Treatment of localized primary non-Hodgkin's lymphoma of bone in children:A Pediatric Oncology Group study

Purpose: The treatment of primary lymphoma of bone (PLB) in children has tr aditionally included radiotherapy to the primary site; more recently, it ha s in eluded systemic chemotherapy. Because of concern about the untoward ef fects of treatment in a disease that is curable, we attempted to determine whether radiotherapy can be safely excluded from treatment. Patients and Methods: The results of three consecutive Pediatric Oncology G roup (POG) studies were examined to determine the impact on outcome of radi otherapy as adjunctive treatment in children and adolescents receiving chem otherapy for early-stage primary lymphoma of bone, Results: From 1983 to 1997,31 patients with localized PLB were entered onto FOG studies of early-stage non-Hodgkin's lymphoma (NHL), Between 1983 and 1986, seven patients were treated with 8 months of chemotherapy with irradi ation (XRT) of the primary site, After 1986, patients were treated without XRT; four received 8 months of chemotherapy, and 20 received 9 weeks of che motherapy, Primary sites were the femur (nine), tibia (eight), mandible (fi ve), mastoid (one), maxilla (one), zygomatic arch (one), rib (one), clavicl e (one), scapula (one), ulna (one), talus (one), and calcaneous (one). Hist ologic classification revealed 21 cases of large-cell lymphoma, five cases of lymphoblastic lymphoma, two cases of small, noncleaved-cell lymphoma, an d three cases of NHL that could not be classified further. One patient rela psed at a distant site 22 months after completion of therapy. There have be en no deaths. Conclusion: Localized PLB is curable in most children and adolescents with a 9-week chemotherapy regimen of modest intensity, and radiotherapy is an u nnecessary adjunct, (C) 1999 by American Society of Clinical Oncology.