The most common histological type of tonsil lymphoma is diffuse large B-cell lymphoma (DLBCL). Treatment approaches that have used include surgery, chemotherapy (CTx) alone, radiation (RT) alone, and combination of both. We reviewed our data and evaluate treatment outcome of patient with DLBCL of the tonsil.
Retrospective review of 114 stage I-II DLBCL patients between 1995 and 2010. Forty-five (39.5%) patients had stage I disease and B-symptoms were present in only 7 patients. Seventy-two (65.5%) patients were treated with CTx alone, whereas the remaining 38 received treatment with a combination of CTx and RT. Chemotherapy was CHOP-based, with R-CHOP in 80 patients (70%). Median involved-field RT dose was 3,960 cGy, with 96% receiving more than 3,000 cGy.
The median age was 59 years and 61% of patients were males. Low to low intermediate by International prognostic index (IPI) was 97.3%. LDH level. Overall CR rate was 73.5% and seven (13.5%) of the patients who had achieved CR had recurred. The median follow-up was 28 months. Five-year disease-free survival (DFS) and overall survival (OS) were 86.3% and 82.5%, respectively. Significant prognostic factors included: age ≥ 60 years old (OS, P = 0.011), LDH >upper normal limit (OS, P = 0.003; DFS, P < 0.001), IPI>0 (OS, P = 0.007; DFS, P = 0.034) and combination of CTx and RT (OS, P = 0.025; DFS, P = 0.038). Germinal center (GC) and non-GC phenotype were not predictors of outcome in localized DLBCL of the tonsil. Chemoimmunotherapy-treated patients with rituximab did not show a significantly better OS and DFS than those without rituximab. On multivariate analysis; LDH >upper normal limit (DFS: hazard ratio [HR], 14.958; 95% CI, 2.474-90.432, P = 0.003; OS: HR, 9.341; 95% CI, 1.635-53.361, P = 0.012), and combination of CTx and RT (DFS: HR, 0.088: 95% CI, 0.009-0.834, P = 0.034; OS: HR, 0.112; 95% CI, 0.014-0.918, P = 0.041), retained statistical significance.
The DFS and OS rates were significantly better for patients receiving combination of CTx and RT. A combined treatment, consisting of CTx and RT (with RT dose of ≥ 45 Gy), results in a satisfactory outcome in patients with localized primary DLBCL of tonsil.
Clinical trial identification
Legal entity responsible for the study
Consortium for Improving Survival of Lymphoma.
Has not received any funding.
All authors have declared no conflicts of interest.