Research Strategy:

• The research was aimed at the identification of studies that compare different treatment strategies for the management of diffuse abdominal B-cell lymphoma (or abdominal DLBCL), primarily focusing on studies that managed the condition with 6 rounds of chemotherapy (R-CHOP), with and without radiation. The priority for this research was to conduct a targeted literature search and highlight overarching treatment methods and their outcomes. We used PubMed to screen for articles in the last 5 years that met the aforementioned inclusion criteria and populated the studies in the attached google spreadsheet. For each article included, we included the year of publication, an overview of the study design, main findings, study conclusions, and citation/relevant links.
• Using PubMed we used the following search strategy with the 'AND' logic: "(R-CHOP) AND (Abdominal diffuse B cell lymphoma)." The search (1st search strategy) yielded 43 results between 2016 and 2021, of which, most studies were case reports or case series, none were clinical trials. Hence, we expanded the search (2nd search strategy) to the last ten years (2011 to 2021) and obtained 74 hits of which only a few were relevant to the research question; the latter search strategy was adopted. The studies were filtered based on the relevance to the search terms and the top ten were included in the spreadsheet. We screened through all studies to identify systematic reviews, meta-analysis, longitudinal studies (prospective or retrospective), when the aforementioned studies were lacking, we prioritized reporting case reports. Using this strategy, we included 5 case reports.
• We developed a 3rd search strategy, with the use of broader search terms on PubMed: "((diffuse B cell lymphoma) AND (chemotherapy)) AND (radiotherapy)." The present search was directed at studies over the past 5 years (2016-2021), which yielded 355 studies. The focus of this targeted search is to identify studies that include chemotherapy and radiotherapy for the management of diffuse B cell lymphoma. While the search yielded clinical trials, which we tried to incorporate, however, trials were lacking for the management of bulky disease lymphoma. In fact, one Chinese trial (Peng-Peng Xu et al., Lancet Haematol . 2019) was most relevant to the research question which has been included in the spreadsheet (access the study design here).
• Most studies were excluded because they did not account for the management of abdominal DLBCL, or lymphomas were in the extra-abdominal cavity or did not include management using R-CHOP therapy.
• One of the limitations was that during our search, mostly we came across case reports and case series, hence, relevant cases matching the inclusion criteria were included. Therefore, to overcome this limitation we included up to 10 studies. For additional reading, refer to the review article here. 
• Disclaimer: Given that any clinical study (particularly trials) is conducted in a highly controlled environment, caution should be sought in making any inference for the clinical management of a patient. In making an inference, refer to the full context of the study including the study design, inclusion/exclusion criteria, and the interventional strategy should be the same to replicate similar outcomes.

Introduction:

Key Takeaways:

• Clinical trials and longitudinal clinical studies assessing the efficacy of chemotherapy with or without radiotherapy in the management of diffuse abdominal B-cell lymphoma (DLBCL) with the BULKY disease are lacking. A large body of scientific evidence stems from case reports and case series.
• The first-line therapy in the management of abdominal DLBCL is R-CHOP or R-EPOCH chemotherapy.
• Case reports and clinical studies (documented in the systematic review) have demonstrated that 4 to 8 R-CHOP chemotherapy cycles are associated with progression-free and overall survival in most patients.
• Adjuvant therapies such as chemotherapeutic agents (including Adriamycin), antibody therapy (Rituximab), and different radiotherapeutic regimens have demonstrated superior, if not inferior efficacy, in the management of abdominal DLBCL, when compared with R-CHOP alone (refer to the clinical trial findings outlined in the spreadsheet).

Main Findings: