LOCALIZED PRIMARY NON-HODGKIN-LYMPHOMA OF THE BREAST

A single institution's experience with the treatment of localized prim ary lymphoma of the breast (PLB) was analyzed to understand the natura l history of this disease and to identify major prognostic factors and optimal treatment. A retrospective analysis of 23 previously untreate d patients who met the strict criteria of PLB from 1972 through 1994 w as undertaken. All pathologic materials were reviewed and classified b y the Working Formulation. The Ann Arbor stages (AASs) were: IE, 17 pa tients; IIE, five patients; TV, one patients (bilateral breast involve ment without distant metastasis). Pathologic findings were: low grade, two patients; intermediate grade, 18 patients (17 with diffuse large- cell lymphoma (DLCL)); high grade, two patients; and unclassifiable, o ne patient. The treatments after biopsy or mastectomy were: radiation alone, two patients; chemotherapy alone, six patients; and combined-mo dality therapy, 13 patients. Two patients had mastectomy alone. Overal l survival (OS) and relapse-free survival (RFS) were calculated actuar ially. Univariate analyses were performed with patient age, treatment modality, AAS, size of the primary tumor (T stage), and International Prognostic Index (IPI) for the 17 patients with DLCL to define prognos tic factors. The median follow-up for the surviving patients was 78 mo nths (range, 45-220 months). The 5-year OS and RFS were 74% and 73%, r espectively for all 23 patients, and 65% and 70%, respectively, for th e 17 patients with DLCL. Statistically significant factors for OS for DLCL were AAS and IPI. Statistically significant factors for RFS were AAS and T stage. With modern staging evaluation and multiagent combina tion chemotherapy, localized primary non-Hodgkin lymphoma of the breas t, especially diffuse large-cell type, has a prognosis as favorable as that of other DLCL. Ann Arbor stage was a significant factor for both OS and RFS.