Analysis of Local Control in Patients with Non-Hodgkin’s Lymphoma According to the WHO Classification

Abstract

Purpose:To analyze the influence of radiotherapy doses, chemotherapy doses, and clinical parameters on in-field disease control to assess the optimal radiation doses for treatment of non-Hodgkin's lymphoma according to the newly proposed WHO classification. Patients and Methods: Subjects consisted of 35 extranodal marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) type, 75 diffuse large B-cell lymphomas (DLBCL), 14 follicular lymphomas, 17 extranodal natural killer (NK)/T-cell lymphomas, nasal type, eight unclassified peripheral T-cell lymphomas, four anaplastic large-cell lymphomas, T/null cell type, and five others. 59 patients received radiotherapy alone. 98 patients received CHOP, modified CHOP, or more intensive chemotherapy, and six patients were treated with other combination. Results: No patients with MALT lymphoma had in-field local recurrence. There were no recurrences in DLBCL patients who received chemotherapy in which the doses of adriamycin were > 200 mg/m 2 , nor in DLBCL patients who were treated with > 45 Gy. Only nine of 15 patients with T-cell lymphoma treated with ≤ 50 Gy and three of five patients treated with > 50 Gy had local control. The dose of adriamycin had no influence on local control of T-cell lymphoma. Conclusion: T/NK-cell lymphomas were more radioresistant than B-cell lymphomas. The prognosis for peripheral T/NK-cell lymphomas is poor even when treated by irradiation combined with chemotherapy. Analyse der lokalen Kontrolle beim Non-Hodgkin-Lymphom gemäß WHO-KlassifikationZiel: Untersuchung des Einflusses der Strahlungsdosis, Chemotherapie-Intensität und klinischer Parameter auf die Kontrolle lokalisierter Herde, um optimale Parameter für die Behandlung des Non-Hodgkin-Lymphoms gemäß der vor kurzem vorgeschlagenen WHO-Klassifikation zu ermitteln. Patienten und Methodik: In die Untersuchung einbezogen wurden 35 extranodale ("marginal-zone") B-Zell-Lymphome des Mukosa-assoziierten-Lymphom-(MALT-)Typs, 75 diffuse großzellige B-Zell-Lymphome (DLBCL), 14 follikuläre Lymphome, 17 extranodale Natürliche-Killer-(NK-)/T-Zell-Lymphome (Nasaltyp), 8 unklassifizierte periphere T-Zell-Lymphome, 4 anaplastische (großzellige) Lymphome (T/null-Zell-Typ) and 5 andere. 59 Patienten erhielten ausschließlich Strahlentherapie. 98 Patienten erhielten CHOP, CHOP modifiziert oder eine intensivierte Chemotherapie, und 6 Patienten wurden mit einer anderen Kombination behandelt. Ergebnisse: Bei keinem der MALT-Lymphom-Patienten kam es zu einem Lokalrezidiv. Rezidive traten weder bei DLBCL-Patienten auf, die Chemotherapie mit Adriamycin in Dosierungen > 200 mg/m 2 erhalten hatten, noch bei DLBCL-Patienten, die mit > 45 Gy behandelt worden waren. Nur bei 9 von 15 T-Zell-Lymphom-Patienten, die mit ≤ 50 Gy, und bei 3 von 5 Patienten die mit > 50 Gy behandelt worden waren, wurde eine lokale Kontrolle erreicht. Die Adriamycin-Dosis beeinflusste die lokale Kontrolle von T-ZellLymphomen nicht. Schlussfolgerungen: T/NK-Zell-Lymphome zeigten sich strahlungsresistenter als B-Zell-Lymphome. Die ...

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