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Annals of Hematology

, Volume 84, Issue 4, pp 223–226 | Cite as

Treatment results of tonsillar lymphoma: a 10-year experience

  • Mohammad MohammadianpanahEmail author
  • Shapour Omidvai
  • Ahmad Mosalei
  • Niloofar Ahmadloo
Original Article

Abstract

Primary extranodal non-Hodgkin’s lymphomas of the head and neck account for 10–20% of all non-Hodgkin’s lymphomas. Primary tonsillar lymphoma accounts for less than 1% of head and neck malignancies, although the tonsil is the most common primary extranodal site of head and neck non-Hodgkin’s lymphomas. In this study we analyzed our cases of tonsillar lymphoma treated in our institution during the last 10 years to compare the finding of this study with those of previous studies. We reviewed the cases of tonsillar lymphoma treated in the Radiation Oncology Department of Shiraz University from 1992 to 2002. Clinical data were obtained from patients’ files. The patients were treated by combined chemotherapy [a median of six cycles of a CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisolone)] and radiation therapy (40–50 Gy to the primary site and neck). Chemotherapy mainly preceded radiotherapy, although the sequence of radiotherapy and chemotherapy was determined by individual physicians and patients’ choice. Surgery was used mainly to establish the diagnosis, and tonsillectomy was performed for localized small lesions. Between 1992 and 2002, 19 patients with stage IE (10), IIE (7), and IIIE (2) disease were treated. Median and mean age was 48 and 44 years (range: 22–76 years), respectively, at the time of diagnosis, with a male to female ratio of 1.2:1. The vast majority of patients presented in early stages with aggressive histology. High-grade tumors seemed to affect mainly young people (p=0.226). Diffuse large B-cell lymphomas were the most prevalent. Male patients were significantly younger than females (p=0.021). The patients were treated by combined chemotherapy and radiation therapy. All patients achieved and maintained complete remission with a median of 60 months relapse-free survival and a 5-year cause-specific survival rate of 100%. All patients developed some degree of oropharyngeal mucositis. Three patients (16%) experienced grade 3 or 4 neutropenia. Mild (grade I) xerostomia remained persistently in four patients (21%). A late fatal side effect was observed in one patient who developed radiation-induced sarcoma 7 years after initial diagnosis and died 8 months later without evidence of recurrent lymphoma. Complete follow-up was obtained in all patients. The follow-up period ranged from 18 to 141 months with a median of 60 and a mean of 60.4 months. At the time of last follow-up, all patients but one were alive. Age, sex, stage, bulk of disease, performance status, number of chemotherapy cycles, number of involved sites, histologic subtypes, and radiation dose were analyzed as prognostically significant for disease-specific survival in our cases. Significant prognostic factors were not identified by multivariate analysis. Combined chemotherapy and radiation therapy is safe, highly effective, and probably curative for most patients with primary tonsillar lymphoma.

Keywords

Tonsillar lymphoma Non-Hodgkin’s lymphoma Combined chemotherapy and radiation therapy 

References

  1. 1.
    Depena CA, Van-Tassel P, Lee YY (1990) Lymphoma of the head and neck. Radiol Clin North Am 28:723–743PubMedGoogle Scholar
  2. 2.
    Jacobs C, Hoppe RT (1985) Non-Hodgkin’s lymphomas of the head and neck extranodal sites. Int Radiat Oncol Biol Phys 11:357–364Google Scholar
  3. 3.
    Endo S, Kida A, et al. (1996) Clinical analysis of malignant lymphomas of tonsils. Acta Otolaryngol Suppl (Stockh) 523:263–266Google Scholar
  4. 4.
    Richard W, Tsang MD, Mary YK, Gospodarowikz MK, et al. (2002) Staging and management of localized non-Hodgkin’s lymphomas: Variation among experts in radiation oncology. Int J Radiat Oncol Biol Phys 52:643–651CrossRefPubMedGoogle Scholar
  5. 5.
    Ruijs CD, Dekker AW, van Kempen-Harteveld ML, van Barrelen J, Hordijk GJ (1994) Treatment of localized non-Hodgkin’s lymphomas of the head and neck. Cancer 74:703–707PubMedGoogle Scholar
  6. 6.
    Aviles A, Delgado S, Ruiz H, de la Torre A, Guzman R, Talavera A (1996) Treatment of non-Hodgkin’s lymphoma of Waldeyer’s ring: radiotherapy versus chemotherapy versus combined therapy. Eur J Cancer Oral Oncol J 32B:19–23Google Scholar
  7. 7.
    Fujitani T, Takahara T, Hattori H, Imajo Y, Ogasawara H (1984) Radiochemotherapy for non-Hodgkin’s lymphoma in palatine tonsil. Cancer 54:1288–1984PubMedGoogle Scholar
  8. 8.
    Artese L, Di Alberti L, Lombardo M, et al. (1995) Head and neck non-Hodgkin’s lymphomas. Eur J Cancer Oral Oncol 31B:299–300Google Scholar
  9. 9.
    Epstein JB, Epstein JD, Le ND, et al. (2001) Characteristics of oral and paraoral malignant lymphoma: a population-based review of 361 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endol 92:519–525CrossRefGoogle Scholar
  10. 10.
    American Cancer Society (1999) Cancer facts and figures 1999. American Cancer Society, Atlanta, GAGoogle Scholar
  11. 11.
    SEER (surveillance, epidemiology and results), National cancer institute (1999) Cancer statistics review 1973–1996 initial content, update 5 November 1999, https://cissecure.nci.nih.gov/ncipubs/Google Scholar
  12. 12.
    Krol AD, le Cessie S, Snijder S, Kluin-Nelemans JC, Kluin PM, Noordijk EM (2003) Primary extranodal non-Hodgkin’s lymphoma (NHL): the impact of alternative definitions tested in the Comprehensive Cancer Centre West population-based NHL registry. Ann Oncol 14:131–139CrossRefPubMedGoogle Scholar
  13. 13.
    Economopoulos T, Fountzilas G, Kostourou A, Daniilidis J, Pavlidis N, Andreopoulou H, Nicolaou A, Papageorgiou E, Mellou S, Dervenoulas J, Stathakis N (1998) Primary extranodal non Hodgkin’s lymphoma of the head and neck in adults: a clinicopathological comparison between tonsillar and non tonsillar lymphomas. (Hellenic Co-operative Oncology Group). Anticancer Res 18:4655–4660PubMedGoogle Scholar
  14. 14.
    Sasai K, Yamabe H, Kokubo M, Shibata T, Oya N, Nagata Y, Hiraoka M (2000) Head-and-neck stages I and II extranodal non-Hodgkin’s lymphomas: real classification and selection for treatment modality. Int J Radiat Oncol Biol Phys 48:153–160CrossRefPubMedGoogle Scholar
  15. 15.
    Barton JH, Osborne BM, Butler JJ, Meoz RT, Kong J, Fuller LM, Sullivan JA (1984) Non-Hodgkin’s lymphoma of tonsil: a clinicopathologic study of 65 cases. Cancer 53:86–95PubMedGoogle Scholar
  16. 16.
    Velasquez WS, Fuller LM, Jagannath S, et al. (1991) Stage I and II diffuse large cell lymphoma. Prognostic factors and long-term results with CHOP-Bleo and radiotherapy. Blood 77:942–947PubMedGoogle Scholar
  17. 17.
    Miller TP, Jones SE (1982) Initial chemotherapy for clinically localized lymphomas of unfavourable histology. Blood 62:413–418Google Scholar
  18. 18.
    Sullivan KM, NeimanPE, Kadin ME, et al. (1983) Combined modality therapy of advanced non-Hodgkin’s lymphoma. An analysis of remission duration and survival in 95 patients. Blood 62:51–61PubMedGoogle Scholar
  19. 19.
    O’Connell MJ, Harrington DP, Earle JD, et al. (1988) Chemotherapy followed by consolidation radiation therapy for the treatment of clinical stage II aggressive histologic type non-Hodgkin’s lymphoma. Cancer 61:1754–1758PubMedGoogle Scholar
  20. 20.
    Mirza MR, Brinker H, Spetch L (1992) The integration of radiotherapy into the primary treatment of non-Hodgkin’s lymphoma. Crit Rev Oncol Hematol 12:217–229PubMedGoogle Scholar
  21. 21.
    Tondini C, Zanini M, Lombardi F, et al. (1993) Combined modality treatment with primary CHOP chemotherapy followed by locoregional irradiation stage I or II histologically aggressive non-Hodgkin’s lymphoma. Clin Oncol 11:721–725Google Scholar
  22. 22.
    Wilder RB, Rodriguez MA, Tucker SL, Ha CS, Hess MA, Cabanillas FF, Cox JD (2001) Radiation therapy after a partial response to CHOP chemotherapy for aggressive lymphomas. Int J Radiat Oncol Biol Phys 50:743–749CrossRefPubMedGoogle Scholar
  23. 23.
    Gao YH, Li YX, Zhao LJ, Yuan ZY, Liu XF, Yu ZH (2003) Treatment of early stage primary tonsil non-Hodgkin’s lymphoma. Zhonghua Xue Ye Xue Za Zhi 24:190–192PubMedGoogle Scholar
  24. 24.
    Miller TP, Dahlberg S, Cassady JR, et al. (1998) Chemotherapy alone with chemotherapy plus radiotherapy for localized intermediate and high-grade non-Hodgkin’s lymphoma. N Engl J Med 339:21–26PubMedGoogle Scholar
  25. 25.
    Makepeace AR, Fermont DC, Bennett MH (1987) Non-Hodgkin’s lymphoma of the tonsil. Experience of treatment over a 27-year period. J Laryngol Otol 101:1151–1158PubMedGoogle Scholar
  26. 26.
    Tsang RW, Gospodarowicz MK, Pintilie M, Bezjak A, Wells W, Hodgson DC, Crump M (2001) Stage I and II MALT lymphoma: results of treatment with radiotherapy. Int J Radiat Oncol Biol Phys 50:1258–1264CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Mohammad Mohammadianpanah
    • 1
    Email author
  • Shapour Omidvai
    • 1
  • Ahmad Mosalei
    • 1
  • Niloofar Ahmadloo
    • 1
  1. 1.Department of Radiation OncologyShiraz University of Medical SciencesShiraz, FarsIran (Islamic Republic)

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