Journal of Clinical Oncology, Vol 1, 682-688, Copyright © 1983 by American Society of Clinical Oncology
Extralymphatic involvement in diffuse non-Hodgkin's lymphoma
S Paryani, RT Hoppe, JS Burke, P Sneed, D Dawley, RS Cox, SA Rosenberg and HS Kaplan
Between 1961 and 1982, 543 patients with diffuse histiocytic, mixed, or
undifferentiated lymphoma were treated at Stanford University, Stanford,
Calif. Of this group, 281 (52%) had extralymphatic lesions and the 111
patients with stage IE and IIE disease were subjected to analysis. Most
patients (94) had diffuse histiocytic lymphoma. Lymphangiography was
performed in 77%, bone marrow biopsy in 91%, and diagnostic or staging
laparotomy in 52% of the patients. All but five patients were treated with
megavoltage irradiation and 35 patients received combination chemotherapy.
Median follow-up was 4.0 years. Kaplan-Meier actuarial survival at five and
10 years was 46% and 36%, respectively. Freedom from relapse (FFR) at five
years was 49% with no relapses beyond that point. The most common
extralymphatic sites were the gastrointestinal tract, the head and neck
region, and the lung. Prognosis could not be correlated with the specific
sites of involvement. Patients with bulky disease (greater than 10 cm) or
more than three sites of involvement had a significantly lower survival and
FFR. There was no significant difference in outcome for patients treated
with irradiation or combined modality therapy. Most patients (62%) relapsed
in distant extralymphatic sites.
