The need of adequate staging and aggressive therapy in non-Hodgkin's lymphomas

This study included 66 new non-Hodgkin's lymphomas with at least five years' follow-up time. The mean age of the patients at diagnosis was 54 years, 48% were female and 38% had B-symptoms. The five year survival was 45%. In stage I the five year survival was 100% (16/16) whereas in stage IV it was only 12% (3/26). Stages II and III had the five years survival of 20% (2/10) and 57% (8/14), respectively. The survival at two years was 10 to 20% better in stages II to IV than at five years. The histopathological subtypes were originally determined by our pathologists according to the Rappaport or Kiel classification. Because of the inhomogenity of classification and the small number of patients in each subgroup, the histological classification was not included in this report. In addition to stage, age and occurrence of B-symptoms the site of primary diagnosis considerably affected the survival: if the lymphoma was diagnosed from the head and neck region the patient belonged more often to the lower stages and had a better prognosis. If the lymphoma was primarily diagnosed from the bone marrow aspiration, the five year survival was nil. The relapses after a complete remission were most frequent in stage II and appeared usually within three years from the treatment with most of the recurrences appearing outside the radiation fields. Radiotherapy alone in the form of mantle or inverted Y fields appeared to be insufficient for the treatment of stage II disease while the more aggressive therapy with cyclophosphamide, vincristine and prednisone combined with local or extended radiotherapy in stages III and IV was satisfactorily tolerated and gave reasonably good results at least in stage III. Among the staging examinations bone marrow biopsy, spleen scan and lymphoscintigraphy had a clear negative correlation to the prognosis. (orig.)