High response rate and improvement of long-term survival with combined treatment modalities in patients with poor-risk primary thyroid diffuse large B-cell lymphoma: an International Extranodal Lymphoma Study Group and Intergruppo Italiano Linfomi study

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“…Asignificant limitation of our review is the inconsistency, due primarily to the subtypes of primary thyroid lymphoma, in the patient populations among the various studies. Very few of the studies we analyzed stratified outcomes by both histologic subtype and treatment modality [6,10,16,34] -a significant constraint, as different histologic subtypes may indicate different treatment modalities.…”

“…Another limitation of our review is the prevailing lack of consensus regarding chemotherapeutic agents and radiation techniques. Most studies used CHOP or CHOP-like regimens, but outcomes may have been distorted by the addition of rituximab or bleomycin and by the use of other modalities such as CVP [1,10,16,26,29,33]. Radiation therapy also varied in terms of exposure fields, dosage, and frequency, possibly sullying interpretation of outcomes [1,6,10,16,26,29,33,34].…”

“…In contrast, Graff-Baker et al reported data supporting an association between surgery and/or radiation and improved survival for patients with stage I MALT lymphomas, DLBCL, and small-lymphocytic variants per histologic tests [4]. Interestingly, Mian et al found a clear trend, in the Kaplan-Meier curve, toward better overall survival in patients who first underwent surgical debulking followed by radiation therapy and chemotherapy [10].…”

“…Moreover, in a retrospective study of 26 patients, Thieblemont et al found that elevated serum LDH and beta 2 -microglobulin levels were associated with more DLBCL, suggesting that the 2 tests might be useful as a measure of disease aggression [6]. Serum LDH measurementas a prognostic indicator of response to treatment and of overall survival has been found to have no statistically significant value in multiple studies [1,5,9,10].…”