Journal of Clinical Oncology, Vol 18, Issue 1
(January), 2000: 54
© 2000 American Society for Clinical Oncology
Angiocentric Lymphoma of the Head and Neck: Patterns of Systemic Failure After Radiation Treatment
By Gwi Eon Kim,
Jae Ho Cho,
Woo Ick Yang,
Eun Ji Chung,
Chang Ok Suh,
Kyung Ran Park,
Won Pyo Hong,
In Yong Park,
Jee Sook Hahn,
Jae Kyung Roh,
Byung Soo Kim
From the Departments of Radiation Oncology, Pathology, Internal Medicine, and Otorhinolaryngology, Yonsei University College of Medicine, Yonsei Cancer Center, Seoul, Korea.
Address reprint requests to Gwi Eon Kim, MD, Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center, CPO Box 8044, Seoul 120-752, Korea; email therapy@ yumc.yonsei.ac.kr.
PURPOSE: To investigate the patterns of systemic failure and the clinical outcome in patients with angiocentric lymphoma of the head and neck who were treated with radiation alone, and to discuss the optimal mode of treatment for these patients.
PATIENTS AND METHODS: We reviewed the records of 92 patients with stage I or II angiocentric lymphoma who were treated at Yonsei Cancer Center between 1976 and 1994. All patients were treated with involved-field irradiation. Radiation doses ranged from 40 to 60 Gy (median dose, 50.4 Gy). Treatment response, patterns of treatment failure including systemic failure, and clinical outcome after radiation treatment were analyzed.
RESULTS: The most frequently involved site was the nasal cavity, either alone or in conjunction with other sites. In 16 patients (17.4%), angiocentric lymphoma was accompanied by cervical lymphadenopathy. Disease was classified as stage I in 62 patients (67.4%) and stage II in 30 patients (32.6%). After completion of radiation treatment, 61 patients (66.3%) achieved a complete response and 16 (17.4%) a partial response. Half of the patients (50.0%) ultimately experienced local recurrence with or without other components of failure, whereas regional failure was relatively uncommon (10.9%). Systemic failure occurred in 25.0% of patients during follow-up. Six patients had histologic findings identical to those at the time of the original disease (group I), whereas four patients exhibited morphologic features of frank lymphomas (group II). The majority of patients with systemic relapse had the predilection sites for widespread extranodal involvement, such as the skin, brain, lung, gastrointestinal tract, or testes. In addition, seven patients died from various medical illnesses or immunologic disorders, including hemophagocytic syndrome and second primary cancers (group III). After a median follow-up of 56 months, the overall survival and disease-free survival rates for all patients were 40.1% and 37.8%, respectively. All patients except one with systemic failure died within 1 year.
CONCLUSION: Treatment with radiation alone had suboptimal results, partly because of the occurrence of a variety of systemic failure with diverse clinicopathologic features. Given the frequent occurrence of systemic failure after radiation treatment, we believe that the multimodality treatment approach containing more effective chemotherapeutic agents should be incorporated in the treatment of angiocentric lymphoma confined to the head and neck.
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