The contribution of radiation therapy in the control of early non-Hodgkin's lymphomas

This is a retrospective analysis of 256 patients with histologically proven non-Hodgkin's lymphomas (NHL) of clinical stage I or II, who were treated with radiation alone (n=113) or in combination with chemotherapy (n=143). Among the 256 patients, 64 had Waldeyer's ring lesions with or without cervical lymphadenopathy (Group A), consisting of 17 stage I and 47 stage II patients. The other 192 patients had cervical lesions with or without lymphadenopathy above the diaphragm (Group B). In Group A, all of the 17 stage I patients and 9 patients of limited stage II, in which hemilateral cervical lymphadenopathy was less than 4 cm in diameter, were treated with radiation alone. Five-year survival rates were 100% and 88% for the two radiation-treated groups, respectively, as compared with 60% for the group of the other 5 limited stage II patients treated with combined radiation and chemotherapy. For advanced stage II patients in Group A, 5-year survival rate was dramatically increased after the era of CHOP therapy, consisting of adriamycin, cyclophosphamide, vincristine and prednisolone, followed by radiation therapy (83%), as compared with that before the era (9.5%). In 129 stage I patients in Group B, prognosis was dependent on histology and tumor size, regardless of the combination of chemotherapy: 10-year survival rate was 86% for favorable histology and 88% for tumors less than 4 cm in diameter. Among the 63 stage II patients, 57 patients with unfavorable histology, except for 6 with favorable histology, had poor prognosis (5-year survival rate of 30%). These results indicate that a solitary use of radiation may contribute to NHL control in carefully selected cases, as shown in stage I and limited stage II patients in Group A. (N.K.)