Osteolymphoma (primary bone lymphoma): an Australian review of 70 cases

Background: To examine prognostic factors, treatment outcomes and design fu ture studies for Osteolymphoma (OL) - also known as primary bone lymphoma. Methods: Between 1979 and 1993, 70 patients with OL were treated in nine Au stralian centres. The effect of patient-, tumour-, and treatment-related fa ctors on local control, distant disease-free survival and overall survival were assessed by multivariate analysis. Results: Most patients (94%) received radiotherapy (RT) (median dose 40 Gy) and 56% received chemotherapy. Multifocal disease was present in 20% of pa tients. The five year rates of overall survival and local control were 59% and 82%. Although there was a trend towards better results with the additio n of chemotherapy, on multivariate analysis, there were no factors identifi ed which appeared to impact upon overall and disease-free survival. Among t he distant recurrences, there was a high proportion in bone (33%). Six pati ents suffered pathological fractures after treatment. Conclusion: High rates of local control were achieved by RT, but the overal l survival remains relatively poor, worse than nodal lymphoma. The natural history of the disease suggests that OL may be a distinct entity, different to nodal lymphomas, so the results of clinical trials in nodal lymphoma ma y not be relevant to OL. Prospective studies could define the outcome of co mbined modality therapy and set a benchmark for testing further proposals, as well as improving our knowledge of the clinical features of OL.