Prognostic factors of stage I or II non-Hodgkin's lymphomas of the head and neck

Between January 1980 and December 1994, 107 cases with stages I or II NHL involving the head and neck region were treated at Sapporo Medical University Hospital. We used involved field radiation therapy for orbital, nasal or paranasal lymphoma and extended field radiation therapy for Waldeyer's ring or neck nodal lymphoma and the radiation doses were from 39 to 48 Gy. From 1980 to 1986, radiation therapy alone was the primary treatment. Since 1987, a chemoradiotherapy has been the standard treatment. Of the 107 patients, 95 achieved CR. Of the 12 patients that did not achieve CR, 9 patients had nasal T-cell lymphomas of the lethal midline granuloma type (LMG-NTL). Only one of 95 patients who obtained CR relapsed in the previously irradiated area and he had LMG-NTL. The prognosis of LMG-NTL was especially poor and 5-year disease-specific survival rate was 22%. In contrast, disease-specific 5-year survival rate for patients with NHL of nasal sinus of non-LMG-NTL type and paranasal sinuses was 69%. Result of patients with nasal or paranasal lymphoma was still significantly worse than that of patients with the other origins in our series when LMG-NTL was excluded from analysis. When LMG-NTL was excluded from analysis, age was the only significant prognostic factor for the disease-specific survival in multivariate analysis. Chemotherapy which included adriamycin was the significant prognostic factor only for patients under 60 years, but not for patients of 60 years or older. The existence of bulky mass and stage was the significant prognostic factor only for patients of 60 years or older, but not for patients under 60 years. Radiotherapy was excellent for obtaining local control. When patients were 60 years or older, adriamycin-based chemotherapy was not so effective in improving the disease-specific 5 year survival rates as it was with younger patients. (K.H.)