title: Extranodal nonorbital indolent lymphomas of the head and neck: relationship between tumor control and radiotherapy.
abstract: OBJECTIVE
  To review our experience managing extranodal nonorbital indolent lymphomas of the head and neck.
  
  
  METHODS
  A retrospective review was made of 40 patients with indolent lymphomas of the head and neck evaluated at Stanford. The tumor head-and-neck location was Waldeyer's ring, 14; salivary glands, 16; thyroid, 4; and other sites, 6. Twenty-five were Stage I-IIE. Pathology was re-reviewed in 37. The most common histologies were marginal zone lymphoma and follicular grade 2. Patients received combinations of surgery, chemotherapy, and radiotherapy. Local therapy included surgery alone in 6 patients, radiotherapy alone in 7, and surgery plus radiotherapy in 12. Median follow-up was 70.5 months.
  
  
  RESULTS
  Freedom from local progression was 86%, and freedom from progression was 61% at 5 years. Patients with radiotherapy had significantly better freedom from local progression (5-year, 100% vs. 72% for patients without radiotherapy, p = 0.006) and freedom from progression (5-year, 90% vs. 34% for patients without radiotherapy, p = 0.001). Improvement in freedom from progression with radiotherapy was statistically significant for Stage I-II patients (88% vs. 50%, p = 0.02) and of borderline significance in Stage III-IV patients (100% vs. 23%, p = 0.07). Overall survival at 10 years was 70%. Multivariate analysis revealed that significant prognostic factors for survival were tumor site (favoring salivary and thyroid, p = 0.02) and age (favoring younger, p = 0.04).
  
  
  CONCLUSIONS
  Survival is excellent in patients with indolent lymphomas of the head and neck. Patients with salivary and thyroid primary tumors had better survival compared with others. Early use of radiotherapy resulted in significantly higher rates of freedom from progression and freedom from local progression in early-stage patients.
authors.affiliation: Department of Radiation Oncology, Stanford University Medical Center, CA 94305, USA.
authors.forename: Dhara
authors.initials: D
authors.lastname: MacDermed
authors.forename: Lisa
authors.initials: L
authors.lastname: Thurber
authors.forename: Tracy I
authors.initials: TI
authors.lastname: George
authors.forename: Richard T
authors.initials: RT
authors.lastname: Hoppe
authors.forename: Quynh-Thu
authors.initials: QT
authors.lastname: Le
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D008224:Lymphoma, Follicular / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D010610:Pharyngeal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D016019:Survival Analysis