title: Long-term outcomes and patterns of relapse of early-stage extranodal marginal zone lymphoma treated with radiation therapy with curative intent.
abstract: OBJECTIVE
  To report the long-term outcome and patterns of relapse of a large cohort of marginal zone lymphoma (MZL) patients treated with curative-intent radiation therapy (RT) alone.
  
  
  METHODS
  We reviewed the charts of 490 consecutive patients with stage IE or IIE MZL referred between 1992 and 2012 to our institution. Of those, 244 patients (50%) were treated with RT alone. Pathology was confirmed by hematopathologists at our institution. Patient and disease factors were analyzed for association with relapse-free survival (RFS) and overall survival (OS).
  
  
  RESULTS
  Median age of the cohort was 59 years, and median follow-up was 5.2 years. Ann Arbor stage was IE in 92%. Most common disease sites were stomach (50%), orbit (18%), non-thyroid head-and-neck (8%), skin (8%), and breast (5%). Median RT dose was 30 Gy. Five-year OS and RFS were 92% and 74%, respectively. Cumulative incidence of disease-specific death was just 1.1% by 5 years. Sixty patients (24%) developed relapse of disease; 10 were in the RT field. Crude rate of transformation to pathologically confirmed large-cell lymphoma was 1.6%. On multivariable analysis, primary disease site (P=.007) was independently associated with RFS, along with age (P=.04), presence of B-symptoms (P=.02), and International Prognostic Index risk group (P=.03). All disease sites except for head-and-neck had worse RFS relative to stomach.
  
  
  CONCLUSIONS
  Overall and cause-specific survival are high in early-stage extra-nodal MZL treated with curative RT alone. In this large cohort of 244 patients, most patients did not experience relapse of MZL after curative RT; when relapses did occur, the majority were in distant sites. Stomach cases were less likely to relapse than other anatomic sites. Transformation to large-cell lymphoma was rare.
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Sewit
authors: S
authors: Teckie
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Shunan
authors: S
authors: Qi
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Shona
authors: S
authors: Lovie
authors: Weill Cornell Medical College, New York, New York.
authors: Scott
authors: S
authors: Navarrett
authors: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Meier
authors: M
authors: Hsu
authors: Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Ariela
authors: A
authors: Noy
authors: Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Carol
authors: C
authors: Portlock
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: yahalomj@mskcc.org.
authors: Joachim
authors: J
authors: Yahalom
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D002423:Cause of Death; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced; D016609:Neoplasms, Second Primary / Q000209:etiology; D009918:Orbital Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D012008:Recurrence; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D016896:Treatment Outcome