Results of radiotherapy in stage I to II extranodal non-Hodgkin's lymphoma of the head and neck

29 patients with previously untreated clinical stage I and II extranodal non-Hodgkin's lymphoma of the head and neck received involved or extended field radiotherapy at the Northern Israel Oncology Center during the years 1968 to 1979. Complete initial locoregional control was achieved in all patients; however, 18 patients (62%) relapsed. Two of the relapsing patients (11%) had 'in field' failure, and one (6%) had 'marginal' failure, with no evidence of disease elsewhere. 13 of the relapsing patients (72%) failed at distant sites, and two of these (11%) both locally and systemically. 13 of 15 patients (87%) with lymphoma of Waldeyer's ring relapsed, most commonly in the abdominal cavity. Only one of seven patients (14%) with lymphoma of the paranasal sinuses recurred. The five- and ten-year actuarial survival of all patientrs was 50% and 46%, respectively. While patients with lymphoma of the paranasal sinuses had a survival probability of 86% at ten years, patients with disease originating in Waldeyer's ring had an actuarial ten-year survival of 18% only. The prognosis of younger patients was better than the prognosis of patients older than 65. Although this series is too small and heterogeneous to derive definite treatment recommendations, it is suggested that radiotherapy to doses of 4000 to 6000 cGy can control most local disease. The overall results of radiation therapy alone have been unsatisfactory in our patients with lymphoma of Waldeyer's ring and the parotid gland due to failure outside the locally treated area, frequently in the abdominal cavity. Precise staging procedures are needed to detect sites of occult disease which require the use of systemic chemotherapy. It is felt that adequately staged, localized, small size non-Hodgkin's lymphoma of the paranasal sinuses can be treated by radiotherapy alone without loss of curability.