Angiocentric lymphoma of the head and neck: Patterns of systemic failure after radiation treatment

Purpose: To investigate the patterns of systemic failure and the clinical o utcome in patients with angiocentric lymphoma of the head and neck who were treated with radiation alone, and to discuss the optimal mode of treatment for these patients. Patients and Methods: We reviewed the records of 92 patients with stage I o r II angiocentric lymphoma who were treated at Yonsei Cancer Center between 1976 and 1994. All patients were treated with involved-field irradiation. Radiation doses ranged from 40 to 60 Gy (median dose, 50.4 Gy). treatment r esponse, patterns of treatment failure including systemic failure, and clin ical outcome after radiation treatment were analyzed. Results: The most frequently involved site was the nasal cavity, either alo ne or in conjunction with other sites. In 16 patients (17.4%), angiocentric lymphoma was accompanied by cervical lymphadenopathy. Disease was classifi ed as stage I in 62 patients (67.4%) and stage II in 30 patients (32.6%). A fter completion of radiation treatment, 61 patients (66.3%) achieved a comp lete response and 16(17.4%) a partial response. Half of the patients (50.0% ) ultimately experienced local recurrence with or without other components of failure, whereas regional failure wets relatively uncommon (10.9%). Syst emic failure occurred in 25.0% of patients during follow-up. Six patients h ad histologic findings identical to those at the time of the original disea se (group I), whereas four patients exhibited morphologic features of frank lymphomas (group II). The majority of patients with systemic relapse had t he predilection sites for widespread extranodal involvement, such as the sk in, brain, lung, gastrointestinal tract, or testes. In addition, seven pati ents died from various medical illnesses or immunologic disorders, includin g hemophagocytic syndrome and second primary cancers (group III). After a m edian follow-up of 56 months, the overall survival and disease-free surviva l rates for all patients were 40.1% and 37.8%, respectively. All patients e xcept one with systemic failure died within 1 year. Conclusion: Treatment with radiation alone had suboptimal results, partly b ecause of the occurrence of a variety of systemic failure with diverse clin icopathologic features. Given the frequent occurrence of systemic failure a fter radiation treatment, we believe that the multimodality treatment appro ach containing more effective chemotherapeutic agents should be incorporate d in the treatment of angiocentric lymphoma confined to the head and neck. (C) 2000 by American Society of Clinical Oncology.