Role of Radiotherapy in Heavily Pretreated Relapsed Nasopharyngeal DLBCL: A Case Report and Review of the Literature

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Background: Diffuse large B-cell lymphoma (DLBCL) of the nasopharynx is a rare extranodal lymphoma. Management of relapsed and refractory disease after multiple lines of chemotherapy remains challenging, particularly in elderly patients with symptomatic locoregional progression. Case Presentation: We report the case of a 72-year-old man with stage IIA nasopharyngeal DLBCL initially treated with R-CHOP and intrathecal prophylaxis, followed by multiple lines of salvage chemotherapy (ICE, DHAP, RDHAOX, gemcitabine-vinorelbine) for successive relapses. In 2025, he presented progressive dysphagia and dysphonia related to bilateral cervical and nasopharyngeal disease progression. Imaging confirmed locoregional relapse with mediastinal lymph node involvement. Biopsy confirmed non–germinal center subtype DLBCL. Given the heavily pretreated status and symptomatic progression, the multidisciplinary tumor board recommended palliative radiotherapy. The patient received 45 Gy in 25 fractions using the VMAT technique, targeting the nasopharynx and cervical lymph nodes. Treatment was well tolerated with significant clinical improvement. Conclusion: Radiotherapy remains an effective palliative option in relapsed or refractory nasopharyngeal DLBCL, providing symptom relief and local disease control when systemic options are limited.

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