Lymphoma of the nasal cavity and paranasal sinuses

Abstract

BACKGROUND Lymphoma of the nasal cavity and paranasal sinuses is a rare presentation of extranodal lymphoma with a natural history that is not well characterized in this era of combination chemotherapy. The goals of this retrospective study were 1) to define the natural history of sinonasal lymphomas; 2) to compare the results of radiation therapy (XRT) alone with those of combined modality therapy (CMT) in the treatment of patients with lymphoma of the nasal cavity and paranasal sinuses; and 3) to define prognostic factors for each treatment. METHODS Between 1947 and 1993, 70 patients with newly diagnosed lymphoma of the nasal cavity and paranasal sinuses were treated. The Ann Arbor stages were: Stage IE: 42 patients; Stage IIE: 14 patients; Stage IIIE: 2 patients; and Stage IV: 12 patients. The distribution of T classifications of the primary tumors was as follows: T1: 2 patients; T2: 16; T3: 18; and T4: 34. Greater than 90% of the patients had intermediate grade lymphoma (Working Formulation), and none had follicular lymphoma. Twenty‐eight patients received XRT alone, and 42 received CMT. RESULTS The actuarial 5‐year freedom from progression (FFP) and overall survival (OS) rates for the entire group were 57% and 52%, respectively. For patients with localized disease (Stages IE and IIE) receiving CMT, the actuarial 5‐year FFP and OS were 83% and 67%, respectively. In multivariate analysis, treatment with CMT (P = 0.0005) and stage (IE vs. IIIE‐IV) (P = 0.0001) were associated with improved FFP. In the group of patients receiving XRT, extent of disease (Stage IE, T1‐3 vs. Stage IE, T4 vs. Stage IIE‐IV) (P = 0.0001) was the only clinical characteristic associated with improved FFP in multivariate analysis. For patients receiving CMT, International Index (0 vs. 1‐3 vs. 4, 5) (P = 0.0001) was the only significant factor predictive of improved FFP in multivariate analysis. One patient failed in the central nervous system (CNS) after initial therapy as a result of a radiation therapy marginal miss. CONCLUSIONS In a Western population, patients with localized lymphoma of the nasal cavity and paranasal sinuses have a favorable prognosis when treated with CMT. FFP is significantly improved by treatment with CMT. For patients treated with XRT, extent of disease is the strongest predictor of outcome. International Index is the most significant prognostic factor for patients receiving CMT. Failure in the CNS is rare after initial therapy and is associated with local failure. Cancer 1997; 80:477‐88. © 1997 American Cancer Society.

Sinonasal Malignant Lymphomas: A Distinct Clinicopathological Category

“…In Asian countries, the nasal cavity is more commonly involved than the paranasal sinuses. 7 This site predilection is due to the prevalence of T-cell lymphomas, which are frequently located in the nasal cavity and the hard or soft palate. 6 · 13 · 14 In the majority of cases, multiple sinuses are initially affected.…”

Fasting blood glucose is a novel prognostic indicator for extranodal natural killer/T-cell lymphoma, nasal type

“…Therefore, analysis of prognostic factors at the time of diagnosis is important for optimisation of treatment strategies for individual patients. Several potential prognostic factors for survival in patients with ENKTL have been investigated, including regional lymph node involvement (You et al , 2004), elevated lactate dehydrogenase (LDH) (Lee et al , 2005), poor performance (Lee et al , 2005), paranasal extension (Logsdon et al , 1997; Li et al , 1998), presence of B symptoms (Kim et al , 2001), high Epstein–Barr virus (EBV) DNA titres (Au et al , 2004) and absolute lymphocyte counts (Huang et al , 2011). The International Prognostic Index (IPI) has prognostic value in many subtypes of non-Hodgkin's lymphoma, but its value in ENKTL remains controversial (Chim et al , 2004).…”

Incidental Finding of Lymphoma after Septoplasty

“…For patients with stage 1E disease (defined as involvement of one organ or extranodal area), there were reports that overall 5-year survival ranges from 67 to 75%. 20–22 Left undiscovered and untreated, the natural progression of B-cell lymphomas of the sinonasal tract is aggressive local extension, with the potential for multiorgan involvement. Based on the findings of the International Non-Hodgkin Lymphoma Prognostic Factors Project, the International Prognostic Index was developed for the prognostication of non-Hodgkin lymphoma, including diffuse large B-cell lymphoma.…”