Treatment of localized non-Hodgkin's lymphomas of the head and neck

Abstract

Background. Localized non‐Hodgkin's lymphomas of the head and neck are generally treated with radiotherapy with or without chemotherapy, although the results of treatment of localized non‐Hodgkin's lymphomas with chemotherapy alone appear to be favorable. It is unclear if and when combined modality therapy should be used. Methods. The authors reviewed the records of 53 patients with Stage I or II non‐Hodgkin's lymphoma of the head and neck, who were treated with radiotherapy alone (13 patients), chemotherapy according to the cyclophosphamide, doxorubicin, vincristine, prednisone‐ (CHOP) regimen (27 patients), or a combination of both treatments (13 patients). Results. A complete remission was achieved in 43 (81%) patients. The 5‐year survival for all patients was 78%. A significant difference (P = 0.03) in 5‐year relapsefree survival was observed between Stages I and II disease, of 92 and 60%, respectively. Extensive tumor was a significantly poor prognostic factor (P = 0.04) with a 5‐year relapse‐free survival of 52 versus 84% for patients with nonextensive lymphoma. Eight relapses occurred; in five patients, a local relapse was the first presentation. Although salvage radiotherapy was successful in these five patients, a distant relapse developed in three. No relapses were observed in previously irradiated areas. Conclusions. Our results suggest that radiotherapy alone is the appropriate treatment for nonextensive Stage I intermediate grade non‐Hodgkin's lymphoma of the head and neck. For extensive Stage I or II non‐Hodgkin's lymphomas, chemotherapy is preferable. The value of combined modality therapy remains unclear. Cancer 1994; 74: 703‐707.

A third generation regimen VACOP-B with or without adjuvant radiotherapy for aggressive localized non-Hodgkin's lymphoma: report from the Italian Non-Hodgkin's Lymphoma Co-operative Study Group

“…In the 1960's and 70's radiotherapy was widely used for the treatment of localized non-Hodgkin's lymphoma (NHL) but results were unsatisfactory due to the high incidence of relapse and progression (1)(2)(3)(4)(5). Patients with localized, aggressive, non-bulky stage I and II NHL can be cured using first generation regimens containing doxorubicin, alone or in combination with involved field radiotherapy (6)(7)(8).…”

“…Combining or alternating chemotherapy and radiotherapy presents significantly superior results to those obtained with radiotherapy alone (2)(3)(4)(5)(7)(8)(9)(10) and represents the most common treatment method for these patients. Radiotherapy alone yielded 5-year survival rates ranging from 56 to 100% for patients with stage I disease and from 0 to 55% for patients in stage II (1)(2)(3)(4)(5). Studies using chemotherapy with and without radiotherapy reported 5-year survival rates ranging from about 70% to about 80%, with no statistically significant difference between stage I and stage II disease (7)(8)(9)(10).…”

Malignant lymphoma of the oral cavity and the maxillofacial region: Overall survival prognostic factors

“…Based on a review of 53 patients with NHL of the head and neck, Ruijs et al (29), suggested that radiotherapy alone is the adequate treatment for localized lymphoma while chemotherapy is preferable for patients with disseminated lymphoma. According to Mok et al (22) the chemotherapy treatment regime does not affect the OS of subjects with a p = 0.715 and a p = 0.41 respectively.…”

Radiation therapy in primary orbital lymphoma: a single institution retrospective analysis

“…The most frequent histology of POL is indolent NHL such as extranodal marginal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) [5-8]. Usually therapeutic management of POL consists of radiation treatment [6,8-25] encompassing the entire orbit [26]. At present it is known that radiotherapy, using low or moderate doses in the range of 25-36 Gy, can obtain 95-100% of local control.…”