In a multivariable analysis of the intention-to-treat population adjusting for International Prognostic Index risk factors and age ( > @ years ) , event-free survival ( EFS ) of patients with bulky disease was inferior without additive RT ( hazard ratio -LSB- HR -RSB- , @ ; @ % CI , @ to @ ; P = @ ) , with trends for inferior progression-free ( PFS ; HR , @ ; @ % CI , @ to @ ; P = @ ) and overall survival ( OS ; HR , @ ; @ % CI , @ to @ ; P = @ ) .