Combined Modality Therapy of Non-Hodgkin's Lymphoma of Waldeyer's Ring

Waldeyer's Ring 비호치킨 림프종의 병합요법

  • Park In-Kyu (Department of Radiation Oncology, School of Medicine, Kyungpook National University) ;
  • Yun Sang-Mo (Department of Radiation Oncology, School of Medicine, Kyungpook National University) ;
  • Park Jun-Sik (Department of Otolaryngology, School of Medicine, Kyungpook National University) ;
  • Kim Jae-Cheol (Department of Radiation Oncology, School of Medicine, Kyungpook National University)
  • 박인규 (경북대학교 의과대학 치료방사선과학교실) ;
  • 윤상모 (경북대학교 의과대학 치료방사선과학교실) ;
  • 박준식 (경북대학교 의과대학 이비인후과학교실) ;
  • 김재철 (경북대학교 의과대학 치료방사선과학교실)
  • Published : 1999.05.01


Purpose: We performed this study retrospectively to evaluate local control, survival, prognostic factors, and failure patterns in patients with non-Hodgkin's lymphoma of Waldeyer's ring. Materials and Methods: From April 1984 to November 1996,41 patients with non-Hodgkin's lymphoma of Waldeyer's ring were treated with combined chemotherapy and radiation therapy. Age was ranged from 19 to 73 years old with a median age of 55 years, and there were 26 male and 15 female patients. Primary site was tonsil in 26 and base of the tongue in 7 and nasopharynx in 8, and stage distribution showed stage I in 12 and stage II in 29 patients. Pathologic classification was done according to Working Formulation. There were 1 with follicular mixed small cleaved and large cell, 8 with diffuse small cleaved cell, 7 with diffuse mixed small and large cell, and 25 cases with diffuse large cell. All patients were treated with combination of chemotherapy and radiation therapy. Chemotherapy regimen consisted of either CHOP-Bleo(cyclophosphamide, adriamycin, vincristine, prednisolone, bleomycin) or COP-BLAM III(cyclophosphamide, vincristine, prednisolone, bleomycin, adriamycin, procarbazine). Radiation dose ranged from 3600cGy to 6620cGy with a median dose of 5040cGy. Follow-up time was ranged from 15 months to 159 months(median 55 months). Results: The complete response was achieved in 98%(40/41) and partial response in 2%(1/41). The complete response rate were the followings: 66.7% for stage I and 51.7% for stage II after chemotherapy, 100% for stage I and 96.6% for stage II after overall treatment respectively. The overall survival rate and disease-tree survival rates at 5 years were 82.6% and 79.5%, respectively. Prognostic factors for overall survival were age(p=0.007), stage(p=0.03), nodal status(p=0.006) and radiation dose(p=0.003). The factors associated with disease-tree survival were stage(p=0.04), nodal status(p=0.004) and radiation dose(p=0.009). The failure patterns were analized in evaluable 35 patients with complete response. Locoregional failure was noted in 2 patients and distant metastasis in 5 patients. Conclusion: Our results suggest that combined modality therapy is the appropriate treatment for stage I-II intermediate grade non-hodgkin's lymphoma of the Waldeyer's ring. However, our material is small and the analysis is retrospective. Randomized prospective studies for combined therapy, radiation therapy alone and chemotherapy alone are needed.