TREATMENT OF LOCALIZED NON-HODGKINS-LYMPHOMAS OF THE NEED AND NECK

Background. Localized non-Hodgkin's lymphomas of the head and neck are generally treated with radiotherapy with or without chemotherapy, alt hough the results of treatment of localized non-Hodgkin's lymphomas wi th chemotherapy alone appear to be favorable. It is unclear if and whe n combined modality therapy should be used. Methods. The authors revie wed the records of 53 patients with Stage I or II non-Hodgkin's lympho ma of the head and neck, who were treated with radiotherapy alone (13 patients), chemotherapy according to the cyclophosphamide, doxorubicin , vincristine, prednisone- (CHOP) regimen (27 patients), or a combinat ion of both treatments (13 patients). Results. A complete remission wa s achieved in 43 (81%) patients. The 5-year survival for all patients was 78%. A significant difference (P = 0.03) in 5-year relapse-free su rvival was observed between Stages I and II disease, of 92 and 60%, re spectively. Extensive tumor was a significantly poor prognostic factor (P = 0.04) with a 5-year relapse-free survival of 52 versus 84% for p atients with nonextensive lymphoma. Eight relapses occurred; in five p atients, a local relapse was the first presentation. Although salvage radiotherapy was successful in these five patients, a distant relapse developed in three. No relapses were observed in previously irradiated areas. Conclusions. Our results suggest that radiotherapy alone is th e appropriate treatment for nonextensive Stage I intermediate grade no n-Hodgkin's lymphoma of the head and neck. For extensive Stage I or II non-Hodgkin's lymphomas, chemotherapy is preferable. The value of com bined modality therapy remains unclear.