.1182/blood-2011-01-293050.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Persky, D. O., & Miller, T. P. (2009). Localized large cell lymphoma: is there any need for radiation therapy? Current Opinion in Oncology, 21(5), 401–406. doi:10.1097/CCO.0b013e32832f3c8b.

    Article  PubMed  Google Scholar 

  4. Ng, A. K. (2007). Diffuse large B-cell lymphoma. Seminars in Radiation Oncology, 17(3), 169–175. doi:10.1016/j.semradonc.2007.02.002.

    Article  PubMed  Google Scholar 

  5. Morton, L. M., Wang, S. S., Devesa, S. S., Hartge, P., Weisenburger, D. D., & Linet, M. S. (2006). Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood, 107(1), 265–276. doi:10.1182/blood-2005-06-2508.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Tilly, H., Vitolo, U., Walewski, J., da Silva, M. G., Shpilberg, O., Andre, M., … Dreyling, M. (2012). Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 23(suppl_7), vii78–vii82. doi:10.1093/annonc/mds273

  7. Morgan, G., Vornanen, M., Puitinen, J., Naukkarinen, A, Brincker, H., Olsen, J., … Cartwright, R. (1997). Changing trends in the incidence of non-Hodgkin’s lymphoma in Europe. Biomed Study Group. Annals of Oncology: Official Journal of the European Society for Medical Oncology / ESMO, 8(Suppl 2), 49–54.

  8. Swerdlow SH, Campo E, Harris NL, E. Al. (2008). World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. In I. A. for R. on C. Cancer (Ed.), Lyon.

  9. Kaminski, M. S., Coleman, C. N., Colby, T. V., Cox, R. S., & Rosenberg, S. A. (1986). Factors predicting survival in adults with stage I and II large-cell lymphoma treated with primary radiation therapy. Annals of Internal Medicine, 104(6), 747–756. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3518561.

  10. Monfardini, S., Banfi, A., Bonadonna, G., Rilke, F., Milani, F., Valagussa, P., & Lattuada, A. (1980). Improved five year survival after combined radiotherapy-chemotherapy for stage I-II non-Hodgkin’s lymphoma. International Journal of Radiation Oncology, Biology, Physics, 6(2), 125–134. doi:10.1016/0360-3016(80)90189-3.

    Article  CAS  PubMed  Google Scholar 

  11. Nissen, N. I., Ersbøll, J., Hansen, H. S., Walbom-Jørgensen, S., Pedersen-Bjergaard, J., Hansen, M. M., & Rygård, J. (1983). A randomized study of radiotherapy versus radiotherapy plus chemotherapy in stage I-II non-Hodgkin’s lymphomas. Cancer, 52(1), 1–7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/6406037.

  12. Hudson, B., Hudson, G., Maclennan, K., Anderson, L., & Linch, D. (1994). Clinical stage-1 Non-Hodgkins-lymphoma—long-term follow-up of patients treated by the British National Lymphoma Investigation with radiotherapy alone as initial therapy. Bristish Journal of Cancer, 69, 1088–1093. Retrieved from http://discovery.ucl.ac.uk/42259/.

  13. Sabattini, E., Bacci, F., Sagramoso, C., & Pileri, S. A. (2010). WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview. Pathologica, 102(3), 83–87.

    CAS  PubMed  Google Scholar 

  14. Sehn, L. H., & Gascoyne, R. D. (2014). Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity. Blood, 125(1), 22–32. doi:10.1182/blood-2014-05-577189.

    Article  PubMed  Google Scholar 

  15. Alizadeh, A.A., Eisen, M.B., Davis, R.E., Ma, C., Lossos, I.S., Rosenwald, A, … Staudt, L.M. (2000). Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling. Nature, 403(February), 503–511. doi:10.1038/35000501.

  16. Rosenwald, A., Wright, G., Chan, W.C., Connors, J.M., Campo, E., Fisher, R.I., … Staudt, L.M. (2002). The use of molecular profiling to predict survival after chemotherapy for diffuse large-B-cell lymphoma. The New England Journal of Medicine, 346(25), 1937–1947. doi:10.1056/NEJMoa012914.

  17. Landberg, T.G., Håkansson, L.G., Möller, T.R., Mattsson, W.K., Landys, K.E., Johansson, B. G., … Dahl, O.G. (1979). CVP-remission-maintenance in stage I or II non-Hodgkin’s lymphomas: preliminary results of a randomized study. Cancer, 44(3), 831–838. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/383273.

  18. Lenz, G., Wright, G., Dave, S.S., Xiao, W., Powell, J., Zhao, H., … Staudt, L.M. (2008). Stromal gene signatures in large-B-cell lymphomas. The New England Journal of Medicine, 359(22), 2313–2323. doi:10.1056/NEJMoa0802885.

  19. Davis, R., Ngo, V., Lenz, G., & Tolar, P. (2010). Chronic Active B cell receptor signaling in diffuse large B cell lymphoma. Nature, 463(7277), 88–92. doi:10.1038/nature08638.Chronic.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Gisselbrecht, C. (1993). Aggressive lymphomas. La Revue du Praticien, 43(15), 1648–1653. doi:10.1056/NEJMra0807082.

    CAS  PubMed  Google Scholar 

  21. Pasqualucci, L. (2013). The genetic basis of diffuse large B-cell lymphoma. Current Opinion in Hematology, 20(4), 336–344. doi:10.1097/MOH.0b013e3283623d7f.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Roschewski, M., Staudt, L. M., & Wilson, W. H. (2014). Diffuse large B-cell lymphoma-treatment approaches in the molecular era. Nature reviews. Clinical Oncology, 11(1), 12–23. doi:10.1038/nrclinonc.2013.197.

    CAS  PubMed  Google Scholar 

  23. Shaffer, A. L., Young, R. M., & Staudt, L. M. (2012). Pathogenesis of human B cell lymphomas. Annual Review of Immunology, 30, 565–610. doi:10.1146/annurev-immunol-020711-075027.

    Article  CAS  PubMed  Google Scholar 

  24. Béguelin, W., Popovic, R., Teater, M., Jiang, Y., Bunting, K., Rosen, M., … Melnick, A. (2013). EZH2 is required for germinal center formation and somatic EZH2 mutations promote lymphoid transformation. Cancer Cell, 23(5), 677–692. doi:10.1016/j.ccr.2013.04.011.

  25. Caganova, M., Carrisi, C., Varano, G., Mainoldi, F., Zanardi, F., Germain, P. L., … Casola, S. (2013). Germinal center dysregulation by histone methyltransferase EZH2 promotes lymphomagenesis. Journal of Clinical Investigation, 123(12), 5009–5022. doi:10.1172/JCI70626.

  26. Morin, R.D., Johnson, N. a, Severson, T.M., Mungall, A.J., An, J., Goya, R., … Marra, M.A. (2010). Somatic mutations altering EZH2 (Tyr641) in follicular and diffuse large B-cell lymphomas of germinal-center origin. Nature Genetics, 42(2), 181–185. doi:10.1038/ng.518.

  27. Sneeringer, C. J., Scott, M. P., Kuntz, K. W., Knutson, S. K., Pollock, R. M., Richon, V. M., & Copeland, R. A. (2010). Coordinated activities of wild-type plus mutant EZH2 drive tumor-associated hypertrimethylation of lysine 27 on histone H3 (H3K27) in human B-cell lymphomas. Proceedings of the National Academy of Sciences of the United States of America, 107(49), 20980–20985. doi:10.1073/pnas.1012525107.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Cerchietti, L.C., Ghetu, A.F., Zhu, X., Da Silva, G.F., Zhong, S., Matthews, M., … Melnick, A. (2010). A small-molecule inhibitor of BCL6 kills DLBCL cells in vitro and in vivo. Cancer Cell, 17(4), 400–411. doi:10.1016/j.ccr.2009.12.050.

  29. McCabe, M.T., Ott, H.M., Ganji, G., Korenchuk, S., Thompson, C., Van Aller, G.S., … Creasy, C.L. (2012). EZH2 inhibition as a therapeutic strategy for lymphoma with EZH2-activating mutations. Nature, 492(7427), 108–12. doi:10.1038/nature11606.

  30. Pfeifer, M., Grau, M., Lenze, D., Wenzel, S.S., Wolf, A., Wollert-Wulf, B., … Lenz, G. (2013). PTEN loss defines a PI3K/AKT pathway-dependent germinal center subtype of diffuse large B-cell lymphoma. Proceedings of the National Academy of Sciences of the United States of America, 110(30), 12420–5. doi:10.1073/pnas.1305656110.

  31. Lenz, G., Wright, G.W., Emre, N.C.T., Kohlhammer, H., Dave, S.S., Davis, R.E., … Staudt, L.M. (2008). Molecular subtypes of diffuse large B-cell lymphoma arise by distinct genetic pathways. Proceedings of the National Academy of Sciences of the United States of America, 105(36), 13520–13525. doi:10.1073/pnas.0804295105.

  32. Iqbal, J., Meyer, P.N., Smith, L.M., Johnson, N.A., Vose, J.M., Greiner, T.C., … Chan, W.C. (2011). BCL2 predicts survival in germinal center B-cell-like diffuse large B-cell lymphoma treated with CHOP-like therapy and rituximab. Clinical Cancer Research, 17(24), 7785–7795. doi:10.1158/1078-0432.CCR-11-0267.

  33. Souers, A.J., Leverson, J.D., Boghaert, E.R., Ackler, S.L., Catron, N.D., Chen, J., … Elmore, S.W. (2013). ABT-199, a potent and selective BCL-2 inhibitor, achieves antitumor activity while sparing platelets. Nature Medicine, 19(2), 202–8. doi:10.1038/nm.3048.

  34. Lenz, G., Davis, R.E., Ngo, V.N., Lam, L., George, T.C., Wright, G.W., … Staudt, L.M. (2008). Oncogenic CARD11 mutations in human diffuse large B cell lymphoma. Science (New York, N.Y.), 319(5870), 1676–1679. doi:10.1126/science.1153629.

  35. Compagno, M., Lim, W.K., Grunn, A., Nandula, S.V, Brahmachary, M., Shen, Q., … Pasqualucci, L. (2009). Mutations of multiple genes cause deregulation of NF-kappaB in diffuse large B-cell lymphoma. Nature, 459(7247), 717–721. doi:10.1038/nature07968.

  36. Kato, M., Sanada, M., Kato, I., Sato, Y., Takita, J., Takeuchi, K., … Ogawa, S. (2009). Frequent inactivation of A20 in B-cell lymphomas. Nature, 459(7247), 712–716. doi:10.1038/nature07969.

  37. Rimsza, L.M., LeBlanc, M.L., Unger, J.M., Miller, T.P., Grogan, T.M., Persky, D.O., … Gascoyne, R.D. (2008). Gene expression predicts overall survival in paraffin-embedded tissues of diffuse large B-cell lymphoma treated with R-CHOP. Blood, 112(8), 3425–3433. doi:10.1182/blood-2008-02-137372.

  38. Meyer, P.N., Fu, K., Greiner, T.C., Smith, L.M., Delabie, J., Gascoyne, R.D., … Weisenburger, D.D. (2011). Immunohistochemical methods for predicting cell of origin and survival in patients with diffuse large B-cell lymphoma treated with rituximab. Journal of Clinical Oncology, 29(2), 200–207. doi:10.1200/JCO.2010.30.0368.

  39. Hans, C.P., Weisenburger, D.D., Greiner, T.C., Gascoyne, R.D., Delabie, J., Ott, G., … Chan, W.C. (2004). Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood, 103(1), 275–282. doi:10.1182/blood-2003-05-1545.

  40. De Jong, D., Rosenwald, A., Chhanabhai, M., Gaulard, P., Klapper, W., Lee, A., … Weller, E. (2007). Immunohistochemical prognostic markers in diffuse large B-cell lymphoma: validation of tissue microarray as a prerequisite for broad clinical applications—a study from the Lunenburg lymphoma biomarker consortium. Journal of Clinical Oncology, 25(7), 805–812. doi:10.1200/JCO.2006.09.4490.

  41. Held, G., & Pfreundschuh, M. (2009). Hematology: germinal center or nongerminal center DLBCL? Nature reviews. Clinical Oncology, 6(4), 188–190. doi:10.1038/nrclinonc.2009.22.

    PubMed  Google Scholar 

  42. Tilly, H., & Dreyling, M. (2010). Diffuse large B-cell non-Hodgkin’s lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology: Official Journal of the European Society for Medical Oncology / ESMO, 21 Suppl 5(suppl_5), v172–v174. doi:10.1093/annonc/mdq203.

  43. Hwang, H. S., Yoon, D. H., Suh, C., Park, C.-S., & Huh, J. (2014). Intestinal diffuse large B-cell lymphoma: an evaluation of different staging systems. Journal of Korean Medical Science, 29(1), 53–60. doi:10.3346/jkms.2014.29.1.53.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Cheson, B. D., Fisher, R. I., Barrington, S. F., Cavalli, F., Schwartz, L. H., Zucca, E., & Lister, T. A. (2014). Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: The Lugano Classification. Journal of Clinical Oncology, 32(27), 1–10. doi:10.1200/JCO.2013.54.8800.

    Article  Google Scholar 

  45. Armitage, J. O. (2005). Staging non-Hodgkin lymphoma. CA: A Cancer Journal for Clinicians, 55(6), 368–376. doi:10.3322/canjclin.55.6.368.

    Google Scholar 

  46. Shipp, M.A., Harrigton, D.P., Anderson, J.R., Bonadonna, G., Brittinger, G., Cabanillhas, F., & Canellhos, G.P. (1993). A predictive model for aggressive non-Hodgkin’s lymphoma. The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. The New England Journal of Medicine, 329. doi:10.1056/NEJM199309303291402.

  47. Sehn, L.H., Berry, B., Chhanabhai, M., Fitzgerald, C., Gill, K., Hoskins, P., … Connors, J.M. (2007). The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood, 109(5), 1857–1861. doi:10.1182/blood-2006-08-038257.

  48. Ziepert, M., Hasenclever, D., Kuhnt, E., Glass, B., Schmitz, N., Pfreundschuh, M., & Loeffler, M. (2010). Standard international prognostic index remains a valid predictor of outcome for patients with aggressive CD20 + B-cell lymphoma in the rituximab era. Journal of Clinical Oncology, 28(14), 2373–2380. doi:10.1200/JCO.2009.26.2493.

    Article  CAS  PubMed  Google Scholar 

  49. Zhou, Z., Sehn, L.H., Rademaker, A.W., Gordon, L.I., LaCasce, A.S., Crosby-Thompson, A., … Winter, J.N. (2014). An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era. Blood, 123(6), 837–842. doi:10.1182/blood-2013-09-524108.

  50. Müller, C., Murawski, N., Wiesen, M. H. J., Held, G., Poeschel, V., Zeynalova, S., … Reiser, M. (2012). The role of sex and weight on rituximab clearance and serum elimination half-life in elderly patients with DLBCL. Blood, 119(14), 3276–3284. doi:10.1182/blood-2011-09-380949.

  51. Maurer, M. J., Micallef, I. N. M., Cerhan, J. R., Katzmann, J. a., Link, B. K., Colgan, J. P., … Witzig, T. E. (2011). Elevated serum free light chains are associated with event-free and overall survival in two independent cohorts of patients with diffuse large B-cell lymphoma. Journal of Clinical Oncology, 29(12), 1620–1626. doi:10.1200/JCO.2010.29.4413.

  52. Sehn, L.H., Scott, D.W., Chhanabhai, M., Berry, B., Ruskova, A., Berkahn, L., … Gascoyne, R.D. (2011). Impact of concordant and discordant bone marrow involvement on outcome in diffuse large B-cell lymphoma treated with R-CHOP. Journal of Clinical Oncology, 29(11), 1452–1457. doi:10.1200/JCO.2010.33.3419.

  53. Pfreundschuh, M., Ho, A.D., Cavallin-Stahl, E., Wolf, M., Pettengell, R., Vasova, I., … Kuhnt, E. (2008). Prognostic significance of maximum tumour (bulk) diameter in young patients with good-prognosis diffuse large-B-cell lymphoma treated with CHOP-like chemotherapy with or without rituximab: an exploratory analysis of the MabThera International Trial Group. The Lancet Oncology, 9(5), 435–444. doi:10.1016/S1470-2045(08)70078-0.

  54. Carson, K.R., Bartlett, N.L., McDonald, J.R., Luo, S., Zeringue, A., Liu, J., … Colditz, G.A. (2012). Increased body mass index is associated with improved survival in United States veterans with diffuse large B-cell lymphoma. Journal of Clinical Oncology, 30(26), 3217–3222. doi:10.1200/JCO.2011.39.2100.

  55. Porrata, L.F., Ristow, K.M., Habermann, T.M., Witzig, T.E., Colgan, J.P., Inwards, D.J., … Markovic, S.N. (2014). Peripheral blood absolute lymphocyte/monocyte ratio during rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone treatment cycles predicts clinical outcomes in diffuse large B-cell lymphoma. Leukemia & Lymphoma, 55(12), 2728–38. doi:10.3109/10428194.2014.893313.

  56. Wilcox, R.A, Ristow, K., Habermann, T.M., Inwards, D.J., Micallef, I.N. M., Johnston, P.B., … Porrata, L. (2011). The absolute monocyte and lymphocyte prognostic score predicts survival and identifies high-risk patients in diffuse large-B-cell lymphoma. Leukemia : official journal of the Leukemia Society of America, Leukemia Research Fund, U.K, 25(9), 1502–1509. doi:10.1038/leu.2011.112

  57. Drake, M. T., Maurer, M.J., Link, B.K., Habermann, T.M., Ansell, S.M., Micallef, I.N., … Cerhan, J.R. (2010). Vitamin D insufficiency and prognosis in non-Hodgkin’s lymphoma. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 28(27), 4191–4198. doi:10.1200/JCO.2010.28.6674.

  58. Hong, F., Habermann, T.M., Gordon, L.I., Hochster, H., Gascoyne, R.D., Morrison, V.A., … Kahl, B.S. (2014). The role of body mass index in survival outcome for lymphoma patients: US intergroup experience. Annals of Oncology, 25(3), 669–674. doi:10.1093/annonc/mdt594.

  59. Persky, D.O., Unger, J.M., Spier, C.M., Stea, B., LeBlanc, M., McCarty, M.J., … Miller, T.P. (2008). Phase II study of rituximab plus three cycles of CHOP and involved-field radiotherapy for patients with limited-stage aggressive B-cell lymphoma: Southwest Oncology Group Study 0014. Journal of Clinical Oncology, 26(14), 2258–2263. doi:10.1200/JCO.2007.13.6929.

  60. Phan, J., Mazloom, A., Medeiros, L.J., Zreik, T.G., Wogan, C., Shihadeh, F., … Dabaja, B.S. (2010). Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy. Journal of Clinical Oncology, 28(27), 4170–4176. doi:10.1200/JCO.2009.27.3441.

  61. Horning, S. J., Weller, E., Kim, K., Earle, J. D., O’Connell, M. J., Habermann, T. M., & Glick, J. H. (2004). Chemotherapy with or without radiotherapy in limited-stage diffuse aggressive non-Hodgkin’s lymphoma: Eastern Cooperative Oncology Group Study 1484. Journal of Clinical Oncology, 22(15), 3032–3038. doi:10.1200/JCO.2004.06.088.

    Article  CAS  PubMed  Google Scholar 

  62. Zelenetz, A.D., Wierda, W.G., Abramson, J.S., Advani, R.H., Andreadis, C.B., Bartlett, N., … Naganuma, M. (2013). Non-Hodgkin’s lymphomas, version 1.2013. Journal of the National Comprehensive Cancer Network: JNCCN, 11(3), 257–72; quiz 273. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23486452.

  63. Miller, T.P., Dahlberg, S., Cassady, J.R., Adelstein, D.J., Spier, C.M., Grogan, T.M., … Fisher, R.I. (1998). Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin’s lymphoma. The New England Journal of Medicine, 339(1), 21–26. doi:10.1056/NEJM199807023390104.

  64. Sehn, L. H. (2012). Chemotherapy alone for localized diffuse large B-cell lymphoma. The Cancer Journal, 18(5), 421–426. doi:10.1097/PPO.0b013e31826c5907.

    Article  CAS  PubMed  Google Scholar 

  65. Maraldo, M. V., Aznar, M. C., Vogelius, I. R., Petersen, P. M., & Specht, L. (2013). Involved node radiation therapy: an effective alternative in early-stage hodgkin lymphoma. International Journal of Radiation Oncology, Biology, Physics, 85(4), 1057–1065. doi:10.1016/j.ijrobp.2012.08.041.

    Article  PubMed  Google Scholar 

  66. Campbell, B. A., Connors, J. M., Gascoyne, R. D., Morris, W. J., Pickles, T., & Sehn, L. H. (2012). Limited-stage diffuse large B-cell lymphoma treated with abbreviated systemic therapy and consolidation radiotherapy: involved-field versus involved-node radiotherapy. Cancer, 118(17), 4156–4165. doi:10.1002/cncr.26687.

    Article  PubMed  Google Scholar 

  67. Coiffier, B., Lepage, E., Briere, J., Herbrecht, R., Tilly, H., Bouabdallah, R., … Gisselbrecht, C. (2002). CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. The New England Journal of Medicine, 346. doi:10.1056/NEJMoa011795.

  68. Feugier, P., Van Hoof, A, Sebban, C., Solal-Celigny, P., Bouabdallah, R., Fermé, C., … Coiffier, B. (2005). Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d’Etude des Lymphomes de l’Adulte. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 23(18), 4117–4126. doi:10.1200/JCO.2005.09.131.

  69. Pfreundschuh, M., Schubert, J., Ziepert, M., Schmits, R., Mohren, M., Lengfelder, E., … Loeffler, M. (2008). Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60). The Lancet Oncology, 9(2), 105–116. doi:10.1016/S1470-2045(08)70002-0.

  70. Maurer, M.J., Ghesquières, H., Jais, J.P., Witzig, T.E., Haioun, C., Thompson, C.A., … Cerhan, J.R. (2014). Event-free survival at 24 months is a robust end point for disease-related outcome in diffuse large B-cell lymphoma treated with immunochemotherapy. Journal of Clinical Oncology, 32(10), 1066–1073. doi:10.1200/JCO.2013.51.5866.

  71. Récher, C., Coiffier, B., Haioun, C., Molina, T.J., Fermé, C., Casasnovas, O., … Tilly, H. (2011). Intensified chemotherapy with ACVBP plus rituximab versus standard CHOP plus rituximab for the treatment of diffuse large B-cell lymphoma (LNH03-2B): An open-label randomised phase 3 trial. The Lancet, 378(9806), 1858–1867. doi:10.1016/S0140-6736(11)61040-4.

  72. André, M., Mounier, N., Leleu, X., Sonet, A., Brice, P., Henry-Amar, M., … Gisselbrecht, C. (2004). Second cancers and late toxicities after treatment of aggressive non-Hodgkin lymphoma with the ACVBP regimen: A GELA cohort study on 2837 patients. Blood, 103(4), 1222–1228. doi:10.1182/blood-2003-04-1124.

  73. Cunningham, D., Hawkes, E.A., Jack, A., Qian, W., Smith, P., Mouncey, P., … Linch, D. (2013). Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone in patients with newly diagnosed diffuse large B-cell non-Hodgkin lymphoma: a phase 3 comparison of dose intensification with 14-day versus 21-day cycles. The Lancet, 381(9880), 1817–1826. doi:10.1016/S0140-6736(13)60313-X.

  74. Delarue, R., Tilly, H., Mounier, N., Petrella, T., Salles, G., Thieblemont, C., … Bosly, A. (2013). Dose-dense rituximab-CHOP compared with standard rituximab-CHOP in elderly patients with diffuse large B-cell lymphoma (the LNH03-6B study): a randomised phase 3 trial. The Lancet Oncology, 14(6), 525–533. doi:10.1016/S1470-2045(13)70122-0

  75. Gang, A.O., Strøm, C., Pedersen, M., d’Amore, F., Pedersen, L.M., Bukh, A., … Nully Brown, P. (2012). R-choep-14 improves overall survival in young high-risk patients with diffuse large b-cell lymphoma compared with r-chop-14. A population-based investigation from the danish lymphoma group. Annals of Oncology, 23(1), 147–153. doi:10.1093/annonc/mdr058.

  76. Pfreundschuh, M., Kuhnt, E., Trümper, L., Österborg, A., Trneny, M., Shepherd, L., … Murawski, N. (2011). CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma: 6-year results of an open-label randomised study of the MabThera International Trial (MInT) Group. The Lancet Oncology, 12(11), 1013–1022. doi:10.1016/S1470-2045(11)70235-2.

  77. Wilson, W.H., Dunleavy, K., Pittaluga, S., Hegde, U., Grant, N., Steinberg, S.M., … Janik, J.E. (2008). Phase II study of dose-adjusted EPOCH and rituximab in untreated diffuse large B-cell lymphoma with analysis of germinal center and post-germinal center biomarkers. Journal of Clinical Oncology, 26(16), 2717–2724. doi:10.1200/JCO.2007.13.1391.

  78. Wilson, W.H., Jung, S.H., Porcu, P., Hurd, D., Johnson, J., Eric Martin, S., … Hsi, E.D. (2012). A cancer and leukemia group B multi-center study of DA-EPOCH-rituximab in untreated diffuse large B-cell lymphoma with analysis of outcome by molecular subtype. Haematologica, 97(5), 758–765. doi:10.3324/haematol.2011.056531.

  79. Martinelli, G., Gigli, F., Calabrese, L., Ferrucci, P. F., Zucca, E., Crosta, C., … Moreno Gomez, H. (2009). Early stage gastric diffuse large B-cell lymphomas: results of a randomized trial comparing chemotherapy alone versus chemotherapy + involved field radiotherapy. (IELSG 4). [corrected]. Leukemia & Lymphoma, 50(6), 925–931. doi:10.1080/10428190902912478.

  80. Bonnet, C., Fillet, G., Mounier, N., Ganem, G., Molina, T.J., Thiéblemont, C., … Reyes, F. (2007). CHOP alone compared with CHOP plus radiotherapy for localized aggressive lymphoma in elderly patients: a study by the Groupe d’Etude des Lymphomes de l’Adulte. Journal of Clinical Oncology, 25(7), 787–792. doi:10.1200/JCO.2006.07.0722.

  81. Ballonoff, A., Rusthoven, K.E., Schwer, A., McCammon, R., Kavanagh, B., Bassetti, M., … Rabinovitch, R. (2008). Outcomes and effect of radiotherapy in patients with stage I or II diffuse large B-cell lymphoma: a surveillance, epidemiology, and end results analysis. International Journal of Radiation Oncology Biology Physics, 72(5), 1465–1471. doi:10.1016/j.ijrobp.2008.02.068.

  82. Ferreri, A.J., Dell’Oro, S., Reni, M., Ceresoli, G.L., Cozzarini, C., Ponzoni, M., & Villa, E. (2000). Consolidation radiotherapy to bulky or semibulky lesions in the management of stage III-IV diffuse large B cell lymphomas. Oncology, 58(3), 219–226.

  83. Schlembach, P. J., Wilder, R. B., Tucker, S. L., Ha, C. S., Rodriguez, M. A., Hess, M. A., & Cox, J. D. (2000). Impact of involved field radiotherapy after CHOP-based chemotherapy on stage III-IV, intermediate grade and large-cell immunoblastic lymphomas. International Journal of Radiation Oncology Biology Physics, 48(4), 1107–1110. doi:10.1016/S0360-3016(00)00760-4.

    Article  CAS  Google Scholar 

  84. Horwitz, S.M., Negrin, R.S., Blume, K.G., Breslin, S., Stuart, M.J., Stockerl-Goldstein, K.E., … Horning, S.J. (2004). Rituximab as adjuvant to high-dose therapy and autologous hematopoietic cell transplantation for aggressive non-Hodgkin lymphoma. Blood, 103(3), 777–783. doi:10.1182/blood-2003-04-1257.

  85. Shi, Z., Das, S., Okwan-Duodu, D., Esiashvili, N., Flowers, C., Chen, Z., … Khan, M.K. (2013). Patterns of failure in advanced stage diffuse large b-cell lymphoma patients after complete response to r-chop immunochemotherapy and the emerging role of consolidative radiation therapy. International Journal of Radiation Oncology Biology Physics, 86(3), 569–577. doi:10.1016/j.ijrobp.2013.02.007.

  86. Dorth, J. A., Prosnitz, L. R., Broadwater, G., Diehl, L. F., Beaven, A. W., Coleman, R. E., & Kelsey, C. R. (2012). Impact of consolidation radiation therapy in stage III-IV diffuse large B-cell lymphoma with negative post-chemotherapy radiologic imaging. International Journal of Radiation Oncology Biology Physics, 84(3), 762–767. doi:10.1016/j.ijrobp.2011.12.067.

    Article  Google Scholar 

  87. Dorth, J. A., Prosnitz, L. R., Broadwater, G., Beaven, A. W., & Kelsey, C. R. (2012). Radiotherapy dose–response analysis for diffuse large B-cell lymphoma with a complete response to chemotherapy. Radiation Oncology, 7(1), 100. doi:10.1186/1748-717X-7-100.

    Article  PubMed Central  PubMed  Google Scholar 

  88. Reyes, F., Lepage, E., Ganem, G., Molina, T.J., Brice, P., Coiffier, B., … Tilly, H. (2005). ACVBP versus CHOP plus radiotherapy for localized aggressive lymphoma. The New England Journal of Medicine, 352(12), 1197–1205. doi:10.1056/NEJMoa042040.

  89. Lowry, L., Smith, P., Qian, W., Falk, S., Benstead, K., Illidge, T., … Hoskin, P. (2011). Reduced dose radiotherapy for local control in non-Hodgkin lymphoma: a randomised phase III trial. Radiotherapy and Oncology, 100(1), 86–92. doi:10.1016/j.radonc.2011.05.013.

  90. Boyle, J., Beaven, A.W., Diehl, L.F., Prosnitz, L.R., & Kelsey, C.R. (2014). Improving outcomes in advanced DLBCL: systemic approaches and radiotherapy. Oncology (Williston Park, N.Y.), 28(12). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25510806.

  91. Juweid, M. E., & Cheson, B. D. (2005). Role of positron emission tomography in lymphoma. Journal of Clinical Oncology, 23(21), 4577–4580. doi:10.1200/JCO.2005.01.904.

    Article  PubMed  Google Scholar 

  92. Juweid, M.E., Stroobants, S., Hoekstra, O.S., Mottaghy, F.M., Dietlein, M., Guermazi, A., … Cheson, B.D. (2007). Use of positron emission tomography for response assessment of lymphoma: consensus of the imaging subcommittee of international harmonization project in lymphoma. Journal of Clinical Oncology, 25(5), 571–578. doi:10.1200/JCO.2006.08.2305.

  93. Mikhaeel, N. G., Hutchings, M., Fields, P. A., O’Doherty, M. J., & Timothy, A. R. (2005). FDG-PET after two to three cycles of chemotherapy predicts progression-free and overall survival in high-grade non-Hodgkin lymphoma. Annals of Oncology, 16(June), 1514–1523. doi:10.1093/annonc/mdi272.

    Article  CAS  PubMed  Google Scholar 

  94. Mikhaeel, N. G., Timothy, A. R., O’Doherty, M. J., Hain, S., & Maisey, M. N. (2000). 18-FDG-PET as a prognostic indicator in the treatment of aggressive non-Hodgkin’s lymphoma-comparison with CT. Leukemia & Lymphoma, 39(5-6), 543–553. doi:10.3109/10428190009113384.

    Article  CAS  Google Scholar 

  95. Noordijk, E.M., Carde, P., Dupouy, N., Hagenbeek, A., Krol, A. D.G., Kluin-Nelemans, J.C., … Henry-Amar, M. (2006). Combined-modality therapy for clinical stage I or II Hodgkin’s lymphoma: long-term results of the European Organisation for Research and Treatment of Cancer H7 randomized controlled trials. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 24(19), 3128–35. doi:10.1200/JCO.2005.05.2746.

  96. Bonadonna, G., Bonfante, V., Viviani, S., Di Russo, A., Villani, F., & Valagussa, P. (2004). ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin’s disease: long-term results. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 22(14), 2835–2841. doi:10.1200/JCO.2004.12.170.

    Article  Google Scholar 

  97. Zwam, H. M. (2013). Involved nodal radiotherapy vs. involved field radiotherapy after chemotherapy in the treatment of early stage Hodgkin’s lymphoma. Journal of Cancer Therapy, 04(01), 271–279. doi:10.4236/jct.2013.41034.

    Article  Google Scholar 

  98. Avilés, A., Delgado, S., Nambo, M. J., Alatriste, S., & Díaz-Maqueo, J. (1994). Adjuvant radiotherapy to sites of previous bulky disease in patients stage iv diffuse large cell lymphoma. International Journal of Radiation Oncology Biology Physics, 30(4), 799–803. doi:10.1016/0360-3016(94)90352-2.

    Article  Google Scholar 

  99. Avilés, A., Neri, N., Delgado, S., Pérez, F., Nambo, M.J., Cleto, S., … Huerta-Guzmán, J. (2005). Residual disease after chemotherapy in aggressive malignant lymphoma: the role of radiotherapy. Medical oncology (Northwood, London, England), 22(4), 383–387. doi:10.1385/MO:22:4:383.

  100. Avilés, A., Fernández, R., Pérez, F., Nambo, M. J., Neri, N., Talavera, A., … Cleto, S. (2004). Adjuvant radiotherapy in stage IV diffuse large cell lymphoma improve outcome. Leukemia & Lymphoma, 45(7), 1385–1389. doi:10.1080/10428190410001667712.

  101. Held, G., Murawski, N., Ziepert, M., Fleckenstein, J., Poschel, V., Zwick, C., … Pfreundschuh, M. (2014). Role of radiotherapy to bulky disease in elderly patients with aggressive B-cell lymphoma. Journal of Clinical Oncology, 32(11), 1112–1118. doi:10.1200/JCO.2013.51.4505.

  102. Jerusalem, G., Beguin, Y., Fassotte, M. F., Najjar, F., Paulus, P., Rigo, P., & Fillet, G. (1999). Whole-body positron emission tomography using 18F-fluorodeoxyglucose for posttreatment evaluation in Hodgkin’s disease and non-Hodgkin’s lymphoma has higher diagnostic and prognostic value than classical computed tomography scan imaging. Blood, 94(2), 429–433. Retrieved from http://www.bloodjournal.org/content/94/2/429.abstract.

  103. Spaepen, K., Stroobants, S., Dupont, P., Van Steenweghen, S., Thomas, J., Vandenberghe, P., … Verhoef, G. (2001). Prognostic value of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ([18F]FDG) after first-line chemotherapy in non-Hodgkin’s lymphoma: Is [18F]FDG-PET a valid alternative to conventional diagnostic methods? Journal of Clinical Oncology, 19(2), 414–419. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11208833.

  104. Ramalingam, S.S., Kotsakis, A., Tarhini, A.A., Heron, D.E., Smith, R., Friedland, D., … Argiris, A. (2013). A multicenter phase II study of cetuximab in combination with chest radiotherapy and consolidation chemotherapy in patients with stage III non-small cell lung cancer. Lung Cancer, 81(3), 416–421. doi:10.1016/j.lungcan.2013.06.002.

  105. Barrington, S.F., Mikhaeel, N.G., Kostakoglu, L., Meignan, M., Hutchings, M., Mueller, S.P., … Cheson, B.D. (2014). Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. Journal of Clinical Oncology, 32(27), 3048–3058. doi:10.1200/JCO.2013.53.5229.

  106. Cheson, B.D., Pfistner, B., Juweid, M.E., Gascoyne, R.D., Specht, L., Horning, S.J., … Diehl, V. (2007). Revised response criteria for malignant lymphoma. Journal of Clinical Oncology, 25(5), 579–586. doi:10.1200/JCO.2006.09.2403.

  107. Juweid, M.E., Wiseman, G.A., Vose, J.M., Ritchie, J.M., Menda, Y., Wooldridge, J.E., … Cheson, B.D. (2005). Response assessment of aggressive non-Hodgkin’s lymphoma by integrated International Workshop Criteria and fluorine-18-fluorodeoxyglucose positron emission tomography. Journal of Clinical Oncology, 23(21), 4652–4661. doi:10.1200/JCO.2005.01.891.

  108. Kamath, S. S., Marcus, R. B., Lynch, J. W., & Mendenhall, N. P. (1999). The impact of radiotherapy dose and other treatment-related and clinical factors on in-field control in stage I and II non-Hodgkin’s lymphoma. International Journal of Radiation Oncology Biology Physics, 44(3), 563–568. doi:10.1016/S0360-3016(99)00051-6.

    Article  CAS  Google Scholar 

  109. Bindra, R. S., & Yahalom, J. (2011). The important role of radiation therapy in early-stage diffuse large B-cell lymphoma: time to review the evidence once again. Expert Review of Anticancer Therapy, 11(9), 1367–1378. doi:10.1586/era.11.88.

    Article  PubMed  Google Scholar 

  110. Habermann, T.M., Weller, E.A., Morrison, V.A., Gascoyne, R.D., Cassileth, P.A., Cohn, J.B., … Horning, S.J. (2006). Rituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. Journal of Clinical Oncology, 24(19), 3121–3127. doi:10.1200/JCO.2005.05.1003.

  111. Shenkier, T.N., Voss, N., Fairey, R., Gascoyne, R.D., Hoskins, P., Klasa, R., … Connors, J.M. (2002). Brief chemotherapy and involved-region irradiation for limited-stage diffuse large-cell lymphoma: an 18-year experience from the British Columbia Cancer Agency. Journal of Clinical Oncology, 20(1), 197–204. doi:10.1200/JCO.20.1.197.

  112. Peyrade, F., Jardin, F., Thieblemont, C., Thyss, A., Emile, J. F., Castaigne, S., … Tilly, H. (2011). Attenuated immunochemotherapy regimen (R-miniCHOP) in elderly patients older than 80 years with diffuse large B-cell lymphoma: a multicentre, single-arm, phase 2 trial. The Lancet Oncology, 12(5), 460–468. doi:10.1016/S1470-2045(11)70069-9.

  113. Kridel, R., & Dietrich, P. Y. (2011). Prevention of CNS relapse in diffuse large B-cell lymphoma. The Lancet Oncology, 12(13), 1258–1266. doi:10.1016/S1470-2045(11)70140-1.

    Article  PubMed  Google Scholar 

  114. Tilly, H., Lepage, E., Coiffier, B., Blanc, M., Herbrecht, R., Bosly, A., … Reyes, F. (2003). Intensive conventional chemotherapy (ACVBP regimen) compared with standard CHOP for poor-prognosis aggressive non-Hodgkin lymphoma. Blood, 102(13), 4284–4289. doi:10.1182/blood-2003-02-0542.

  115. Abramson, J.S., Hellmann, M., Barnes, J.A., Hammerman, P., Toomey, C., Takvorian, T., … Hochberg, E.P. (2010). Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high-risk patients with diffuse large B-cell lymphoma. Cancer, 116(18), 4283–4290. doi:10.1002/cncr.25278.

  116. Ferreri, A.J., Reni, M., Foppoli, M., Martelli, M., Pangalis, G.A., Frezzato, M., … Cavalli, F. (2009). High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomised phase 2 trial. The Lancet, 374(9700), 1512–1520. doi:10.1016/S0140-6736(09)61416-1.

  117. Brugiatelli, M., Bandini, G., Barosi, G., Lauria, F., Liso, V., Marchetti, M., Tura, S.,… Tura, S. (2006). Management of chronic lymphocytic leukemia: Practice guidelines from the Italian Society of Hematology, the Italian Society of Experimental Hematology and the Italian Group for Bone Marrow Transplantation. Haematologica, 91(1), 1662–1673. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed7&NEWS=N&AN=2007009472.

  118. Moskowitz, C. H. (2012). Interim PET-CT in the management of diffuse large B-cell lymphoma. Hematology/the Education Program of the American Society of Hematology. American Society of Hematology. Education Program, 2012(1), 397–401. doi:10.1182/asheducation-2012.1.397.

    Google Scholar 

  119. Awan, U., Siddiqui, N., SaadUllah, M., Bashir, H., Farooqui, Z. S., Muzaffar, N., & Mahmmood, M.T. (2013). FDG-PET scan in assessing lymphomas and the application of Deauville Criteria. JPMA. The Journal of the Pakistan Medical Association, 63(6), 725–30. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23901673.

  120. Armitage, J. O., & Loberiza, F. R. (2006). Is there a place for routine imaging for patients in complete remission from aggressive lymphoma? Annals of Oncology, 17(6), 883–884. doi:10.1093/annonc/mdl099.

    Article  CAS  PubMed  Google Scholar 

  121. Kewalramani, T., Zelenetz, A.D., Nimer, S.D., Portlock, C., Straus, D., Noy, A., … Moskowitz, C.H. (2004). Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma. Blood, 103(10), 3684–3688. doi:10.1182/blood-2003-11-3911.

  122. Gisselbrecht, C., Glass, B., Mounier, N., Gill, D.S., Linch, D.C., Trneny, M., … Schmitz, N. (2010). Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era. Journal of Clinical Oncology, 28(27), 4184–4190. doi:10.1200/JCO.2010.28.1618.

  123. Glass, B., Hasenkamp, J., Wulf, G., Dreger, P., Pfreundschuh, M., Gramatzki, M., … Schmitz, N. (2012). Oral Abstract Session , Sat, 3 : 00 PM-6 : 00 PM High-dose chemotherapy followed by allogeneic stem cell transplantation in high-risk relapsed and refractory aggressive non-Hodgkin lymphoma : results of a prospective study of the German high-grade non-H. Journal of Clinical Oncology, Retrieved from http://meetinglibrary.asco.org/content/99784-114.

  124. El Gnaoui, T., Dupuis, J., Belhadj, K., Jais, J.P., Rahmouni, A., Copie-Bergman, C., … Haioun, C. (2007). Rituximab, gemcitabine and oxaliplatin: an effective salvage regimen for patients with relapsed or refractory B-cell lymphoma not candidates for high-dose therapy. Annals of Oncology, 18(8), 1363–1368. doi:10.1093/annonc/mdm133.

Download references

Acknowledgments

Fernando José Figueiredo Agostinho D’Abreu Mendes would like to thank the Portuguese Foundation for Science and Technology for the award Portugal (Strategic Project PEst-C/SAU/UI3282/2013 and UID/NEU/04539/2013), COMPETE-FEDER.

Conflict of interest

The authors declare that they have nothing to disclose.

Author information

Authors and Affiliations

  1. Biophysics Unit-IBILI.CNC, Faculty of Medicine of University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548, Coimbra, Portugal

    Fernando Mendes, Ricardo Teixo, Ana Margarida Abrantes & Maria Filomena Botelho

  2. ESTESC-Coimbra Health School, Department Biomedical Laboratory Sciences, Polytechnic Institute of Coimbra, Coimbra, Portugal

    Fernando Mendes

  3. Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine of University of Coimbra, Coimbra, Portugal

    Fernando Mendes, Cátia Domingues, Ana Margarida Abrantes, Ana Cristina Gonçalves, Ana Bela Sarmento & Maria Filomena Botelho

  4. Applied Molecular Biology and Clinical University of Hematology, Faculty of Medicine of University of Coimbra, Coimbra, Portugal

    Cátia Domingues, Ana Cristina Gonçalves & Ana Bela Sarmento

  5. Radiation Oncology Department, Hospital and University Center of Coimbra, Coimbra, Portugal

    Inês Nobre-Gois & Miguel Jacobetty

  6. Immunology Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    Manuel Santos Rosa

Authors
  1. Fernando Mendes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cátia Domingues
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ricardo Teixo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana Margarida Abrantes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ana Cristina Gonçalves
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Inês Nobre-Gois
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Miguel Jacobetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ana Bela Sarmento
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maria Filomena Botelho
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Manuel Santos Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernando Mendes.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mendes, F., Domingues, C., Teixo, R. et al. The importance of radiotherapy on diffuse large B cell lymphoma treatment: a current review. Cancer Metastasis Rev 34, 511–525 (2015). https://doi.org/10.1007/s10555-015-9581-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10555-015-9581-1

Keywords

Search

Navigation