TREATMENT OF STAGE-IE PRIMARY LYMPHOMA OF BONE

Purpose: A retrospective analysis was performed to assess the efficacy of various treatments of Stage IE primary non-Hodgkins lymphoma of bo ne. Methods and Materials: Sixty-three patients with Stage IE primary non-Hodgkins lymphoma of bone (single osseous focus) were seen at our institution between the years 1970 and 1989. Information was obtained regarding each patients' presentation and clinical course. The histolo gy was reviewed in all patients. Modern immunohistochemical stains wer e performed on each case with available paraffin-embedded tissue. Resu lts: The histologic classification of the tumors was as follows: 43 di ffuse large cell, 13 diffuse mixed cell, 3 small noncleaved, and 4 unc lassified. The most common presenting symptom was pain (97%) and the f ollowing bony sites were involved: 36 long bone, 9 flat bone, 13 spine , and 5 pelvis. Of the 63 cases, 50 were treated with radiation alone, 10 with chemotherapy and radiation, 2 with chemotherapy alone, and 1 with surgery alone. Univariate analysis revealed a suggestion of an im proved 5-year disease-free survival for patients treated with chemothe rapy and radiation vs. radiation alone (90% vs. 57% respectively, p = .08). Multivariate analysis (controlling for extent of initial evaluat ion, extent of pathological evaluation and other potential prognostic factors) showed that neither treatment resulted in superior outcome wi th respect to disease-free survival, disease specific survival, or ove rall survival, however, doses of radiation greater than 4000 cGy resul ted in improved overall survival compared to lower doses (p = 0.01). C onclusion: This study supports the use of primary RT (> 4000 cGy) for Stage IE PLB, however, the addition of chemotherapy to the radiotherap eutic management may decrease the initial relapse rate of some patient s. Future studies should address this question.