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M.D. Berger et al.
ment of DLBCL in the European Society for Medical Oncology (ESMO)6 and National Comprehensive Cancer Network (NCCN) guidelines (https://www.nccn.org/profes- sionals/physician_gls/pdf/b-cell.pdf (last access: Nov 28, 2019; for details see Online Supplementary Table S1). However, significant conceptual issues on its current use outside a clinical trial remain. They include different def- initions of bulky disease, the use in advanced stages, and the recent implementation of positron emission tomogra- phy-computed tomography (PET-CT) in the clinical man- agement. Albeit not limited to consolidation radiotherapy in DLBCL, treatment recommendations are often built on experience, clinical judgment and guidelines, but ideally should be based on data, preferably from randomized tri- als. Here we present a comprehensive meta-analysis to assess the impact of radiotherapy in addition to and after first-line chemo-immunotherapy of DLBCL based on the best currently available data by randomized controlled
trials. With this large meta-analysis, we aim to provide the rational basis for a future randomized trial on the use of consolidation radiotherapy in DLBCL.
Methods
Literature search
We performed a comprehensive search in electronic databases (Pubmed, Embase, Cochrane) in any language between June 1966 and December 2018 for randomized controlled trials. As the data presented on meetings may differ from the peer-reviewed publica- tions,7 a manual search was done of abstracts from ASCO, ASH, ESMO, and ASTRO proceedings between 2009 and 2018. We used the following search strategy: (radiation therap*[Title] OR radio- therapy*[Title] OR radio-therap*[Title]) AND (non-hodgkin*[Title] OR non Hodgkin*[Title] OR nonhodgkin[Title] OR no Hodgkin*[Title] OR nhl[Title]) OR (lymphoma*[Title]) AND
Figure 1. Study selection. Flow diagram according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIS- MA) statement to illustrate the search and selection process. DLBCL: diffuse large B-cell lymphoma.
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