title: Localized non-Hodgkin's lymphoma of Waldeyer's ring: clinical features, management, and prognosis of 130 adult patients.
abstract: BACKGROUND
  Waldeyer's ring (WR) is the primary site of non-Hodgkin's lymphoma (NHL) involvement in approximately 5% to 10% of all lymphoma patients, and it accounts for more than half of all primary extranodal lymphomas of the head and neck. Materials and Methods A retrospective review was performed of 130 adult patients with localized (stages I and II) WR-NHL seen at a single institution over 18 years.
  
  
  RESULTS
  Patients had a median age of 55 years, and the male-female ratio was 1:5:1. Seventy five (58%), 46 (35%), and 9 (7%) patients had primary tonsillar, nasopharyngeal, and base of the tongue lymphoma, respectively. Forty-five (35%) and 85 (65%) had stage I and stage II disease, respectively. Most patients (109 patients, 84%) had diffuse large B-cell NHL (DLC). Chemotherapy (CT) was given to 58 (45%) patients, whereas 26 (20%) received radiation therapy (RTX), and 46 (35%) were managed with a combination of chemotherapy and radiotherapy (CMT). One hundred nine (84%), 16 (12%), and 5 (4%) patients attained complete remission (CR), partial remission (PR), and treatment failure, respectively, with no difference in CR rates between the three therapeutic modalities. Of those patients with DLC, 90 (83%), 15 (14%), and 4 (3%) demonstrated CR, PR, and treatment failure, respectively. In a multivariate analysis, the modified International Prognostic Index (IPI) was found to predict the attainment of CR. Over a median follow-up of 49 months; 76 (58%) of the patients were alive and disease-free, 5 (4%) were alive with evidence of disease, and the remaining 49 (38%) were dead. Most distant relapses were in nongastrointestinal extranodal sites. The median overall survival (OS) has not been reached; however, the projected 5-year OS was 58%. No OS difference was noted between patients with stage I and stage II. Cox proportional hazards model identified primary tonsillar site and a low-risk group as defined by the modified IPI were associated with favorable OS. The median event-free survival was 82.3 months, with the primary tonsillar site, and low-risk modified IPI group were associated with favorable EFS in a multivariate analysis. Probably because of the high frequency of patients with DLC, the outcome and the prognostic factors in those patients were not distinctive from those for the whole group. The CMT was not associated with a superior OS compared with either of the single modality treatments; however, it was associated with more favorable EFS.
  
  
  CONCLUSIONS
  This series characterized the clinicopathologic features and outcome of adult patients with early stage WR-NHLs. No survival difference was noted between stage I and stage II, and the outcome was favorable. Primary tonsillar site and the low-risk group of the modified IPI predicted favorable OS and EFS. CMT is probably superior to single modality treatment; however, prospective studies are warranted.
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital & Research Centre, PO Box 3354, Riyadh, 11211, Saudi Arabia.
authors.forename: A A
authors.initials: AA
authors.lastname: Ezzat
authors.forename: E M
authors.initials: EM
authors.lastname: Ibrahim
authors.forename: A N
authors.initials: AN
authors.lastname: El Weshi
authors.forename: Y M
authors.initials: YM
authors.lastname: Khafaga
authors.forename: M
authors.initials: M
authors.lastname: AlJurf
authors.forename: J M
authors.initials: JM
authors.lastname: Martin
authors.forename: D S
authors.initials: DS
authors.lastname: Ajarim
authors.forename: S N
authors.initials: SN
authors.lastname: Bazarbashi
authors.forename: R K
authors.initials: RK
authors.lastname: Stuart
authors.forename: E
authors.initials: E
authors.lastname: Zucca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D016393:Lymphoma, B-Cell / Q000601:surgery; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis