Radiation therapy of Waldeyer's ring lymphoma

Abstract

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.

Prognostic Factors and Treatment Outcome in Non-Hodgkin's Lymphoma of Waldeyer's Ring

“…When our stage 1-11 patients were further classified according to status of cervical lymph node involvement, patients with unilateral large nodes or bilateral nodes showed significantly poorer prognosis than patients with unilateral small nodes or without any nodes. Similar significance has also been reported (5,7,8). The number, locations, and sizes of the cervical nodes are regarded as good criteria for establishing the degree of malignancy as well as the treatment policy of these tumors.…”

“…Non -Hodgkin 's Iympliornu of' Wuldeyer 's ring 4 19 ported to be over 85% each; but those of lymphomas with intermediate-or high-grade histology were around 40?h and 50%, respectively (I, [8][9][10]. In our series, the 5 year DFS and 0s of stage 1-11 diseases treated with radiotherapy alone, all of which had an intermediate-or high-grade histology, were 49% and 60')/0, respectively.…”

“…It is generally accepted that the frequency of follicular lymphomas in Asia appears to be relatively low compared with that in western countries. The histologic grade is reported to be one of the most useful prognostic factors for WR lymphomas (2,3,8). Although our multivariate analysis failed to demonstrate histologic grade as an independent prognostic factor because of a limited number of cases with low-grade histology, univariate analysis showed that high-grade histology was associated with unfavorable outcome.…”

“…Histologically, diffuse large lymphomas (1 -5) with B-cell phenotype (4,6) are common. Several investigators have reported that the prognosis of WR lymphomas is associated with Ann Arbor stage (1-3, 5, 7), tumor bulk (3), presence or absence of systemic symptoms (3), status of cervical lymph node involvement (5,7,8), or histology (2,3,8). However, the prognostic value of some factors is a matter of controversy and multivariate analysis was not available in those reports.…”

“…Most lymphomas with low-grade histology have been cured by radiotherapy alone; however, relapse occurred frequently in lymphomas with intermediate or high-grade histology (1,(8)(9)(10). Radiotherapy with systemic chemotherapy in the treatment of localized W R lymphomas with intermediate-or high-grade histology has become common (5, 9, 1 l), but there is still some disagreement about the treatment modality.…”