Oncology Q 18

A 56-year-old man is evaluated for an enlarging, painful inguinal lymph node he first noticed 1 month ago. He has a history of follicular lymphoma of 8 years' duration. The patient was treated in the past with two courses of rituximab 8 and 3 years ago with durable partial responses. For the past 3 years, he had stable diffuse adenopathy managed with observation. He has no other symptoms. On physical examination, vital signs are normal. The patient has diffuse adenopathy in the neck, axillae, and right inguinal area and a new left inguinal conglomerate nodal mass measuring 5 × 7 cm. Complete blood count and metabolic profile are normal. PET/CT scan shows diffuse uptake in axillary, mediastinal, hilar, and mesenteric nodes with elevated standardized uptake values in the 4 to 12 range, but 28 in the left inguinal area.

Which of the following is the most appropriate management?

A Begin bendamustine and rituximab

B Begin rituximab

C Biopsy of the left inguinal nodes

D Radiation therapy to the left inguinal node

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