A CONTROVERSIAL ISSUE - COULD A WATCH-AND-WAIT POLICY FOR PATIENTS WITH NON-HODGKINS-LYMPHOMA CLINICAL STAGE-I OR IE WITH NO LYMPHOMA LEFT FOLLOWING DIAGNOSTIC SURGERY BE JUSTIFIED - RESULTS OF A SINGLE-CENTERSTUDY

Background: A subset of patients with non-Hodgkin's lymphoma (NHL) wit h clinical stage I or IE at presentation is left without other NHL loc alizations following surgery performed for diagnostic histology, and t hus without any target lesion to judge the immediate effectiveness of immediately applied additional treatment modalities. Material and meth ods: Since 1988 we have adopted in this single centre, prospective non -randomized study, a watch-and-wait policy for such patients, who in a ddition had to have non-bulky disease, normal LDH levels, no 'B' sympt oms and no Burkitt, lymphoblastic and cutaneous T-cell histology. Up t o 1993 we have observed 50 consecutive cases. Patients were regularly followed with the endpoint to determine the relapse-free interval and overall survival. NHL relapses were treated, either with locoregional radiotherapy, or with chemotherapy, or both. Results: The median obser vation time is at the moment 53.5+ months (range 6-106+). The initial NHL localizations were: a solitary cervical or auxiliary lymph node in 18 patients, inguinal or scarpal lymph node in eight, tonsil in 12 an d skin/subcutis in 12 (B-cell NHL only for skin/subcutis). Nine patien ts had low, 15 intermediate, and 26 high-grade histology. Within the o bservation period NHL relapses occurred in 10/50 patients (20 per cent ). At the moment 46/50 patients (92 per cent) are alive and NHL free. The estimated 9-year freedom from relapse is 79 per cent and overall s urvival 92 per cent, and for 41 patients with intermediate/high-grade histologies 80 per cent and 95 per cent respectively. Conclusion: It s eems that a proportion of the very selected subgroup of patients with stage I of IE NHL and absolutely no NHL left following diagnostic surg ery, with additional criteria as described in this study can achieve a substantial freedom from relapse and overall survival rate without im mediate additional therapeutic procedures following diagnosis of NHL, but no prognostic factors predicting this outcome seem yet available. (C) 1997 John Wiley & Sons, Ltd.