Thirty-two patients with nasal NK/T-cell lymphoma and disseminated disease (lung, skin, and bone marrow) were treated with an intensive combined therapy that consisted of three cycles of CMED (cyclophosphamide 2 g/m(2), metothrexate 200 mg/m(2), etoposide 600 mg/m(2), and dexamethasone 80 mg/m(2) with leucovorin rescue administered 24 h after) every 14 d, following high-dose radiotherapy: 55 Gy in 20 sesions to centrofacial region and three cycles more of the same chemotherapy regimen. To ameliorate the presence of severe granulocytopenia, granulocyte colony-stimulating factor, 5 microg/kg, daily for 14 d, begun on d 2 after chemotherapy, was administered. Complete response was achieved in 21 cases (65%); failure or progression was observed in 11 cases (35%). With a median follow-up of 69.1 mo, relapse has not been observed; thus, actuarial curves at 5 yr showed that event-free survival (EFS) is 100% in 21 patients and overall survival (OS) is 65%. Granulocytopenia grade IV was observed in 15% cycles, Nonhematological toxicity was mild and well tolerated. Radiotherapy was well tolerated; only mild mucositis was observed. Nasal NK/T-cell lymphoma is an rare presentation of malignant lymphoma (<1% of all cases) with a worse prognosis; less than 5% patients are alive free of disease at 1 yr. The use of intensive more specific chemotherapy and high dose of local radiotherapy, appear to be an excellent therapeutic approach with improvement in EFS and OS.

Objectives: Primary orbital malignant lymphoma (POML) is a rare malignancy, thus treatment remains to be defined. The present study was designed to define if the use of radiotherapy is sufficient in these patients or if the use of adjuvant chemotherapy would improve the outcome. Methods: Between 1983 and 1995, 98 previously untreated patients diagnosed with POML, stage IE, were randomly allocated to receive either radiotherapy (34–40 Gy) or the same radiotherapy combined with chemotherapy including anthracycline. The median follow-up was 11.4 years (range 9.8–10.8 years). Results: Complete response was similar in both arms: 98% (95% confidence interval, CI: 89–100%) in the radiotherapy arm, and 100% (95% CI: 89–100%) in the combined therapy group. At a median follow-up of 16.4 years, event-free survival was 94% (95% CI: 87–100%) and 85% (95% CI: 88–100%), respectively. Overall survivals were: 96% (95% CI: 89–99%) and 91% (95% CI: 83–98%). No statistical differences were found. Acute and late toxicities were mild. Conclusions: The addition of chemotherapy is of no further benefit, since the results did not differ, thus, radiotherapy will be considered as the treatment of choice in POML patients.

We performed a retrospective analysis of prognostic factors in patients with stage III and IV and high-tumor burden follicular lymphoma (FL) treated with uniform schedules and with a long term follow-up. Eight-hundred and ten patients treated with intensive, anthracycline-based, chemotherapy and adjuvant radiotherapy to sites of initial bulky nodal disease were the basis of this analysis. Age >60 years, presence of B symptoms, bulky disease, >2 extranodal sites involved, high levels of LDH and the presence of serous effusions all identified as worse prognostic factors in univariate analysis were subject to multivariate analysis. Three factors remained significant: age >60 years old, presence of B symptoms and >2 extranodal sites involved and these were found to influence overall survival (OS) and progression-free survival (PFS). We developed a score system and only two groups (score 0 and 1 and score 2 and 3) showed statistical significance in OS. When the International Prognostic Index was applied to these patients, no statistical differences were observed in OS and PFS between the four groups. Comparison of our results with multiple previous studies showed a lack of uniform prognostic factors and adequate prognostic classification could not be performed. In conclusion, it is mandatory for multicentric international clinical analysis to define prognostic factors and search for a clinical classification, as in diffuse large B cell lymphoma, so as to define groups of FL for more aggressive or conservative therapy.

The use of adjuvant RT in patients with DLBCL and nodal bulky disease improves the outcome with PFS and OS, with minimal toxicity; thus, we felt that adjuvant RT will be considered as a part of the initial treatment in this setting of patients, even in the rituximab era.

ObjectivePrimary mediastinal B‐cell lymphoma is a rare and unique type of non‐Hodgkin's lymphoma that develops more frequently in younger patients and women. The combination of immunochemotherapy and radiotherapy (RT) has been suggested as the primary treatment choice. However, no consensus has been reached. Thus, we carried out an open‐label clinical trial. Patients with complete response after six cycles of immunochemotherapy were randomized to receive or not receive RT (control group).MethodsFrom July 2004 to December 2012, 324 patients with primary mediastinal B‐cell lymphoma were enrolled and randomized at 1:1, with 164 and 160 patients in the RT and control groups, respectively.ResultsThe 5‐year progression‐free survival was 84% (95% confidence interval [CI] 77–89%) in the RT group and 67% (95% CI 60–76%) in the control group (P < 0.01). The 5‐year overall survival was 86% (95% CI 79–96%) in the RT group and 68% (95% CI 60%–74%) in the control group (P < 0.01). Toxicity was minimal and well controlled. No late toxicities were observed.ConclusionRT as adjuvant treatment in patients with complete response after six cycles of immunochemotherapy improved the progression‐free survival and overall survival with minimal toxicities.