Localised lymphoma of bone: prognostic factors and treatment recommendations

Abstract

SummaryTwenty seven adult patients with newly diagnosed non-Hodgkin's lymphoma localised to either bone (Stage IE) or bone and regional lymph nodes (Stage IIE) were treated between 1967 and 1988. Median age was 53 years and the commonest histology (21 patients) was diffuse histiocytic lymphoma. Twenty-four patients were treated radically: 15 with radiation therapy (XRT) alone and nine with chemotherapy plus radiation therapy (CMT). The cause specific survival for these patients was 56% at 5 years and 40% at 10 years. Survival was significantly better for patients treated by CMT (88% at 5 years) as compared to XRT alone (40% at 5 years, P = 0.03) and for age <60 (72% at 5 years) compared to > 60 (30% at 5 years, P = 0.018). Relapse-free rate was 27% at 5 years with XRT alone and 89% with CMT (P = 0.01). Risk factors for loco-regional relapse (seven cases) included: large tumour bulk, treatment by XRT alone and use of 'limited' radiation fields. No radiation dose-response relationship could be identified in this study. Long term local control and survival for localised lymphoma of bone were excellent after treatment by CMT but XRT alone was associated with unacceptably high local and distant failure rates.

Malignant Lymphoma of Bone: A Review of 119 Patients

“…Most studies had small patient numbers retrospectively collected over a long timespan, resulting in a heterogeneous group of patients with different staging methods and treatment approaches [3,5,6,8,9,13,15,16]. Any study on this subject needs to span years or even decades; Ostrowski et al's report covers 75 years [11].…”

True

“…Several studies suggest that the combination of chemotherapy and radiotherapy is the best treatment, as a consequence of which resection or amputation can be prevented. 4,17,18 In this cohort the overall 5-year survival was 61%. This is surprisingly high when the heterogeneous treatment schedules over the years of the study and the inclusion of stage IV patients are taken into account.…”

“…Of note, many studies on PLB excluded patients with stage IV disease, partly in an effort to eliminate malignancies in which bone involvement is secondary. [4][5][6]19 This exclusion is not supported by our data that stage IV disease is mostly determined by multiple, osseous localisations.…”

“…Any study of the pathophysiology of PLB and on prognostic factors is complicated by the small patient numbers and by the fact that the results of earlier studies are often not comparable to each other. [4][5][6] We studied a relatively large and representative group of patients, diagnosed and treated between 1943 and 1996. Patients were selected by reviewing all cases previously diagnosed as malignant lymphoma, lymphosarcoma or reticulum cell sarcoma.…”

“…In many studies stage IV tumours were excluded and patients were only treated with radiotherapy. [4][5][6][7][8][9][10][11] Uniform directives for classification, treatment and prognosis are still lacking. We describe a relatively large group of 60 patients with clinico-radiologically and histologically documented PLB, collected from the files of the Netherlands Committee on Bone Tumours and the Leiden University Medical Centre.…”