Management of localized (stage I and II) clinically aggressive lymphomas

The treatment for non-Hodgkin's lymphomas is chiefly dependent on the histo logic type and the anatomic extent of the disease, reflected by the stage. In the past 30 years, the treatment of localized large cell lymphomas has e volved from the use of radiotherapy (RT) alone to the routine use of combin ed modality therapy (CMT). Randomized controlled trials have shown superior ity of the CMT approach as compared to RT alone, or chemotherapy alone. The data will be critically appraised in this review. Currently, approximately two-thirds of patients with stage I and II clinically-aggressive lymphomas will be cured with initial planned combined modality therapy. The clinical prognostic factors predicting refractory or relapse disease are now clearl y recognized, and they are: older age, stage II disease, high lactate dehyd rogenase (LDH), poor performance status, and bulky disease. Patients with p oor-risk features are candidates for clinical trials to examine the potenti al benefits of initial treatment intensification programs. Elderly patients over the age of 60 years account for about half of the patients with lymph oma, and they may tolerate therapy less well. They are a special subgroup w here prospective studies are required to determine the optimal management.