Management of head-and-neck lymphomas: from the standpoint of radiotherapy

Abstract In order to clarify clinical features, treatment results, prognostic factors, and role of radiotherapy for clinical stages I and II lymphomas of the head and neck, we analyzed 218 patients treated between 1983 and 1997 at our two hospitals. All patients were treated with radiotherapy, whereas 159 patients were also treated with combination chemotherapy regimens, most of which included anthracycline derivatives (e.g. CHOP). Seventeen patients with follicular medium- or mixed-cell lymphoma had a trend towards better survival than 201 patients with any diffuse or follicular large-cell histology (5-year survival rate: 93% vs. 66%, p =0.062). In the latter patients, T-cell phenotype, tumor size ≥6 cm, elevated lactate dehydrogenase (LDH), and worse performance status (PS) were associated with poorer survival. B-ALPS, which is similar to the international prognostic index but includes tumor bulk instead of the number of extranodal involvement, was thought to be a useful prognostic index. Forty-nine patients treated with radiotherapy alone and 152 patients treated with both radiotherapy and chemotherapy had similar survival rates (65% vs. 67% at 5 years). A proportion of patients with clinical stage I or II head-and-neck lymphoma may be successfully treated with radiotherapy alone, if they are carefully selected and are treated by expert radiation oncologists.