At first I thought it was because I hadn't gone anywhere and had just waited in the place I was after I patched, but then after moving to a new location, I'm getting the same issue. The game just freezes at some point during the wait screen and I have to hard boot the 360 to get it working again.

It may be worth noting that I'm waiting in 24 hour blocks to see if Boone shows up now that the game has been patched. Or at least thats what I'm trying to do.

Have you tried holding the Right Bumper, Left Bumper, and the X button simultaneously while the game is booting? Doing that clears the FNV cache without removing patches.

What locations is it happening?

It's happening everywhere. I'll try clearing out the cache next time. Mostly it's happening at Fort McCarren or whatever and in the Lucky 38, because I'm trying to wait there to see if my Boone shows up or the NPC I need for a quest that disappeared shows back up after the patch.

I'm also having freeze issues, but only when I try to go into VATS. How frustrating!