Management of stage I-II diffuse aggressive non-Hodgkin's lymphoma of the Waldeyer's ring: combined modality therapy versus radiotherapy alone

Twenty five patients with stage I and II diffuse aggressive non-Hodgkin's lymphoma of the Waldeyer's ring were reviewed. There were 19 patients with diffuse histiocytic, 4 diffuse lymphocytic poorly differentiated and 2 diffuse mixed lymphoma. Their median age was 51 years. There were 12 males and 13 females. Eight patients had stage I, and 17 had stage II disease. There was a significantly higher incidence of involvement of the left side of the Waldeyer's ring compared to the right (p = 0.0251). Fifteen patients received radiotherapy alone, and ten had radiotherapy and chemotherapy. The median durations of follow-up were 42 (range 8-162) and 44 (range 8-97) months respectively. All patients had complete remission but 9 patients (36 per cent) subsequently had relapse of their lymphomas. Stomach was the commonest site of relapse (44 per cent). The disease free survival and overall survival at 5 years were 59 per cent and 57 per cent respectively. Higher relapse rate was observed in the radiotherapy alone group (60 per cent) as compared to the combined modality therapy group (0 per cent). Patients who received combined modality therapy had significantly superior 5 years disease free survival (100 per cent versus 32 per cent, p less than 0.01) and overall survival (81 per cent versus 40 per cent, p less than 0.05). After radiotherapy alone, patients with stage II disease appeared to have a high relapse rate than those with stage I disease (70 per cent versus 40 per cent) but the difference did not reach statistical significance due to small sample sizes. The histological subtypes did not appear to affect their prognosis. All patients with stage I and II diffuse aggressive non-Hodgkin's lymphoma of the Waldeyer's ring should have gastrointestinal barium studies at initial staging, and a prospective randomised study on these patients comparing radiotherapy alone and combined modality therapy should be performed.     

Results of radiation therapy of stage I-II non-Hodgkin's lymphoma localized in the head and neck: Osaka University Hospital experience

A retrospective analysis of 251 patients (stage I: 125; stage II: 126) with non-Hodgkin's lymphoma localized in the head and neck and treated between 1971 and 1985 was performed. Of these, 28 patients (11%) had histology of low-grade malignancy, and 218 (87%) had intermediate malignancy. Waldeyer's ring was the most frequent site of involvements (114 cases), extranodal site (91), and cervical lymph node(s) (46) in the order. Treatment consisted of radiation therapy alone in 173 patients and 78 patients were treated with chemotherapy combined. Local control rates by radiation therapy was 95%. Five-year survival and relapse-free survival rates were 72% and 61%, respectively, in stage I, and 63% and 54%, respectively, in stage II. A brief chemotherapy for 2 cycles followed by local-regional radiation therapy appeared better survival as compared to initial radiation therapy alone.     

The role of radiation therapy of diffuse large cell lymphoma localized in the head and neck

Eighty-one patients with diffuse large cell lymphoma localized in the head and neck were treated with radiation between 1971 and 1981. Of these, 52 had Waldeyer's ring disease, 14 nodal, and 15 extranodal disease. Overall survival and relapse-free survival rates at five years after radiation therapy alone were 69% and 52%, respectively. Five-year disease-free rates of patients with Waldeyer's ring disease were 91% in stage I, and 71% in stage II, which are much better than those of other extranodal and nodal diseases. According to mass size, the five-year relapse-free rate for the small-mass less than 5 cm in diameter group was much better (72%) than that for the large-mass group (29%).     

Tumor bulk as a prognostic factor for the management of localized aggressive non-Hodgkin's lymphoma: a survey of the Japan Lymphoma Radiation Therapy Group

PURPOSE: To identify the prognostic factors that specifically predict survival rates of patients with localized aggressive non-Hodgkin's lymphoma (NHL). METHODS AND MATERIALS: The survey was carried out at 25 radiation oncology institutions in Japan in 1998. The 5-year event-free (EFS) and overall survival rates (OAS) were calculated, and univariate and multivariate analyses were done to identify which of the following factors, namely, gender, age, performance status (PS), serum lactate dehydrogenase (LDH) level, Stage (I vs. II), tumor bulk (maximum diameter), and treatment, were significant from the viewpoint of prognosis. RESULTS: A total of 1141 patients with Stage I and II NHL were treated by the Japanese Lymphoma Radiation Therapy Group between 1988 and 1992. Of them, 787 patients, who were treated using definitive radiotherapy with or without chemotherapy for intermediate- and high-grade lymphomas in working formulation, constituted the core of this study. Primary tumors arose mainly from extranodal organs (71%) in the head and neck (Waldeyer's ring: 36% and sinonasal cavities: 9%). The factors associated with poorer prognosis were age over 60 years old (p < 0. 0001), radiation therapy alone (p < 0.0001), PS = 2-4 (p = 0.0011), (sex male, p = 0.0078), a bulky tumor more than 6 cm in maximum diameter (p = 0.0088), elevated LDH (p = 0.0117), and stage II (p = 0.0642). A median dose of 42 Gy was delivered mainly to the involved fields. Short-course chemotherapy was provided in 549 (70%) patients. The 5-year OAS and EFS rates for all patients were 71% and 67%, respectively. According to the stage-modified International Prognostic Index, the 5-year EFS of the patients with risk factors from 0 to 1 was 76%, 61% for patients with two risk factors, and 26% for patients with three or more risk factors. CONCLUSION: Extranodal presentation, especially Waldeyer's ring and sinonasal cavities, is encountered more frequently in Japan than in Western countries. Tumor bulk is an important prognostic factor in patients with localized aggressive extranodal NHL. Short course chemotherapy followed by radiation therapy was associated with prolonged survival in patients with localized aggressive NHLs of extranodal origin and 0-1 risk factor.     

原发鼻腔非霍奇金淋巴瘤的治疗选择和疗效

目的 分析原发鼻腔非霍奇金淋巴瘤（NHL）放疗和化疗的近期疗效以及治疗方法对预后的影响。方法 129例经病理证实的原发鼻腔NHL患者中,经形态学诊断为鼻腔NK／T细胞淋巴瘤者116例。做免疫组化57例,其中52例为NK／T细胞来源,占91．2％;5例为B细胞来源,占8．8％。根据Ann Arbor分期,ⅠE期102例,ⅡE期22例,ⅣE期5例,ⅠE和ⅡE期患者中,单纯放疗22例,单纯化疗7例,综合治疗95例,ⅣE期以化疗为主。结果 5年总生存率（OS）和无病生存率（DFS）分别为68．0％和55．8％,ⅠE期和ⅡE期患者的5年OS分别为71．7％和70．6％（P=0．77）,DFS分别为60．9％和47．0％（P=0．09）。首程治疗后达CR患者的5年OS为83．1％,而未达CR患者的5年OS为18．0％（P=0．000）,相应5年DFS分别为68．0％和15．5％（P=0．000）。124例ⅠE和ⅡE期患者中,67例患者接受单纯放疗或放疗后化疗,放疗后完全缓解率（CR）为74．7％,其余57例为化疗后放疗或单纯化疗,化疗后CR率仅19．3％（P=0．000）,46例化疗后未达CR的患者中,42例仍局限于局部区域,31例经放疗达到CR,ⅠE和ⅡE期患者中,先放疗组（放疗＋化疗或单纯放疗）、化疗后放疗组的5年OS分别为76．0％和74．4％,DFS分别为65．0％和56．2％（P〉0．05）,ⅠE和ⅡE期单纯化疗7例,3例存活,4例死亡,中位生存时间15个月,1年生存率为26．7％。结论 中国人原发鼻腔NHL主要为NK／T细胞来源,放疗的近期疗效显著优于化疗,化疗加入放疗并未改善生存率,ⅠE和ⅡE期患者应以放射治疗为主要治疗手段。     

Adjuvant chemotherapy for stage I and II non-Hodgkin's lymphoma--a seven-year follow up

From 1975 to 1983, 51 patients of stage I (30) and II (21) of non-Hodgkin's lymphoma were treated with a combination chemotherapy consisting of vincristine, cyclophosphamide and prednisolone as an adjuvant therapy after radiation or operation. The following results were obtained. 1) Nine patients in stage I and 7 in stage II relapsed, so that 10 year-relapse free survival rates were 68% in stage I and 67% in stage II, respectively. 2) Three patients in nodal lymphomas, 7 in Waldeyer's ring lymphomas and 6 in extranodal lymphomas relapsed, so that 10 year-relapse free survival rates were 80%, 48% and 72%, respectively. 3) Ten year-survival rates were 86% in stage I and 70% in stage II. 4) Ten year-survival rates were 82% in nodal lymphomas, 62% in Waldeyer's ring lymphomas and 86% in extranodal lymphomas. 5) Ten patients relapsed within 1 year, 4 between 1-5 years and 2 after 5 years. Relapses occurred in other than primary sites in most patients. These results suggest that an adjuvant chemotherapy is useful for localized non-Hodgkin's lymphoma, but more intensive chemotherapy before local treatments is necessary.     

A systematic overview of radiation therapy effects in non-Hodgkin's lymphoma

A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for non-Hodgkin's lymphoma (NHL) is based on data from seven randomized trials. Moreover, data from 17 prospective studies, 22 retrospective studies and 27 other articles were used. In total, 73 scientific articles are included, involving 13,305 patients. The results were compared with those of a similar overview from 1996 including 14,137 patients. The conclusions reached can be summarized as follows: Indolent lymphomas. Data indicate that one-third to one-half of patients with indolent lymphoma in stage I are cured by radiotherapy (follow-up more than 15 years). Addition of chemotherapy to radiotherapy does not indicate any improvement in overall outcome. Optimal radiation dose is not defined and extended field is not superior to involved field. Aggressive localized lymphomas. Data indicate that half of the patients in stage I are cured by radiotherapy alone. Although randomized and non-randomized studies favour combined modality treatment with chemotherapy followed by radiotherapy instead of radiotherapy or chemotherapy alone in localized disease, no firm conclusions can be drawn. Conflicting data have been published on the value of radiotherapy towards bulky disease and no firm conclusions can be drawn. Optimal dose for radiation alone or after chemotherapy has not been established. Total body irradiation (TBI). The value of TBI for treatment of NHL has not been proven. There is no proof that fractionated TBI in conjunction with high-dose chemotherapy is superior to chemotherapy regimens alone. Primary CNS lymphomas. Data show that radiotherapy induces a response of short duration and is associated with major neurotoxicity, especially in elderly patients. High-dose methotrexate therapy seems to lead to longer survival than radiotherapy alone. No randomized trials have been performed. There is fairly good support for primary chemotherapy including high-dose methotrexate followed by radiotherapy in patients below 60 years. To minimize the risk of neurotoxicity of combined modality treatment it has been proposed to use chemotherapy alone and delay radiotherapy for relapse, especially in patients above 60 years, or use it in chemotherapy-resistant disease. Optimal chemotherapy regimen is not defined and the role of radiotherapy remains to be determined. Head and neck lymphomas. There is some support for combined modality treatment with chemotherapy and radiotherapy for aggressive lymphomas in Waldeyer's ring with limited disease. There are sparse data supporting radiotherapy alone in localized indolent lymphomas in salivary glands. Radioimmunotherapy (RIT). Radioimmunotherapy is a new treatment modality with systemic radiation for patients with advanced NHL, where conventional external beam radiotherapy plays only a minor role. Several phase I and II studies with RIT have documented promising results. A variety of monoclonal antibodies, radionuclides and study designs with both myeloablative and non-myeloablative approach have resulted in high response rates in patients with recurrent or refractory NHL. One randomized clinical trial is published, showing superior therapy results with radiolabelled antibody compared with the corresponding unlabelled antibody.     

Prognostic Factors in Stage I and II Non-Hodgkin's Lymphoma of Waldeyer's Ring

Sixty-nine stage I and II patients treated for non-Hodg-kin's lymphoma of Waldeyer's ring were retrospectively analysed. Diffuse histiocytic lymphoma (Rappaport's classification) was the most common histology (67%). Staging without laparotomy revealed 31 patients in stage I and 38 in stage II. Sixty-five patients received radiation therapy against involved or extended fields. In 43 patients adjuvant chemotherapy with single or multiple agents was given and 4 patients received only chemotherapy. A relapse occurred in 34 (49%) patients. The 5-year relapse-free survival was 67 per cent and 36 per cent in stage I and stage II, respectively. Radiation doses of 50 Gy gave no recurrence within treated volumes. However, since relapse below the clavicles and especially below the diaphragm was common, the radiation doses did not seem important for reduction of the overall failure rate. In stage II, patients with a single neck node less than 5 cm in diameter seemed to have a better prognosis than patients with large or multiple neck nodes. In this non-randomized study adjuvant chemotherapy seemed to reduce the risk of relapse, especially in stage II patients.     

Malignant lymphoma of Waldeyer's ring: is lymphography always necessary?

The role of lymphography for patients with malignant lymphomas involving Waldeyer's ring was retrospectively reviewed. The materials were 97 patients who were treated at Kyushu University Hospital from January, 1966 to December 1982. Lymphography was performed in 72 patients. Abnormal retroperitoneal nodes were detected only in 13 of them (18%). Six of the 7 patients (86%) with gastrointestinal involvement as well as Waldeyer's ring had positive lymphography, whereas only 6 of the 51 patients (12%) without gastrointestinal involvement had such findings. Although there was a significant difference in survival by cervical and inguinal lymph node status, no such discrepancy was seen between 41 stage II patients staged after lymphography and 16 stage II patients staged clinically. All these results suggest that lymphography is not always essential for patients with malignant lymphomas involving Waldeyer's ring.     

Head and neck extranodal non-hodgkin-lymphoma - radiation-therapy and chemotherapy

One hundred and seventy-five patients with extranodal non-Hodgkin lymphoma (NHL) treated between 1974 and 1993 in the Institute of Radiology and in the Department of Haematology of 'La Sapienza' University of Rome, have been examined. The sites involved were: Waldeyer's ring 96 patients (tonsils 84, nasopharinx 12), parotid 20, orbit 16, oral cavity 16, paranasal sinus 7, mandible 7, nasal fossal 3, minor salivary glands 3, larynx 3, conjunctive 2, lacrymal glands 1, thyroid 1. One hundred and forty-three patients had high and medium grade unfavourable histology; 68 patients were in stage I, 67 in II, 23 in III and 17 in IV. Fifteen patients were treated with radiotherapy alone and 86% obtained complete remission (CR). Chemotherapy alone was used in 90 cases and 87% C.R, was achieved; when chemotherapy in association with radiotherapy was used in 70 cases 85% obtained CR. The actuarial survival rate was 79% and recurrence-free survival in those patients who achieved complete remission 87%. Surviving and relapse-free patients were analysed in relation to main prognostic factors and therapy, and patterns of recurrence are reported. From the analysis of these cases we can learn how systemic therapy combined with the general conditions of patients and histology can control the disease. A minor relapse incidence with pharmacological therapy combined with a radiotherapic loco-regional treatment was also ascertained.     

Prognostic factors in patients with early stage non-Hodgkin's lymphomas of the head and neck treated with definitive irradiation

Between 1974 and 1989, 58 patients with clinical Stages I and II non-Hodgkin's lymphomas of the head and neck were treated with radiation at the Fox Chase Cancer Center. Forty-one treated with radiotherapy alone form the basis for this retrospective analysis of outcome and prognostic factors. With a mean radiation dose of 4400 cGy, the 5-year actuarial local control rate is 92%. Only one patient failed within an irradiated field. The 5-year actuarial survival and relapse-free survival rates are 85% and 54%, respectively. In a univariate analysis, poor survival was significantly correlated with involvement of Waldeyer's ring, postoperative tumor size greater than 3 cm, and greater than two involved lymph nodes and extranodal sites (p less than 0.02). No such correlations were seen for stage, histologic grade, the presence of extranodal disease, or any of the other parameters that were examined. Relapse free survival was significantly correlated only with the total of the number of involved nodes and extranodal sites. Patients with one or two involved nodes and sites had a 68% chance of remaining disease-free at 5 years compared to 0% for patients with greater than two (p = .02). Again, significant trends were not seen for the other parameters analyzed. These data demonstrate excellent local control, survival, and relapse-free survival using radiation alone with doses of 3000-5000 cGy. In our group of clinically staged patients preselected for treatment with radiation alone, the total of the number of involved nodes and extranodal sites, involvement of Waldeyer's ring, and tumor size after resection correlated strongly with relapse-free survival and overall survival. In patients with early stage non-Hodgkin's lymphomas of the head and neck, initial management with external beam radiotherapy should be considered in particular for those with one or two involved nodes and extranodal sites that are less than 3 cm following resection and that do not involve Waldeyer's ring.     

Results of radiation therapy of stage II non-Hodgkin's lymphoma of the Waldeyer's ring: a report of the Japanese Lymphoma Radiation Therapy Study Group

A retrospective analysis of 245 patients with stage II non-Hodgkin's lymphoma of the Waldeyer's ring treated between 1972 and 1985 was performed. Treatment consisted of radiation therapy alone in 96 patients and 149 patients were treated with chemotherapy combined. Five-year survival and relapse-free survival rates were 57% and 50%, respectively. For cases with DH, they were 64% and 55% respectively, and for DLPD 31% and 27%, respectively. Of the cases with relapse, 21% were seen in stomach or intestine. There were no difference on survival rates between radiation therapy alone and chemotherapy combined with radiation therapy.     

A Systematic Overview of Radiation Therapy Effects in Non-Hodgkin's Lymphoma

A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for non-Hodgkin's lymphoma[G1] (NHL) is based on data from seven randomized trials. Moreover, data from 17 prospective studies, 22 retrospective studies and 27 other articles were used. In total, 73 scientific articles are included, involving 13 305 patients. The results were compared with those of a similar overview from 1996 including 14 137 patients. The conclusions reached can be summarized as follows: Indolent lymphomas Data indicate that one-third to one-half of patients with indolent lymphoma in stage I are cured by radiotherapy (follow-up more than 15 years).Addition of chemotherapy to radiotherapy does not indicate any improvement in overall outcome.Optimal radiation dose is not defined and extended field is not superior to involved field. Aggressive localized lymphomas Data indicate that half of the patients in stage I are cured by radiotherapy alone.Although randomized and non-randomized studies favour combined modality treatment with chemotherapy followed by radiotherapy instead of radiotherapy or chemotherapy alone in localized disease, no firm conclusions can be drawn.Conflicting data have been published on the value of radiotherapy towards bulky disease and no firm conclusions can be drawn.Optimal dose for radiation alone or after chemotherapy has not been established. Total body irradiation (TBI) The value of TBI for treatment of NHL has not been proven.

There is no proof that fractionated TBI in conjunction with high-dose chemotherapy is superior to chemotherapy regimens alone. Primary CNS lymphomas Data show that radiotherapy induces a response of short duration and is associated with major neurotoxicity, especially in elderly patients.High-dose methotrexate therapy seems to lead to longer survival than radiotherapy alone. No randomized trials have been performed.There is fairly good support for primary chemotherapy including high-dose methotrexate followed by radiotherapy in patients below 60 years.To minimize the risk of neurotoxicity of combined modality treatment it has been proposed to use chemotherapy alone and delay radiotherapy for relapse, especially in patients above 60 years, or use it in chemotherapy-resistant disease. Optimal chemotherapy regimen is not defined and the role of radiotherapy remains to be determined. Head and neck lymphomas There is some support for combined modality treatment with chemotherapy and radiotherapy for aggressive lymphomas in Waldeyer's ring with limited disease.There are sparse data supporting radiotherapy alone in localized indolent lymphomas in salivary glands.

Radioimmunotherapy (RIT) Radioimmunotherapy is a new treatment modality with systemic radiation for patients with advanced NHL, where conventional external beam radiotherapy plays only a minor role. Several phase I and II studies with RIT have documented promising results. A variety of monoclonal antibodies, radionuclides and study designs with both myeloablative and non-myeloablative approach have resulted in high response rates in patients with recurrent or refractory NHL.

One randomized clinical trial is published, showing superior therapy results with radiolabelled antibody compared with the corresponding unlabelled antibody.     

鼻咽非霍奇金淋巴瘤的临床与预后分析

目的 探讨鼻咽非霍奇金淋巴瘤的临床特点、治疗及国际预后指数(IPI)的应用价值。方法 回顾性分析1983—1997年间136例首程治疗的鼻咽非霍奇金淋巴瘤患者的临床资料。按照工作分类原则进行分类,高度恶性18例,中度恶性77例,低度恶性2例,未分类39例。根据Ann Arbor分期,Ⅰ期25例,Ⅱ期91例,Ⅲ期12例,Ⅳ期8例。Ⅰ期单纯放疗13例,综合治疗12例;Ⅱ期单纯放疗31例,综合治疗57例,Ⅲ和Ⅳ期以化疗为主。结果 5年和10年总生存率(OS)、癌症相关生存率(CSS)和无病生存率(OFS)分别为56．2％和48．3％,61．2％和58．0％,51．1％和46．5％。IPI为0,1及2～3分的5年CSS分别为70．9％、44．9％、30．0％(P=0．004)。Ⅰ期化放疗综合治疗和单纯放射治疗的5年CSS分别为82．2％和83．1％,10年CSS分别为82．2％和66．4％,差异无显著性(P=0．779)。Ⅱ期综合治疗和单纯放射治疗5年CSS分别为70．9％和46．0％,10年CSS分别为65．4％和46．0％,差异有显著性(P=0．04)。Cox多因素分析显示,影响预后的因素为Ann Arbor分期、B组症状和IPI。结论 IPI是判断原发于鼻咽非霍奇金淋巴瘤预后的重要指标,Ⅱ期鼻咽非霍奇金淋巴瘤应考虑综合治疗。     

原发睾丸非霍奇金淋巴瘤26例临床分析

目的：探讨原发睾丸非霍奇金淋巴瘤(non-Hodgidn’s lymphoma,NHL)的临床特点、治疗方法。方法：收集我院1980年10月至2002年2月收治的睾丸NHL26例,Ann Arbor分期ⅠE期17例,ⅡE期6例,ⅣE期3例。全部手术治疗。首程术后化疗24例,以CHOP方案为主,3～6周期,化疗加放疗9例,其中对盆腔／腹主动脉旁／阴囊等区域进行预防性放疗7例,针对病灶区放疗2例。阴囊区用9～12M eV电子线,其余用6～8MV-X线照射。照射剂量范围在36～50Gy,预防照射的平均剂量为40Gy。单纯手术和手术加放疗各1例。结果：全组一、三、五年总体生存率和无进展生存率分别为96．0％、78．1％、52．0％和70．2％、55．3％、49．2％。总失败率为53．8％,其中对侧睾丸、中枢神经系统受侵率分别为15．4％、11．5％,腹膜后淋巴转移率19．2％。结论：睾丸NHL一般为中-高度恶性,结外器官和淋巴结受侵率高,睾丸和腹膜后区分别占结外器官和淋巴结受侵的首位。所有期别的睾丸NHL都应化疗。ⅠE、ⅡE期病例应常规行腹主动脉旁、同侧髂血管旁和阴囊区预防性照射。ⅢE、ⅣE期以化疗为主,残留病灶辅以局部放疗。     

Results of radiation therapy in extranodal non-Hodgkin's lymphoma of the head and neck--a study of the Japan Lymphoma Radiation Therapy Study Group

Extranodal non-Hodgkin's lymphoma (NHL) in the head and neck except Waldeyer's ring treated with radiation were analyzed. No definite difference was observed both in actuarial and relapse-free five-year survival rate between stage I and II. There was a high survival rate with orbital NHL in which most of the patients occupied with favorable histology. Prognosis of the disease was highly influenced by the histologic subtype; five-year survival was 91.4% in DWDL, 77.2% in the DM, 52.0% in DPDL and 51.7% in DH. Application of histologic classification with the Working Formulation was also recommended. There was a high incidence of extranodal relapses to bone and/or soft tissue from the lesions with nasal cavity, paranasal sinus and oral cavity.     

Stage I malignant lymphoma of Waldeyer's ring: frequent relapse after radiation therapy.

The natural history and therapeutic results of 26 patients with stage I malignant lymphoma of Waldeyer's ring (ML-WR) were analyzed retrospectively. Complete response was achieved in all 26. Relapse occurred in 9 of 21 (43%) patients treated with radiation therapy (RT) alone, while no relapse was seen in those treated with a combination chemotherapy consisting of cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP therapy). Relapse occurred within 1 year in 8 of the 9 patients. Relapse-free survival in the patients treated with RT alone was considered suboptimal.     

Patterns of disease in localized extranodal lymphomas

The site of origin of lymphoid tissue is an important determinant of lymphocyte migration patterns. The association of gastrointestinal (GI) and Waldeyer's ring lymphoma and the unique lymphocyte migration pattern of gut-associated lymphoid tissue (GALT) have been previously described. To establish whether predictive clinical patterns of disease occur in localized Non-Hodgkin's lymphoma, survival and relapse patterns for 496 patients with stage I and II non-Hodgkin's lymphoma (NHL) treated with loco-regional irradiation (XRT) alone were examined. We identified 139 patients with GALT lymphoma (defined as arising from primitive gut and including Waldeyers' ring, thyroid, and GI lymphomas) and 87 patients with extranodal non-gut-associated lymphoma (ENL). Survival and relapse data were assessed in multifactorial analysis to correct for previously identified other prognostic variables. GALT lymphomas (GALT-L) have a survival advantage compared with other ENL (P = .017) independent of stage and histology. A difference in distant relapse (DR) rate between GALT-L and other ENL (P = .0002) was also identified. The presentation site of localized extranodal NHL is predictive of clinical behavior and is an independent determinant of outcome. This may be an expression of lymphocytic origin and determinants of migration patterns.     

Stage Ia Non-Hodgkin's Lymphoma of the Waldeyer's Ring Limited chemotherapy and radiation therapy versus radiation therapy alone

Seventeen patients with stage IA non-Hodgkin's lymphoma of the Waldeyer's ring were treated with radiation therapy with or without chemotherapy. All lesions were judged as having intermediate grade malignancy in the Working Formulation. Eight patients received combined treatment with three cycles of cyclophosphamide, doxorubicin, vincristine and prednison (CHOP) and radiation therapy with 30 to 40 Gy. Another 9 patients were treated with radiation therapy 40 to 60 Gy alone. After a median follow-up of 69 months, all 8 patients, treated with combined modality were alive and relapse-free, whereas 4 of the 9 treated with irradiation alone had relapsed. All relapses occurred transdiaphragmatically. Two of the 4 relapsing patients were saved, but the other two died of the disease. the 5-year relapse-free and cause-specific survival rates were 100% and 100% in the combined modality group, and 56% and 76% in the radiation therapy alone group (relapse-free: p = 0.04, cause-specific: p = 0.16). There were no serious complications related to treatment, although most patients complained of mouth dryness and most patients given CHOP had paresthesia. Our opinion was that the total impact of these two side-effects on quality of life was less pronounced after combined modality than after radiation therapy alone. Limited chemotherapy and radiation therapy seemed to be more beneficial than radiation therapy alone not only in relapse-free survival but also in quality of life after treatment.     

A case of non-Hodgkin's lymphoma manifesting an eyelid tumor as a major symptom

It is well known that a majority of non-Hodgkin's lymphoma (NHL) in the head and neck region arises from the Waldeyer's ring and neck lymph nodes. This report covers a rare case of a 69 year-old male with a symptom like the Mikulicz syndrome, who was diagnosed as having the NHL of B-cell type. This patient has been in complete remission following local radiotherapy for the tumor of the eyelid.