title: Primary diffuse large B-cell lymphoma of the tonsil: is a higher radiotherapy dose required?
abstract: BACKGROUND
  The purpose was to evaluate the prognostic factors and treatment outcome of Indian patients with primary diffuse large B-cell lymphoma (DLBCL) of the tonsil treated at a single institution.
  
  
  METHODS
  In all, 121 patients with DLBCL of the tonsil, treated at the Tata Memorial Hospital, Mumbai, India, from January 1990 to December 2002, were included. The median age was 45 years and the majority of patients (68%) were males. Systemic symptoms were present in 12% of patients; 28% presented with stage I and 67% had stage II disease. Treatment consisted of a combination of chemotherapy (CTh) and radiotherapy (RT) for the majority of patients (69.4%). Among those receiving RT, 64% received an RT dose of > or =45 Gy.
  
  
  RESULTS
  After a median follow-up of 62 months, disease-free survival (DFS) and overall survival (OS) were 66.4% and 81.6%, respectively. Significant prognostic factors included: WHO performance score > or =2 (OS: 72.1% vs 95.6%, P = .016), bulky tumors (OS: 68.5% vs 86.9%, P = .001), presence of B-symptoms (OS: 36.7% vs 79.6%, P < .001), and Ann Arbor stage. On multivariate analysis; WHO performance score > or =2 (hazard ratio [HR], 4.27; 95% confidence interval [CI], 1.20-15.12), and B symptoms (HR, 6.27; 95% CI, 2.38-16.48), retained statistical significance. CTh + RT resulted in a significantly better outcome than those treated with CTh alone (OS: 85.7% vs 70.7%, P = .008). The complete response (P = .053), DFS (P = .039), and OS (P = .014) rates were significantly better for patients receiving an RT dose > or =45 Gy.
  
  
  CONCLUSIONS
  Tumor bulk, WHO performance score, the presence of B symptoms, and Ann Arbor stage significantly influence outcome. A combined modality treatment, consisting of CTh and RT (with an RT dose of > or =45 Gy), results in a satisfactory outcome in patients with this uncommon neoplasm.
authors.affiliation: Department of Radiation Oncology, Tata Memorial Centre, Tata Memorial Hospital, Mumbai, India. laskars2000@yahoo.com
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Laskar
authors.forename: Gaurav
authors.initials: G
authors.lastname: Bahl
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Muckaden
authors.forename: Reena
authors.initials: R
authors.lastname: Nair
authors.forename: Sudeep
authors.initials: S
authors.lastname: Gupta
authors.forename: Ashish
authors.initials: A
authors.lastname: Bakshi
authors.forename: Sumeet
authors.initials: S
authors.lastname: Gujral
authors.forename: Tanuja
authors.initials: T
authors.lastname: Shet
authors.forename: Shyam Kishore
authors.initials: SK
authors.lastname: Shrivastava
authors.forename: Ketayun Ardeshir
authors.initials: KA
authors.lastname: Dinshaw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D016896:Treatment Outcome