Chemorefractory dlbcl

[Reaganite]

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How high have you guys gone? Have a lady who presented with about a 7cm neck mass, initially responded to chemo but over final 2 cycles exploded to a 12+ cm mass. Not a candidate for any further chemotherapy, transplant, etc. Has been under external beam with me and has completed about 45 Gy already And only this week have I begun to see some shrinkage of tumor. I see recommendations suggesting treating these up to 55 Gy but I'm thinking that might not be enough. thoughts? She is tolerating treatment extremely well for what it's worth

 

[seper]

If grossly non-metastatic, treating to 60 Gy makes sense.. Is it activated B-cell–like subtype?

 

[medgator]

I had a large refractory testicular dlbcl that seemed to do nothing through treatment until I hit about 40-45 Gy and then it started to shrink down. I ended up going to 55.8 Gy, I believe nccn blesses up to 55 Gy in this situation.

Would hit it hard though, 60 Gy ISRT should not be a problem with imrt, just talk it over with the patient.

If she fails, harsher chemo and eventual transplant will be far worse