TREATMENT OF NON-HODGKINS-LYMPHOMA OF WALDEYERS RING - RADIOTHERAPY VERSUS CHEMOTHERAPY VERSUS COMBINED THERAPY

Treatment of stage IA non-Hodgkin's lymphoma (NHL) of Waldeyer's ring remains controversial, probably because of the small number of patient s and the scarcity of controlled studies. Between 1981 and 1991, 316 p atients with stage I NHL of Waldeyer's ring were randomised for treatm ent with radiotherapy alone (extended fields), 101 patients; combined chemotherapy with a regimen of CHOP (cyclophosphamide, vincristine, do xorubicin, and prednisone) or CHOP-like (epirubicin instead of doxorub icin), 106 patients; and combined therapy (radiotherapy followed by th e same combination chemotherapy), 109 patients. Median follow-up was 6 .8 years. Complete response was achieved in 93, 87 and 97%, respective ly. Relapses were least frequent in patients treated with combination therapy. The 5-year rate for failure-free survival was 48% for radiati on therapy, 45% for the patients who were treated with chemotherapy, w hich was statistically significantly less than the 83% for patients tr eated with combined therapy (P<0.001). Overall survival was also bette r in the combined therapy arm: 90%, statistically different to 58% for the patients treated with chemotherapy alone and 56% for patients tre ated with radiation therapy (P<0.001). Toxicity was mild and late side -effects were not observed in any patients. From these results combine d therapy should be considered as the best therapeutic approach in pat ients with localised NHL of Waldeyer's ring.