Analysis of treatment outcomes for primary tonsillar lymphoma

Lee, Yun Hee; Cho, Seok Goo; Jung, Seung Eun; Kim, Sung Hoon; O, Joo Hyun; Park, Gyeong Sin; Yang, Suk Woo; Lee, In Seok; Rhee, Chin Kook; Choi, Byung Ock

doi:10.3857/roj.2016.01781

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…NHL of the head and neck is increasingly seen in patients above 50 years (1). Our study revealed that age of presentation of tonsil lymphoma was between 26-79 years of age, with a median age of 51 years and a male preponderance (male: female ratio of 3.33); this is comparable with other studies (2,4,5).…”

Section: Discussionsupporting

confidence: 90%

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Lymphomas of palatine tonsil in patients at a tertiary care centre in coastal India: A ten-year case analysis

Khadilkar¹,

Dosemane²,

Mithra³

et al. 2022

Biomedicine

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Introduction and Aim: Head and neck is affected in 11-33% of extra-nodal Non-Hodgkin Lymphomas with the Waldeyer’s ring comprising 50% and among which palatine tonsils are most commonly involved. Materials and Methods: A retrospective analysis was performed using medical case files to study the demographic and clinical details of 13 patients diagnosed with primary lymphoma of palatine tonsil between 2011 and 2020 at a tertiary care hospital in coastal India. Results: Mean age was 49.7 years with a male preponderance. The usual presentation was either as a unilateral palatine mass or neck swelling with dysphagia, odynophagia and otalgia. All patients had high-grade lymphoma, diffuse large B-cell lymphoma was the commonest type. B-symptoms were seen more often in B-cell lymphoma; stage I was the most frequent. Stage at diagnosis was statistically significant when compared with B-symptoms, bulky disease and International Prognostic Index (IPI) (p-values of 0.02, 0.02 and 0.035 respectively). Overall survival (OS) rate was 44.44%, being higher in females than in males. Higher OS rate was noted for IPI of 1 & 2, and early stage lymphoma, unilateral tonsillar enlargement, normal lactate dehydrogenase, and European Cooperative Oncology Group score of 0. Combined chemoradiation proved to be better (50% OS) than chemotherapy (33.33% OS) alone. Conclusion: Lymphoma must be suspected in unilateral or bilateral asymmetrical tonsillar enlargement, especially in the older age group. Histopathology with immunohistochemistry plays a crucial role in diagnosis and typing of lymphoma, for proper and early institution of treatment with chemoradiation.

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Section: Discussionsupporting

confidence: 90%

“…Bulky disease is defined as primary tumour greater than 5 cm. in diameter (5) and occurs in 11% patients(4); the present study revealed bulky disease in 38.46%, the majority with late stage disease (stage III/ IV). The presence of bulky disease conferred lower OS (20%) when compared to smaller tumours (75%).…”

Section: Discussionsupporting

confidence: 50%

Lymphomas of palatine tonsil in patients at a tertiary care centre in coastal India: A ten-year case analysis

Khadilkar¹,

Dosemane²,

Mithra³

et al. 2022

Biomedicine

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“…The 5-year PFS rates in the CHOP + RT (> 40 Gy) group vs. R-CHOP + RT (≤ 40 Gy) group were 50% vs. 100% ( P = 0.018) and 5-year OS rates were 66.7 %vs. 100% ( P = 0.087) [ 30 ]. RT dose reduction may be the trend for PT-DLBCL in the rituximab era especially for favorable good responders.…”

Section: Discussionmentioning

confidence: 99%

Role of radiation therapy in primary tonsil large B cell lymphoma: a SEER-based analysis

Jia

Chen

2021

Radiat Oncol

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Backgroud Primary tonsil diffuse large B cell lymphoma (PT-DLBCL) is an uncommon disease entity. The role of radiation therapy (RT) in PT-DLBCL is debatable in both the pre- and post- rituximab era. The purpose of this study was to evaluate the treatment outcome and establish a prognostic model in PT-DLBCL based on the Surveillance, Epidemiology, and End Results (SEER) database. Materials and methods Data of 1214 PT-DLBCL patients diagnosed between 1975 and 2016 were extracted from SEER 18. The effect of RT was assessed for the entire cohort and subgroups by stages using univariate, multivariate Cox regression analyses and propensity score matching (PSM). Results The entire cohort included 1043 patients with early-stage (ES) PT-DLBCL and 171 patients with advanced-stage (AS) disease. A decreasing trend of RT utilization in the ES cohort after 2002 was observed. 47.4% of patients in ES received RT, whereas 25.1% in AS underwent RT. RT significantly improved overall survival in both univariate (P < 0.001) and multivariate (P = 0.002) analyses. PSM analysis further validated the survival advantage of RT (P = 0.002). A nomogram was established to predict the potential survival benefit. Subgroup analysis revealed RT was significantly associated with overall survival in ES patients of PT-DLBCL (P = 0.001) and in the rituximab era (P = 0.001) but not in those with AS disease (P = 0.241). Conclusions This population-based study encloses the largest sample of PT-DLBCL to date and demonstrates a favorable survival role of RT in early stages rather than advanced stages. The established nomogram helps to identify high risk patients to improve prognosis.

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“…Thus, a direct comparison of oncologic outcomes between combined modality and chemotherapy alone groups was not available. [ 18 , 19 ] To verify our results, future multicenter trials are needed that will compare chemotherapy alone and chemotherapy plus radiotherapy methods for the treatment of DLBCL involving the head and neck.…”

Section: Discussionmentioning

confidence: 86%

Treatment outcome of diffuse large B-cell lymphoma involving the head and neck

et al. 2017

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This study was performed to analyze the treatment outcome for diffuse large B-cell lymphoma (DLBCL) involving the head and neck and to evaluate the role of radiotherapy in the rituximab era. Fifty-six patients diagnosed with DLBCL involving the head and neck were assessed. All patients were treated with 6 cycles of rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone (R-CHOP). After chemotherapy, radiation was delivered to the head and neck area in a median dose of 36 Gy. Radiation was delivered using 3-dimensional radiotherapy (n = 25) or intensity-modulated radiotherapy (n = 31). Primary endpoints were relapse-free survival (RFS), overall survival (OS), and local control rate. After median follow-up time of 45 months, the 5-year RFS and OS rates were 72% and 61%, respectively. Fourteen (25%) of 56 patients relapsed; 1 had a local relapse, 11 had distant relapses, and 2 had both local and distant relapses. The final local control rate after radiotherapy was 94%. Age, performance status, international prognostic index score, and radiotherapy response were significant prognostic factors for both RFS and OS in the multivariate analysis. Incidence of acute grade 3 and 4 hematologic toxicity was 9% and 4%, respectively. Grade 3 nonhematologic toxicity occurred in 2 (4%) patients, and there was no grade 4 nonhematologic toxicity for the irradiated patients. Excellent local control and survival rates can be achieved with R-CHOP followed by radiotherapy in patients with DLBCL involving the head and neck. Treatment-related toxicity after the introduction of modern radiotherapy was acceptable and limited.

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Analysis of treatment outcomes for primary tonsillar lymphoma

Cited by 8 publications

References 16 publications

Lymphomas of palatine tonsil in patients at a tertiary care centre in coastal India: A ten-year case analysis

Lymphomas of palatine tonsil in patients at a tertiary care centre in coastal India: A ten-year case analysis

Role of radiation therapy in primary tonsil large B cell lymphoma: a SEER-based analysis

Treatment outcome of diffuse large B-cell lymphoma involving the head and neck

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