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Non‐Hodgkin's lymphoma. Involvement of Waldeyer's ring
Author(s) -
Hoppe Richard T.,
Burke Jerome S.,
Glatstein Eli,
Kaplan Henry S.
Publication year - 1978
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(197809)42:3<1096::aid-cncr2820420310>3.0.co;2-z
Subject(s) - medicine , lymphoma , hodgkin lymphoma , pathology
From 1963 through 1976, 59 patients with non‐Hodgkin's lymphoma involving Waldeyer's ring were evaluated in the Division of Radiation Therapy at Stanford University. Fifty‐one patients had clinical stage I—III disease. Most were staged with a lymphangiogram and percutaneous needle marrow biopsy. Lymphangiograms were positive in 12% of clinical stage I or II patients. Although the bone marrow biopsy was not positive in any of the patients with clinical stage I or II disease, 67% of patients with clinical stage III disease had bone marrow involvement. Fourteen patients also underwent a staging laparotomy and splenectomy and this procedure influenced the final stage in 36% of the patients submitted to the operation. The histologic pattern of the biopsies in 90% of the cases was diffuse and in 55% the cell type was histiocytic. Six patients had lymphoblastic lymphoma. Most patients with stage I or II disease were treated with involved field or extended field irradiation. This often consisted of an enlarged Waldeyer's field matched to a mantle or “minimantle” field. Several patients with stage I or II disease and most patients with stage III disease were treated with total lymphoid irradiation, usually modified to treat the entire abdominal mesentery. The long‐term freedom from relapse among patients with stage I disease was significantly better than among patients with stage II or III disease (50% vs. 25% and 17%). All patients with lymphoblastic lymphoma died with active disease. Stage I or II patients treated with total lymphoid irradiation seemed to enjoy a better freedom from relapse than those treated with involved or extended field irradiation, but variations in staging techniques may account for some of the observed differences. The most frequently recognized site of initial failure was in lymph nodes, primarily untreated nodes; the bone marrow was the second most common site of relapse. Comparisons with our overall lymphoma experience are made and justification is given for consideration of Waldeyer's ring as a separate lymphoid region.