Non-Hodgkin's lymphoma of the head and neck: A 30-year experience at the University of Florida

Background. Outcome in previously untreated patients with non-Hodgkin's lym phoma of the head and neck needed to be assessed. Methods. A retrospective review was performed of 79 patients with stage I o r II non-Hodgkin's lymphoma of the head and neck treated between 1964 and 1 994 with radiotherapy (RT) or combined modality therapy (CMT) at the Univer sity of Florida. Freedom from relapse, cause-specific survival, and absolut e survival were analyzed by the Kaplan-Meier method. Patterns of failure we re defined, and the relationship between dose and infield recurrence was st udied. Histology was classified as low grade or intermediate/high grade. Results. At 10 years, absolute survival for patients with low-grade lymphom a treated with RT was 45%; absolute survival for patients with intermediate /high-grade lymphoma was 41% for those treated with RT and 57% for those wh o received CMT. Twenty-seven patients had a recurrence of lymphoma after in itial treatment. Twenty patients (74%) had recurrences outside the radiatio n treatment field; 90% of these failures were in predictable sites that wou ld be included in comprehensive lymphatic irradiation fields (Waldeyer's ri ng, mantle, and whole abdomen). No clear dose response was observed. Multiv ariate analysis showed that patients with tumors < 5 cm in diameter had imp roved cause-specific survival, absolute survival, and freedom from relapse compared with patients with tumors greater than or equal to 5 cm in diamete r. Conclusions. Patients with non-Hodgkin's lymphoma in the head and neck with tumors greater than or equal to 5 cm in diameter appear to have a worse pr ognosis than those with smaller tumors. The patterns of failure suggest tha t initial treatment with comprehensive lymphatic irradiation fields could p otentially eliminate the majority of treatment failures. (C) 1999 John Wile y & Sons, Inc.