Results of prophylactic adjuvant chemotherapy for early stage non-Hodgkin's lymphoma of the head and neck

Results were reviewed in 46 patients who had stage I and II head and neck non-Hodgkin's lymphoma, and received five to six cycles of CVP chemotherapy after regional irradiation. Disease-free survival, pattern of relapse, and time of relapse were compared with those of 64 patients, who received regional irradiation alone. Adjuvant, post irradiation CVP significantly improved five-year survival in stage I (and IE) disease, 49.6% to 81.9% (p less than 0.05), but was less successful in patients with heavier tumor burden, such as stage II disease or advanced loco regional disease in Waldeyer's ring (48.3% to 63.7%; p greater than 0.10 in stage II patients). In addition, in those who relapsed, the time and pattern of relapse were not altered by adjuvant CVP chemotherapy. This easily tolerated, mild adjuvant chemotherapy, we conclude, failed to prove significant in preventing relapse, especially in patients with heavier tumor burden.     

Radiation therapy for primary non-Hodgkin's lymphoma of the head and neck in stages I and II

From January 1975 through December 1986, 58 previously untreated patients with primary non-Hodgkin's lymphoma of the head and neck in stages I and II were treated at our department. Thirty-seven patients were classified as stage I and 21 as stage II. Complete local remission was obtained in all cases. The 5-year survival rates were 68% and 79% in stages I and II, respectively. The 5-year survival rates according to site of origin were as follows: Waldeyer's ring 77% and neck lymph node 63%. The 5-year survival rates according to the histological classification of the Working Formulation were 73% intermediate grade malignancy and 63% for high grade malignancy. Chemotherapy combined with radiotherapy was essential, especially for cases in stage II. The 5-year survival rate was 100% for patients with chemotherapy and 71% without chemotherapy. The relapse-free 5-year survival rate was 67% with chemotherapy and 36% without chemotherapy. Most first failures were due to the development of generalized disease and the 5-year survival rate after salvage was 44%.     

The radiotherapy of primary extranodal non-Hodgkin's lymphoma of the nasopharynx

Primary non-Hodgkin's lymphoma occurs quite seldom in the nasopharynx, therefore reports on this topic are rare in medical literature. The treatment results of 30 irradiated patients (40 to 60 Gy) are presented. The period of the study ranges from 1960 to 1985. 13 patients with low grade lymphoma and 17 patients with high grade lymphoma according to the Kiel classification form the basis of this study. The overall actuarial 5-year survival rate is 24%. This also applies for the subgroups of low grade and high grade lymphomas with a 5-year survival rate of 24%, respectively. The evaluation of the patients without generalization in the course of disease shows that the prognosis of stage IE patients with 43% was superior to the one of stage IIE patients with 25% (p less than 0.001). Only patients with lymphoma limited to the nasopharynx survived longer than five years (46%), but none of the patients with simultaneous spread to the nasal cavity, the oropharynx and/or the base of the skull. Local and regional recurrences were rare. However, a generalization of the disease occurred more often (20%), mainly due to insufficient staging in former years. Long-term sequelae of the radiation therapy like rhinitis or pharyngitis sicca were registered occasionally. At present, locoregional radiation therapy is recommended for stage IE and IIE low grade lymphomas and stage IE high grade lymphomas of the nasopharynx.     

Radiation therapy for primary non-Hodgkin's lymphoma of the head and neck in stage I-II

From September 1977 through January 1983, 34 previously untreated cases with primary non-Hodgkin's lymphoma of the head and neck in stage I-II were treated at our department. 16 cases were classified into stage I and 18 into stage II. Patients were treated with 4 MV X-ray (40 to 45 Gy) which encompassed Waldyer's ring and supraclavicular region with or without chemotherapy. The survival rates at three years were 93% and 50% in stage I and II, respectively. Stage, surface markers (T- and B-cell analysis) and initial primary site and the level of lymph node involvement were important prognostic factors. Chemotherapy in pre- or post-irradiation was essential, especially for cases in stage II. It was also indicated that the adequacy of radiation portal with special reference to anatomical consideration was necessary.     

MRI of neck nodes in non-Hodgkin's lymphoma of the head and neck

The aim of this study is to describe the imaging features of neck nodes in non-Hodgkin's lymphoma (NHL). The MR scans of 61 patients undergoing staging of a primary extranodal NHL of the head and neck were reviewed retrospectively. Those MR images with nodal disease were assessed for (a) the pattern of nodal disease, (b) presence of nodal necrosis and (c) presence of extracapsular neoplastic spread (ENS) and nodal matting. The features of the nodal disease were analysed in relationship to the sites of the primary NHL (palatine tonsil (PT) n=23, nasal cavity (NC) n=24, nasopharynx (NP) n=6, other extralymphatic sites (OES) n=8), and histology (natural killer/T-cell (NK/T) n=26, diffuse large cell (DLC) n=24, other subtypes (OS) n=11). Nodal disease was present in 26 patients (43%) and occurred in NHL of the PT n=16 (70%), NP n=3 (50%), NC n=5 (21%) and OES n=2 (25%) and in DLC n=15 (63%), NK/T n=6 (23%) and OS n=5 (45%). Nodal disease was significantly more frequent in DLC than NK/T lymphomas (p=0.0053). Nodal disease spread in a contiguous fashion in 25 (96%) patients with nodes. Necrosis was present in 7 of 26 (27%) being present in DLC of the PT in 5, NK/T of the NP in one and NK/T of the NC in one. ENS and matting were present in 19 (73%) and 13 (50%) patients with nodes, respectively. ENS was found in DLC, NK/T, OS, NC, NP, PT, OES (11, 4, 4,1, 2, 14, 2, respectively) and matting was found in DLC, NK/T, OS, NC, NP, PT, OES (9, 3, 1, 0, 2, 10, 1, respectively). Nodal NHL spreads in a contiguous fashion and is most commonly associated with DLC lymphoma of the NP and PT in Waldeyer's ring. Extracapsular nodal spread is frequent and found in most histological subtypes especially those arising from Waldeyer's ring. Necrosis is more common than previously believed.     

Radiation therapy for primary non-Hodgkin's lymphoma of the head and neck

From October 1977 through September 1986, a total of 77 patients (Stage I, 26; II, 35; and III-IV, 16) with primary non-Hodgkin's lymphoma (NHL) of the head and neck were treated with radiation therapy and chemotherapy (CVP or CHOP regimen) or radiation therapy alone. Actuarial 5-year survival rates by stage were 79% in Stage I, 35% in II, and 8% in III-IV. Significant prognostic factors were clinical stage (p = 0.0001), histological grade by the Working Formulation (p = 0.0089), and surface marker (T and B cell analysis) (p = 0.0001). In Stage II patients, the serum lactate dehydrogenase (LDH) level (p = 0.0286), the number of cervical lymph nodes involved (p less than 0.03), and maintenance chemotherapy after initial treatment (p = 0.0077) were significant prognostic factors. In conclusion, more intensive chemoradiotherapy is necessary as the first-line treatment in those with poor prognosis, especially those with T-cell type and high grade histology. In addition, maintenance chemotherapy after initial chemoradiotherapy is very important for Stage II NHL patients, especially those with a high LDH value or multiple cervical lymph node involvement.     

Stage I and II non-Hodgkin's lymphoma: results of combined of THP-COP chemotherapy and radiotherapy

PURPOSE: We evaluated the usefulness of radiotherapy plus THP-COP chemotherapy consisting of cyclophosphamide, vincristine, pirarubicin (tetrahydropyranyl adriamycin, THP), and prednisone for stage I and II non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: Between October 1998 and October 2001, 32 patients with Stage I or II NHL were treated with THP-COP plus radiotherapy. The patients consisted of 19 men and 13 women with a median age of 60 years (range, 23-81 years). The histological type was intermediate grade in 29, high in one, and unclassified in two. The number of cycles of THP-COP ranged from three to six (median, three cycles). Doses of irradiation ranged from 18.0 to 46.5 Gy (median, 40.0 Gy). The median length of follow-up was 19 months (range, 1-47 months). RESULTS: The 3-year overall survival rate and progression-free survival rate were 81.3% and 74.9%, respectively. Leukopenia of grade 3-4 was documented in 24 patients (75%) and thrombopenia of grade 3-4 in four (12.5%). CONCLUSION: THP-COP plus radiotherapy appeared to be feasible for stage I and II NHL patients. However, further evaluation is needed to determine the usefulness of this treatment.     

Non-Hodgkin's lymphoma of the head and neck: CT evaluation of nodal and extranodal sites

Forty-five patients with non-Hodgkin's lymphoma (NHL) of the extracranial head and neck who had undergone CT as part of their evaluation were reviewed to assess the impact of CT on clinical management. The sites of tumor deposition were subdivided by location: I, nodal; II, extranodal, lymphatic (Waldeyer's ring); and III, extranodal, extralymphatic (orbit, sinonasal, deep facial spaces, mandible, salivary gland, skin, and larynx). The CT appearance of NHL in each of the three locations was analyzed for characteristic CT signatures. Nodal NHL was suspected when CT showed multiple, large, homogeneous lymph nodes, often in unusual nodal chains of the head and neck. Extranodal, lymphatic NHL of Waldeyer's ring was indistinguishable from squamous cell carcinoma of this area unless synchronous tumor deposit in an extranodal, extralymphatic location was also present. When NHL was in nodes and/or Waldeyer's ring, CT-derived information was of limited clinical value since treatment was unfocused (chemotherapy and/or large-field radiotherapy). The CT appearances of extranodal, extralymphatic NHL was generally not distinguishable from other malignancies of these areas. However, CT-derived information regarding deep-tissue tumor size and extent was critical to planning the radiotherapy ports.     

Imaging of supradiaphragmatic manifestations of extranodal non-Hodgkin's lymphoma

Malignant lymphomas are differentiated into Hodgkin's and non-Hodgkin's-lymphoma (NHL). The following article discusses the imaging of extranodal NHL in supradiaphragmatic localizations. Lymphoma can affect nearly all tissues, and represent a rare entity as primary extranodal NHL. A secondary involvement of non-nodal tissue as consequence of a generalized lymphoproliferative disease is more common,and may be seen as well in HIV-positive patients defining AIDS. As extranodal lymphoma mimic the radiologic appearance of other malignant tumors, direct diagnosis without histologic analysis is often impossible. The article describes typical manifestations of lymphoma of the lungs, the head and neck area including the large glands, and rare localizations as the heart or the breast.     

An original accelerated radiotherapy schedule in stage III to IV head and neck cancers. Results in a multicenter setting.

BACKGROUND: Accelerated radiotherapy delivery has recently been shown to be effective in overcoming repopulation during fractionated radiotherapy. The therapeutic ratio may be particularly favorable for 5-week regimens. This study reports the feasibility and results of a particular accelerated schedule in Stage III to IV head and neck carcinomas used in a multicenter setting. PATIENTS AND METHODS: Seventy-four patients with Stage III (26 patients) or IV (48 patients) head and neck carcinomas were treated with a 5-week accelerated schedule (69.6 to 69.8 Gy in 41 to 40 fractions over a period of 35 to 36 days). Treatment began with 20 Gy in 10 daily fractions to initial involved sites, followed by bi-fractionated radiotherapy (2 x 1.6 Gy to 1.66 Gy/day) to a larger head and neck volume. Thirty-six (49%) patients received induction chemotherapy (median 3 cycles, range 1 to 4 cycles). RESULTS: Grade 3 or 4 (RTOG) confluent mucositis was observed in 57 patients (77%) and Grade 3 dysphagia in 33 patients (44%). Grade 3 or 4 (RTOG-EORTC) late complications were scored in 10.5% of cases. The 5-year actuarial locoregional control rate was 56% (95% CI: 42 to 71). The 5-year overall actuarial survival was 32% (95% CI: 18 to 46). Induction chemotherapy was not associated with a more favorable outcome. CONCLUSIONS: This study demonstrates the feasibility of this schedule in a multicenter setting. The oncologic results appear similar to those obtained by other accelerated regimens, while the rate of late complications seems acceptable. Five-week accelerated regimens warrant further evaluation, particularly in conjunction with concomitant chemotherapy, in the framework of prospective trials.     

Low grade stage I and II non-Hodgkin's lymphoma: results of treatment and relapse pattern following therapy

Sixty-four patients (37 stage I and 27 stage II) with low grade non-Hodgkin's lymphoma were treated by surgical excision alone (two patients) or with radiotherapy (53 patients), chemotherapy (five patients) or both (four patients). Actuarial survival was 80.7% at 5 years and 77.9% at 10 years. Actuarial recurrence-free survival at 10 years was 49.4% for stage I and 38.0% for stage II patients. Local control was achieved in 52 out of 56 (93%) patients treated with a radiation dose of 30 Gy or greater. There was no advantage for extended compared with involved, field irradiation. A multivariate analysis identified age, sex, stage and disease site as independent prognostic variables for survival.     

Phase I/II study of high-dose rate interstitial radiotherapy for head and neck cancer.

From July 1991 through December 1991, a phase I/II study of high-dose rate interstitial radiotherapy for head and neck cancer was performed to determine any acute adverse effects and mucosal reaction as well as the feasibility of this therapy. A total of seven patients with head and neck cancer (tongue: four cases; mouth floor: one case; buccal mucosa: one case; oral mucosa of lower lip: one case) were entered into this study. The dose schedule of high-dose rate interstitial radiotherapy ranged from 35 Gy/ten fractions (bid)/week to 60 Gy/ten fractions/week. No major or minor early complication was observed. Spotted mucositis appeared starting three days after the end of high-dose rate interstitial radiotherapy while confluent mucositis developed and approached a peak at ten days but disappeared by the fourth to eighth week. Early tumor responses of all patients were complete.     

Sequential polychemotherapy and large-field radiotherapy of non-Hodgkin's lymphoma

The combination of polychemotherapy and large-field radiotherapy essentially promoted the improved total results achieved during the period of 1976 and 1982 in 272 patients with non-Hodgkin's lymphomas (NHL) of low and high malignancy. In case of centroblastic-centrocytic (cb/cc) NHL of stages II A/III A, the recurrence-free survival after radiotherapy (n = 21) could be increased by the combined method (n = 25) from 17% to 60%, and the probability of seven-year survival could be improved from 70% to 90%. All of the ten initially irradiated patients in the stages I A/II A/III A of centrocytic (cc) NHL suffered from a recurrence, whereas the development seems to be more favorable in the five patients submitted to combined treatment who had only one recurrence. The recurrence-free seven-year survival of the highly malignant NHL in stage I A/II A increased from 40% after unique radiotherapy (n = 15) to 70% after combined therapy (n = 39), the survival probability increased from 55% to 75%. Despite the partly insufficient therapy results after unique radiotherapy and polychemotherapy, the combined method has largely contributed to achieve after eight years the total survival rates of 76% for cb/cc NHL (n = 123) and of 55% for the highly malignant immunoblastic NHL (n = 57), centroblastic NHL (n = 35) and NHL with uncertain classification, whereas the cc-NHL (n = 36) hitherto has a relatively unfavorable prognosis with only 29%.     

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Lymphocyte subpopulations in Hodgkin's disease and non-Hodgkin's lymphoma and the effects of radiotherapy

Examination of peripheral blood lymphocyte subsets in untreated patients with Hodgkin's disease and non-Hodgkin's lymphoma revealed depressed ratios of helper/suppressor T-cells, assessed with monoclonal antibodies OKT4 and 8. Non-Hodgkin's lymphoma and Hodgkin's disease patients studied from 1 to 204 months following treatment by radiotherapy also demonstrated depressed ratios, although the patients were clinically free of disease. The failure of the helper T-cells to recover following apparently successful treatment suggests that either the initial disease or the radiotherapy produces a virtually irreversible effect on T-cell subpopulations. Treated Hodgkin's disease patients also exhibited a long term increase in B-cell numbers but this effect could be correlated with splenectomy performed during staging laparotomy.