Primary non-Hodgkin's lymphoma of the nasopharynx: Prognostic factors and outcome of 113 Indian patients

Abstract

This single institutional study evaluated the prognostic factors and treatment outcome of 113 Indian patients with primary nasopharyngeal non-Hodgkin's lymphoma. At presentation, 28% had stage I and 62% had stage II disease. Treatment comprised of a combination of chemotherapy (CTh) and radiotherapy (RT) in the majority of the patients (76%). After a median follow-up of 56 months, the 5-year disease-free survival (DFS) and overall survival (OS) for the whole group were 55.8% and 57.9%, respectively. Multivariate analysis showed that; age > 30 years [hazard ratio (HR) = 6.59, 95% confidence interval (CI) = 2.59 - 16.7, P < 0.0001], WHO performance score > or = 2 (HR = 2.34, 95% CI = 1.01 - 5.46, P = 0.050), T-cell lymphomas (HR = 2.81, 95% CI = 1.14 - 6.96, P < 0.001) and the presence of B symptoms (HR = 3.65, 95% CI = 1.77 - 7.53, P = 0.025), had a negative influence on survival. Patients treated with a combination of CTh and RT had a significantly better outcome than those treated with CTh alone (OS: 69%vs. 31%, P < 0.00001). HR for death in the CTh alone group was 3.73 (95% CI = 1.95 - 7.13). The CR (P = 0.01), DFS (P = 0.01) and OS (P = 0.03) rates were significantly better for patients receiving a RT dose of > or =4500 cGy. HR in the subgroup that received a RT dose of <4500 cGy was 2.51 (95% CI = 1.04 - 6.06). These results suggest that combined modality treatment, comprising of CTh and RT (with an RT dose of > or =4500 cGy), results in satisfactory outcome in patients with this rare neoplasm.

Primary diffuse large B‐cell lymphoma of the tonsil

“…Furthermore, in a previously reported series on NHL of the nasopharynx from our institute, we found a significant improvement in the CR (72% vs 21%, P 5 .00001), DFS (68% vs 23.3%, P 5 .00001), and OS (68.3% vs 31%, P 5 .00001) rates using an RT dose of 45 Gy. 24 Similarly, in this study we observed that the escalation of RT doses to 45 Gy and above may result in an improved locoregional control and OS for patients with DLBCL of the tonsil.…”

“…Although there has been no report to date on the most appropriate RT dose for primary NHL of the tonsil, there are a few studies that have suggested a benefit with the use of higher RT doses in patients with nasal and nasopharyngeal NHL. [22][23][24] Isobe et al 23 reported a local failure rate of 67% for patients with nasal-type NK/T-cell lymphoma treated with an RT dose of less than 50 Gy as compared with 27% (P 5 .038) for 50 Gy or more. In another study, Koom et al 22 used a median dose of 45 Gy and reported a local failure rate of 64% for an RT dose less than 45 Gy vs 38% (P 5 .02) for 45 Gy or higher.…”

B Lymphoblastic Lymphoma Presenting as a Tumor of the Nasopharynx in an Adult Patient

“…Nodal NHL is the most common, followed by extranodal lymphatic (Waldeyer's lymphatic ring) and extranodal extralymphatic sites (orbit, sinus, nose, mandible, deep facial spaces, parotid gland, and dermis) [12]. In the case reported here, the patient's MRI scan pointed to a primary lesion originary of the extranodal lymphatic Waldeyer ring (nasopharynx) with multivectorial spread to other extranodal extralymphatic Primary nasopharyngeal NHL is infrequent in adults, representing a small fraction (10-28%) of Waldeyer's ring lymphomas [4], with a higher incidence in males in the sixth decade of life [13]. According to the literature the largest proportion of Waldeyer's lymphoma are of B cell origin with diffuse large B cell lymphoma being the commonest histological variant [14,15] while T cell-type lymphoma is more common in the nasopharynx and nasal cavity [16,17].…”

“…According to the literature the largest proportion of Waldeyer's lymphoma are of B cell origin with diffuse large B cell lymphoma being the commonest histological variant [14,15] while T cell-type lymphoma is more common in the nasopharynx and nasal cavity [16,17]. Nasopharyngeal NHLs like other Waldeyer's ring lymphomas tend to be a localized disease, the majority (60-90%) of patients presenting an intermediate to high grade disease in an early stage (stages I and II) [4,13]. Contrary to the common findings, our patient had a primary nasopharyngeal NHL of precursor B cell origin (B-LBL) and not mature B cell as in B diffuse large B cell lymphoma, without nodal involvement, locoregionally aggressive with stage IV disease (bone marrow involvement, although minimal).…”

“…After the gastrointestinal tract, extranodal NHL arising in the head the neck (the Waldeyer's ring tonsils being the commonest affected site) follows, accounting for 10% of all NHL and 1% of head and neck tumours [3]. Primary NHL of the nasopharynx corresponds to a small proportion of Waldeyer's lymphomas [4] with an aggressive clinical course and poor outcome even in the early stages [4,5].…”