title: Bulky disease has an impact on outcomes in primary diffuse large B-cell lymphoma of the breast: a retrospective analysis at a single institution.
abstract: OBJECTIVE
  Primary breast lymphoma (PBL) is rare, and its clinical behavior and standard initial treatment are not yet established.
  
  
  METHODS
  We retrospectively analyzed the clinicopathological features and treatment outcomes of 14 patients with primary breast diffuse large B-cell lymphoma.
  
  
  RESULTS
  There were nine patients with stage IE and five with stage IIE disease. The median largest tumor diameter was 4.5 cm, and five patients had bulky disease >5 cm. The complete response rate was 94%. However, the 5-year progression-free survival rate was 52% with a median follow-up of 5.2 years. Patients with bulky disease had an unfavorable prognosis. All five patients with bulky disease progressed or relapsed. Of the four patients that recurred in the central nervous system (CNS), three had bulky disease although some received rituximab. There were no CNS recurrences in the three patients who received CNS prophylaxis. All eight patients who responded to radiotherapy (RT) did not have recurrences in the ipsilateral breast, although one patient with bulky disease relapsed in the adjacent regional lymph nodes within the RT field despite immunochemotherapy.
  
  
  CONCLUSIONS
  Patients with bulky disease had a poorer prognosis and recurred frequently in the CNS. CNS prophylaxis might yield better outcomes, but a larger, prospective trial is needed to elucidate the optimal initial treatment of PBL in the rituximab era.
authors: Department of Hematology, and Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.
authors: Suguru
authors: S
authors: Fukuhara
authors: Takashi
authors: T
authors: Watanabe
authors: Wataru
authors: W
authors: Munakata
authors: Masakazu
authors: M
authors: Mori
authors: Dai
authors: D
authors: Maruyama
authors: Sung-Won
authors: SW
authors: Kim
authors: Yukio
authors: Y
authors: Kobayashi
authors: Hirokazu
authors: H
authors: Taniguchi
authors: Akiko M
authors: AM
authors: Maeshima
authors: Ryuji
authors: R
authors: Tanosaki
authors: Yoshihiro
authors: Y
authors: Matsuno
authors: Kensei
authors: K
authors: Tobinai
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D016543:Central Nervous System Neoplasms / Q000473:pathology / Q000517:prevention & control; D003520:Cyclophosphamide / Q000008:administration & dosage; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone