title: Primary non-Hodgkin lymphoma of the breast: The Mayo Clinic Experience.
abstract: OBJECTIVE
  To retrospectively evaluate the characteristics, natural history, results of treatment, and prognostic factors for patients diagnosed with primary breast lymphoma.
  
  
  METHODS
  Between 1973 and 1998, 25 women and 1 man with the diagnosis of primary breast non-Hodgkin lymphoma (PNHLB) were seen at Mayo Clinic Rochester and Mayo Clinic Scottsdale. Patient characteristics, treatment methods, and outcome were analyzed.
  
  
  RESULTS
  The median follow-up for surviving patients was 6.6 years (range: 1.8-22.1 years). There were 11 low-grade NHL, 13 intermediate-grade NHL, and 2 high-grade NHL. Three patients underwent mastectomy while 23 had local excision. The Ann Arbor stage of disease included: Stage I-21 patients, Stage II-5 patients. Sixteen patients received radiation after surgery (15 after biopsy, 1 after mastectomy). Chemotherapy was given to 10 patients as part of the initial treatment. Four patients with low-grade disease were treated with excision only. The 5-year overall survival rate was 70% and relapse-free survival rate 42%, while local control rate was 75% and distant control rate 51%. Five-year survival and relapse-free survival rates for patients with low-grade disease were 91 and 61%, respectively. Three of four patients with low-grade disease treated with excision alone were free of local recurrence. For intermediate- and high-grade PNHLB, 5-year survival rate was 61% for those treated with chemotherapy, compared to 31% for those without chemotherapy (P = 0.35), and the 5-year relapse-free survival rates were 49%, compared to 0%, respectively (P = 0.0017). Three patients with intermediate- or high-grade disease developed central nervous system (CNS) dissemination. On univariate analysis, Ann Arbor stage was the only significant prognostic factor for survival (P = 0.0021).
  
  
  CONCLUSIONS
  The management of PNHLB should be based on histologic grade. Patients with low-grade disease may be managed with local therapy alone. The role of chemotherapy in this group is unclear. Patients with intermediate- or high-grade disease have better outcome if chemotherapy is included. An unusual site of distant dissemination for these patients is the CNS. The only significant prognostic factor for survival is Ann Arbor stage.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA. wong.william@mayo.edu
authors.forename: William W
authors.initials: WW
authors.lastname: Wong
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
authors.forename: Michele Y
authors.initials: MY
authors.lastname: Halyard
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Schomberg
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality* / Q000601:surgery; D018567:Breast Neoplasms, Male / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality* / Q000601:surgery; D008297:Male; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome