RT administered with curative intent in the salvage setting has been used alone or in combination with chemotherapy. Small single-institution series of highly selected patients report a significant local control rate and 5-year FFTF of approximately 30%. The strategy of incorporating RT into HDT is based on the premise that the pattern of relapse post-HDT is similar to relapse following front-line chemotherapy; i.e., it most commonly occurs at sites of initial nodal involvement and is therefore amenable to treatment with RT. Considering the excellent local control afforded by RT, many institutions successfully incorporated RT into their second-line therapeutic approaches; however, there remains no random assignment data that support this strategy.
RT is most commonly given in two fashions: post-transplant consolidation or as part of pretransplant cytoreduction (Table 75.2).
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