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Combined modality treatment for primary lymphoma of bone: a report of the mgh experience
Radiation Oncology, Biology, Physics
238
October 1990, Volume 19, Supplement 1
1027 A RADIOTHERAPEUTIC histological grade
EXPERIENCE FOR NON-HODGKIN'S LYMPHOMA: and the role of combined chemotherapy
the prognostic
Kazushige
MD, Yuta
MD,
Tsutsui,
Department of Radiology Kyoto 606, Japan.
Shibamoto,
and *Laboratory
MD,*Hirohiko of Anatomic
Yamabe,
Pathology,
Mitsuyuki Kyoto
importance
Abe,
University
of
MD Hospital,
During the past decade there has been considerable progress in developing effective chemotherapy (CT) for non-Hodgkin's lymphoma (NHL), and the combination of radiotherapy (RT) and CT has become popular. But the role of combined CT in the treatment of localized NHL has not been clearly assessed.In this retrospective study, we investigated the effect of CT on prognosis of patients with localized NHL. 212 patients treated with RT for localized NHL between 1966 and 1988, 89 received Among majority adjuvant CT.The were treated with 60 Co gamma-radiation or 10 MV X-ray. The average of total dose was 39.8 Gy for low grade histologies,48.7 Gy for others. The main regimen of CT for intermediate and high grade lymphomas was VEPA (vincristine, cyclophosphamide, doxorubicin, prednisolone). Histologically 35 tumors were of low grade,156 of intermediate grade and 10 of high grade according to the Working Formulation studies were performed, and 162 tumors were B-cell (WF). In 187 cases,immunohistochemical lymhpomas. The majority of lymphomas in Waldeyer's ring(WAR), central nervous system(CNS), paranasal sinus, nasal cavity, and testis consisted of intermediate or high grade lesions. T-cell lymphomas (10 tumors) were found mainly in the nasal cavity, nasopharynx, and lymphnode. All of low grade histology were B-cell lymphomas. The overall actuarial and disease-free 10 year survival rates were 49.1 % and 43.3 % respectively. The 5-year survival rates were: nodal-56.3 %, WAR-46.6 %, CNS-22.9 %, orbit-69.0 %, paranasal sinus-85.7 %, thyroid-83.3 %, oral cavity-88.9 %, testis-44.4 8, cavity-20.8 %. The 5-year survival rates according to nasal the histopathological classification were 83.7 % for low grade NHL, 51.1 8 for intermediate, 28.7 8 for high grade, 55.7 8 for B-cell NHL, 35.0 % for T-cell. The impact of various factors on the duration of disease-free survival was assessed using the generalized Wilcoxon test and Cox proportional hazards model. In a group of patients treated with RT alone, histological grade of WF, tumor bulk, and radiation dose (30-39 Gy / 40Gy-), had much prognostic importance. While tumor bulk was the most important prognostic factor, followed by T/B phenotype in RT+CT. CT improved significantly the survival rate only for NHL with intermediate and high grades, B-cell NHL, and NHL without bulky mass. T/B phenotype was an important factor even in NHL except low grade histology. Our data suggest l)Combined CT is unnecessary for localized NHL of low grade histology, more intensive chemotherapy is necessary for NHL except B-cell NHL or while with bulky 2)The important prognostic factors mass. are tumor bulk and T/B phenotype in combined the WF and the total dose of RT modalities. Histological grade of have not so much prognostic importance as in the treatment by RT alone.
1028 COMBINED MODALITY TREATMENT EXPERIENCE Mark Sobczak,MD*, David Herman Suit, MD PhD*.
FOR PRIMARY LYMPHOMA
Harmon,MD#,
Massachusetts General Hospital #Dept of Medical Oncology
*Dept
Lawrence
of Radiation
OF BONE: A REPORT OF THE MGH
Zuckerberg,MD*,
Medicine
“Dept
Nancy
Harris,MD*,
of Pathology
$Dept
Henry
Mankin,MD$,
of Orthopedics
Primary Lymphoma of Bone (PLB) is an unusual form of non-Hodgkin’s lymphoma (NHL). The records of 33 cases of biopsy proven PLB which were diagnosed at the Massachusetts General Hospital between 1973 and 1987 were reviewed. Twenty-one (21) patients with stage Ie disease were treated with combined modality therapy receiving multidrug chemotherapy and local radiation therapy. All patients were extensively staged using modern imaging techniques prior to treatment. The actuarial probability of disease free and overall survival at five years were 79 and 82% respectfully. There were no local failures or secondary neoplasms noted within the irradiated tissues. This group is compared with prior same institution studies in which radiation therapy was employed as a single modality treatment. Marked improvements in both local and distant disease control with resultant gains in disease free and overall survival clearly demonstrates the superiority of combined modality therapy in the treatment of this disease. An analysis and review of both the chemotherapy and radiation complications is also included.
238
October 1990, Volume 19, Supplement 1
1027 A RADIOTHERAPEUTIC histological grade
EXPERIENCE FOR NON-HODGKIN'S LYMPHOMA: and the role of combined chemotherapy
the prognostic
Kazushige
MD, Yuta
MD,
Tsutsui,
Department of Radiology Kyoto 606, Japan.
Shibamoto,
and *Laboratory
MD,*Hirohiko of Anatomic
Yamabe,
Pathology,
Mitsuyuki Kyoto
importance
Abe,
University
of
MD Hospital,
During the past decade there has been considerable progress in developing effective chemotherapy (CT) for non-Hodgkin's lymphoma (NHL), and the combination of radiotherapy (RT) and CT has become popular. But the role of combined CT in the treatment of localized NHL has not been clearly assessed.In this retrospective study, we investigated the effect of CT on prognosis of patients with localized NHL. 212 patients treated with RT for localized NHL between 1966 and 1988, 89 received Among majority adjuvant CT.The were treated with 60 Co gamma-radiation or 10 MV X-ray. The average of total dose was 39.8 Gy for low grade histologies,48.7 Gy for others. The main regimen of CT for intermediate and high grade lymphomas was VEPA (vincristine, cyclophosphamide, doxorubicin, prednisolone). Histologically 35 tumors were of low grade,156 of intermediate grade and 10 of high grade according to the Working Formulation studies were performed, and 162 tumors were B-cell (WF). In 187 cases,immunohistochemical lymhpomas. The majority of lymphomas in Waldeyer's ring(WAR), central nervous system(CNS), paranasal sinus, nasal cavity, and testis consisted of intermediate or high grade lesions. T-cell lymphomas (10 tumors) were found mainly in the nasal cavity, nasopharynx, and lymphnode. All of low grade histology were B-cell lymphomas. The overall actuarial and disease-free 10 year survival rates were 49.1 % and 43.3 % respectively. The 5-year survival rates were: nodal-56.3 %, WAR-46.6 %, CNS-22.9 %, orbit-69.0 %, paranasal sinus-85.7 %, thyroid-83.3 %, oral cavity-88.9 %, testis-44.4 8, cavity-20.8 %. The 5-year survival rates according to nasal the histopathological classification were 83.7 % for low grade NHL, 51.1 8 for intermediate, 28.7 8 for high grade, 55.7 8 for B-cell NHL, 35.0 % for T-cell. The impact of various factors on the duration of disease-free survival was assessed using the generalized Wilcoxon test and Cox proportional hazards model. In a group of patients treated with RT alone, histological grade of WF, tumor bulk, and radiation dose (30-39 Gy / 40Gy-), had much prognostic importance. While tumor bulk was the most important prognostic factor, followed by T/B phenotype in RT+CT. CT improved significantly the survival rate only for NHL with intermediate and high grades, B-cell NHL, and NHL without bulky mass. T/B phenotype was an important factor even in NHL except low grade histology. Our data suggest l)Combined CT is unnecessary for localized NHL of low grade histology, more intensive chemotherapy is necessary for NHL except B-cell NHL or while with bulky 2)The important prognostic factors mass. are tumor bulk and T/B phenotype in combined the WF and the total dose of RT modalities. Histological grade of have not so much prognostic importance as in the treatment by RT alone.
1028 COMBINED MODALITY TREATMENT EXPERIENCE Mark Sobczak,MD*, David Herman Suit, MD PhD*.
FOR PRIMARY LYMPHOMA
Harmon,MD#,
Massachusetts General Hospital #Dept of Medical Oncology
*Dept
Lawrence
of Radiation
OF BONE: A REPORT OF THE MGH
Zuckerberg,MD*,
Medicine
“Dept
Nancy
Harris,MD*,
of Pathology
$Dept
Henry
Mankin,MD$,
of Orthopedics
Primary Lymphoma of Bone (PLB) is an unusual form of non-Hodgkin’s lymphoma (NHL). The records of 33 cases of biopsy proven PLB which were diagnosed at the Massachusetts General Hospital between 1973 and 1987 were reviewed. Twenty-one (21) patients with stage Ie disease were treated with combined modality therapy receiving multidrug chemotherapy and local radiation therapy. All patients were extensively staged using modern imaging techniques prior to treatment. The actuarial probability of disease free and overall survival at five years were 79 and 82% respectfully. There were no local failures or secondary neoplasms noted within the irradiated tissues. This group is compared with prior same institution studies in which radiation therapy was employed as a single modality treatment. Marked improvements in both local and distant disease control with resultant gains in disease free and overall survival clearly demonstrates the superiority of combined modality therapy in the treatment of this disease. An analysis and review of both the chemotherapy and radiation complications is also included.