Stage I and II Waldeyer's ring and oral-sinonasal non-Hodgkin's lymphoma

Sixty-six patients with Ann Arbor Stage I and II Waldeyer's ring and oral-sinonasal non-Hodgkin's lymphoma are presented. Ten-year survival was better for the 32 patients with Waldeyer's ring non-Hodgkin's lymphoma (Stage I, 83%; Stage II, 75%) than for the 34 with oral-sinonasal non-Hodgkin's lymphoma (Stage I, 47%; Stage II, 50%). Diffuse large cell lymphomas were common in patients with Waldeyer's ring involvement (59%). In those affected in the oral-sinonasal region, 38% had high-grade lymphoma. There was a high incidence of extranodal relapses outside of the gastrointestinal tract in patients with oral-sinonasal lymphoma (10 cases). Gastrointestinal tract relapse occurred commonly in patients with Waldeyer's ring lymphoma and was found in five cases.     

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.     

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.     

Radiation therapy of Waldeyer's ring lymphoma

Forty-nine patients with biopsy-proven Waldeyer's ring lymphoma were treated with radiation therapy between 1968 and 1979; 45 to 50 Gy were given to Waldeyer's ring structures with a 5- to 10-Gy boost to the primary site. Uninvolved low cervical nodes received 40 to 50 Gy. Chemotherapy was reserved for treatment failures. Actuarial 5-year survival was 53%, disease-free survival was 48%, and local control was 98%. Patients with Stage I disease fared better than patients with Stage II disease, and unilateral adenopathy conferred a better prognosis than bilateral adenopathy. When classified by the Rappaport system, nodular lymphomas had a better prognosis than diffuse lymphomas, and of the diffuse lymphomas, histiocytic lymphoma was a more lethal disease than lymphocytic lymphoma. Patients with diffuse undifferentiated lymphomas in the Rappaport system, or high-grade lymphomas in the Working Formulation, fared poorly. Most relapses were systemic, and actuarial 5-year survival after salvage was only 20%. A logical approach to the treatment of this disease can be based on these prognostic features.     

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.     

咽淋巴环非霍奇金淋巴瘤的影像学特征及临床意义

背景与目的:咽淋巴环是非霍奇金淋巴瘤(non-HodgkinslymphomaNHL)常见的结外侵犯部位,早期临床及影像学表现均与该部位常见的鳞状上皮癌相似,常引起误诊。为了提高对本病影像特点的认识,本文拟分析有关资料,探讨咽淋巴环NHL的影像学特点及临床意义。方法:回顾性分析149例经病理确诊的咽淋巴环NHL的CT和MRI表现。结果:病理分型:B细胞来源占65.8%,T和NK/T细胞占34.2%。病变部位:发生于扁桃体的最多见,其次为鼻咽扁桃体等多部位受累。CT和MRI表现:(1)病变形态为肿块型81例、浸润性36例、溃疡型7例及混和型25例,其中肿块型以B细胞NHL多见,浸润型以NK/T细胞多见。(2)肿块型多表现为CT密度和MRI信号均匀。(3)病变以局限在咽粘膜间隙多见,咽旁间隙等深层结构及颅底骨质侵犯少。(4)总的颈淋巴结受累率52.3%,其中B细胞65.3%,和NK/T细胞27.5%,后者明显低于前者(P<0.05)。结论:多部位多中心起源、大肿块、咽壁弥漫浸润性增厚、颅底及深层结构侵犯少是咽淋巴环NHL典型的影像学特征;不同的免疫表型又有一定的特点。CT和MRI在咽淋巴环NHL的诊断、临床分期有重要的参考价值。     

Results of radiotherapy in patients with stage I orbital non-Hodgkin's lymphoma

This paper describes the results of radiotherapy in early stage orbital non-Hodgkin's lymphoma. From 1970 to 1985, 33 orbital localizations in 30 patients were treated. The total dose applied ranged from 21 to 57 Gy (2 Gy per fraction), two-thirds of all patients received a dose of 40 Gy. The complete-response rate was 94% and the 10 years actuarial survival was 90%; no significant difference in survival was observed between patients with low grade or intermediate grade lymphoma. No local recurrence was detected during follow up and 20% of the patients developed generalized disease. Two optic nerve neuropathies and three retinopathies were observed in five patients, four of these occurred at a dose level of less than 43 Gy. Keratitis occurred in 58% of the patients treated, a sicca syndrome in 30% and cataract of different grades in 58% of the patients treated. Although local control was excellent, severe complications were observed in 13% of the patients who received a dose of less than 43 Gy.     

Non-Hodgkin's lymphoma of Waldeyer's ring

The authors retrospectively analyzed 103 patients to investigate the value of examination of Waldeyer's ring with biopsies as a staging procedure in patients with non-Hodgkin's lymphoma. Twenty-three patients had clinical involvement of Waldeyer's ring. In 55 of 80 remaining patients, this staging procedure was performed but positive biopsy specimens were found only in patients with advanced disease. No correlation was found between positive biopsy specimens and the histologic subtype. No positive biopsy specimens of Waldeyer's ring were obtained in patients with cervical lymphadenopathy without clinical involvement of the nasopharynx and in patients with localized lymphoma of the gastrointestinal tract. Blind biopsies of Waldeyer's ring as a staging procedure proved to be of no value in the patients. The results of therapy in 23 patients with involvement of Waldeyer's ring were good. Unfavorable histologic subtypes (intermediate or high-grade malignancy) were predominant (91%). Eighteen of 22 patients (82%) achieved complete remission, with a relapse-free survival rate at 60 months of 95%. For the whole group of patients, the actuarial survival rate at 72 months was 71%.     

Value of gallium scans and lymphangiography in non-Hodgkin's lymphoma of the Waldeyer's ring

In 37 patients with seemingly localized non-Hodgkin's lymphoma of the Waldeyer's ring (WR-NHL), lymphangiography (LAG) and/or gallium-67 scans (Ga-67 scans) were done. Before these procedures, 20 patients were diagnosed as Stage I, and 17 as Stage II. LAG was done for 30, and Ga-67 scans for 32, 25 of whom had both. Five patients (16%) were upstaged to Stage III or IV by Ga-67 scans. Only one (3%) had abnormal LAG findings, in whom Ga-67 scans also showed abnormal accumulation in the para-aortic region. Because of this low positive rate, LAG is not recommended for staging of WR-NHL.     

Stages I and II non-Hodgkin's lymphomas of Waldeyer's ring and the neck

In a previous communication we reported our results for patients with localized extranodal presentations of non-Hodgkin's lymphomas of the head and neck who were admitted between 1961-1969. This review describes our larger experience from 1947-1982 in treating 137 Stages I and II Waldeyer's ring patients whose slides were available for reclassification according to the modified Rappaport System. All of these patients were treated definitively as follows: radiotherapy only, 113 patients; radiotherapy and combination chemotherapy, 17 patients; chemotherapy only, seven patients. The overall 5-year survival was 50%. Significant differences were determined for specific subgroups. For patients staged after lymphangiography, the 5-year survival was 67% as compared with 32% for non-lymphangiogram staged patients (p = 0.002). Stage (Ann Arbor) also influenced results. The 5-year survival figure for Stage I was 70% as compared with 42% for Stage II (p = 0.002). The combination of extent of disease in Waldeyer's ring and the status of the neck had a major impact on survival. When the disease was staged according to the TNMAJCC System, the 5-year survivals were: 75% for T1-T2-TX N0; 53% for T1-T2-TX N+; 54% for T3-T4 N0; and 36% for T3-T4 N+. Also, results for tonsil (52%) and base of tongue (66%) disease were better than for disease involving the nasopharynx (39%) or multiple sites (25%). Treatment also influenced survivals and disease-free survivals. The best results were obtained in patients who were treated with radiotherapy and combination chemotherapy. The 5-year survival and disease-free survival figures were 78% and 69%, respectively.     

The significance of reinduction chemotherapy with adriamycin for relapsed non-Hodgkin's lymphoma of Waldeyer's ring

Of those patients with localized (CS I-II) non-Hodgkin's lymphoma of Waldeyer's ring who were treated with radiotherapy or radiotherapy plus chemotherapy and who suffered relapses at the National Cancer Center Hospital over the past 22 years, 24 cases were analyzed on the basis of their response rate and duration of remission with reinduction chemotherapy, and survival time after recurrence. The group [ADM (+)], treated with regimens including adriamycin, was compared with the group [ADM (-)] treated with regimens excluding adriamycin. Complete response was seen in 9 out of 11 cases (81.8%) and in 8 out of 13 cases (61.5%) for the ADM (+) group and the ADM (-) group, respectively (p greater than 0.1). The period of complete response of the ADM (+) and ADM (-) groups was compared using the logrank method. The prognosis of the former was significantly (p less than 0.01) better than that of the latter and the median duration of remission was 30 months and 7 months, respectively. When the survival after recurrence of the ADM (+) and ADM (-) groups was compared, the median survival time was 38 months for the ADM (+) group and 12 months for the ADM (-) group, but no significant difference was observed between the two groups (0.05 less than p less than 0.1).     

Radiotherapy and chemotherapy in stages I and II non-Hodgkin's lymphomas of Waldeyer's ring

Sixty-four patients with stages I and II non-Hodgkin's lymphomas (NHL) involving Waldeyer's ring treated between 1970 and 1987 were reviewed. Patients with stage II NHL were subdivided into stage II 1 (limited type) and stage II2 (advanced type) from the state of neck nodes. Stage II1 was defined as involvement of unilateral cervical nodes less than 4 cm in diameter as well as Waldeyer's ring involvement. Other stage II cases were classified as stage II2. All 17 patients with stage I NHL were treated with radiation therapy alone. Their diseases were well controlled, and none of them died of causes related to the lymphoma. Among 14 patients with stage II1 NHL, the 5-year survival rate for the 9 patients treated with radiation therapy alone was 87.5%. Until 1982, 19 of 21 patients with stage II2 NHL treated with radiation therapy alone or radiation therapy and adjuvant chemotherapy (VEMP or COPP) died within 5 years mainly of disseminated diseases. Since 1983, CHOP has been used as the main treatment as well as radiotherapy for the 12 stage II2 NHL patients. So far, only 3 of them relapsed and 2 of them died of causes related to the lymphoma. Only 1 of these 12 patients was T-cell lymphoma compared to 7 of 9 stage II2 patients before 1982. This suggests that patients with stage I and those with limited stage II can be safely treated with radiotherapy. Also aggressive chemotherapy as well as radiotherapy should be used for patients with advanced stage II NHL involving Waldeyer's ring.     

Results of radiotherapy in control of stage I and II non-Hodgkin's lymphoma.

We retrospectively analyzed 114 patients with non-Hodgkin's lymphoma, clinical stages I and II, classified by the criteria of Rappaport and treated by radiotherapy alone. Of 84 patients classifiable, one-third were nodular and two-thirds diffuse lymphomas. Berkson-Gage actuarial and relapse-free survivals were determined for these two groups and for subgroups stratified by histology, stage, and by presence or absence of extranodal disease. Five year relapse-free and overall survivals were 83% and 100%, respectively, for the nodular group and 37% and 59% for the diffuse group. Extranodal involvement was less frequent in the nodular (19%) than in the diffuse (52%) group, where it was associated with Stage IE disease and increased relapse-free and actuarial survival. Histopathological subtype in the diffuse group (histiocytic versus combined lymphocytic poorly differentiated and mixed lymphocytic-histiocytic) did not influence survival. Extranodal involvement and stage I disease were associated with better survival in the diffuse histiocytic group. Successful radiotherapy for all stages of disease, all histologies, was not correlated with extended versus involved fields, and 89% of the relapses in the entire series were by wide dissemination.     

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.     

Role of radiation therapy in localized non-Hodgkin's lymphoma

Relapse occurs in 50% of patients receiving radiation for clinical stage (C.S.) I and II nodal and extranodal non-Hodgkin's lymphoma (N.H.L.). Prior to the introduction of intensive chemotherapy those failing primary control with irradiation and most of those who relapsed died of their disease with a resultant overall mortality of 50%. An analysis of Princess Margaret Hospital results with radiation for C.S. I and II N.H.L. between January 1967 and December 1978 revealed that tumour bulk, age, stage and histology were of independent prognostic significance. It was possible to group patients using combinations of these attributes so that each group encompassed only patients with similar outcomes. Such prognostic groups were identified separately within the low grade and the intermediate plus high grade categories of the Working Formulation. Patients with a high probability of cure with radiation were so defined. Also those patients in whom chemotherapy would be optimal initial therapy were also defined. Such patients were in the intermediate plus high grade histology groups. Thirty percent of all patients with low grade histology lymphoma had an actuarial survival of 83%, and relapse-free rate of 63% at 10 years. By implication, approximately 20% of all patients with these histologies seen at the Princess Margaret Hospital for the same time period achieved prolonged relapse-free survival by localized therapy. This is at variance with the implications of staging from studies where laparotomy and multiple bone marrow biopsies have been used. Such aggressive staging procedures suggest truly localised disease in only 5-6% of patients with low grade lymphoma. A significant relationship between radiation dose and disease control was demonstrated only for patients with intermediate and high grade lymphoma of medium or large bulk. A minimum tumour dose of 30 Gy was required for optimal local control with radiation.     

External beam radiation therapy in the treatment of patients with extranodal stage IA non-Hodgkin's lymphoma

The purpose of this report was to study the results of external beam radiotherapy for patients with extranodal stage IA non-Hodgkin's lymphoma (NHL). A retrospective review was carried out on 27 patients seen between 1984 and 1998 with stage IA NHL of extranodal sites, and followed up for a minimum of 1 year. Sites involved included eye/orbit (seven), parotid (five), breast (four), Waldeyer ring (four), thyroid (three), other head and neck (two), stomach (one), and prostate (one). All patients had biopsy-proven disease and underwent staging workup to rule out other sites of disease. Histologic analysis revealed 16 patients with low-grade NHL, 9 with intermediate-grade, and 2 with high-grade. Ten patients received chemotherapy before radiation therapy, and eight of them had a complete response. The remaining 17 patients were treated with external beam radiation therapy alone. Radiation was directed to the involved field at 1.8 Gy to 2.0 Gy per fraction to a median dose of 40 Gy (range: 20-50.4 Gy). The median patient age was 71 years (range: 39-85 years); 55% were female, and 45% were male. A complete response was attained in all 27 patients after radiation therapy. There were five failures (all in uninvolved distant sites), and two deaths during the follow-up. Median disease free survival (DFS) and overall survival (OS) have not been reached. The 5-year DFS and OS are 85% and 94%, respectively. Older age at presentation showed a trend toward worse outcome (p = 0.07), but because of the relatively few events, other factors (radiation dose, grade of disease, sex, or the use of chemotherapy) showed no statistical differences among the patients. External beam radiation therapy is a highly effective treatment for stage IA NHL found in extranodal sites.     

Results of radiation therapy of stage I and II nodal non-Hodgkin's lymphoma originated in the cervical lymph nodes--a study of the Japan Lymphoma Radiation Therapy Study Group

During the years 1972-81, 118 patients with stage I (78 cases) and II (40) nodal non-Hodgkin's lymphoma originated in the neck were treated with radiation. 5 year survival rates were 74% for stage I and 40% for stage II. Favorable histology group showed better prognosis than unfavorable one. Among stage I patients with unfavorable histology group, prognostic factors were studied and tumor size larger than 4 cm is found to be a sole prognostic factor.