title: Head and neck extra nodal NHL (HNENL)--Treatment Outcome and Pattern of failure--A Single Institution Experience.
abstract: BACKGROUND
  Extra nodal lymphoma (ENL) constitutes about 33 % of all non-Hodgkin's lymphoma. 18-28% develops in the head and neck region. A multimodality treatment with multi-agent chemotherapy (CT) and radiotherapy (RT) is considered optimum.
  
  
  METHODS
  We retrieved the treatment charts of patients of HNENL treated in our institute from 2001-2012. The charts were reviewed and the demographic, treatment details and outcome of HNENL patients were retrieved using predesigned pro-forma.
  
  
  RESULTS
  We retrieved data of 75 consecutive patients HNENL. Median age was 47 years (Range: 8-76 years). Of the 75 patients 51 were male and 24 were female. 55 patients were evaluable. The patient and tumor characteristics are summarized in Table 1. All patients were staged comprehensively with contrast enhanced computed tomography of head, neck, thorax, abdomen, pelvis and bone marrow aspiration and biopsy 66 patients received a combination multi-agent CT with CHOP being the commonest regimen. 42 patients received 4 or lesser number of cycles of chemotherapy whereas 24 received more than 4 cycles chemotherapy. Post radiotherapy, 41 out of 42 patients had a complete response at 3 months. Only 21 patients had a complete response after chemotherapy. All patients received radiation (mostly involved field radiation) as a part of the treatment. The median radiation dose was 45 Gray (Range: 36 Gray-50 Gray). The radiation was planned by 2D fluoro simulation based technique in 37 cases and by 3 Dimensional conformal radiation therapy (3DCRT) in 36 cases. Two patients were planned by the intensity modulated radiation therapy (IMRT) technique. IMRT was planned for one thyroid and one nasal cavity primary. 5 patients experienced relapse after a median follow up of 19 months. The median survival was not reached. The estimated two and three year survival were 92.9% (95%CI-68.6-95.35) and 88% (95%CI-60.82-92.66) respectively. Univariate analysis revealed higher stage and poorer baseline performance status to be significantly associated with worse progression free survival. 5 patients progressed (relapse or primary disease progression) after treatment. Of the 5 patients, two patients were primary orbital NHL, two patients had NHL nasal cavity and one was NHL thyroid.
  
  
  CONCLUSIONS
  Combined modality treatment in HNENL confers excellent disease control with acceptable side effects.
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi E-mail : drsupriyamallick@gmail.com.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Giridhar
authors.forename: Supriya
authors.initials: S
authors.lastname: Mallick
authors.forename: Suman
authors.initials: S
authors.lastname: Bhasker
authors.forename: Sushmita
authors.initials: S
authors.lastname: Pathy
authors.forename: Bidhu Kalyan
authors.initials: BK
authors.lastname: Mohanti
authors.forename: Ahitagni
authors.initials: A
authors.lastname: Biswas
authors.forename: Atul
authors.initials: A
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059248:Chemoradiotherapy; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000628:therapy*; D006304:Health Status; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone