Head and neck extra nodal NHL (HNENL) - Treatment Outcome and Pattern of failure - A Single Institution Experience

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) andradiotherapy (RT) is considered optimum. Materials and
Methods: We retrieved the treatment charts of patientsof HNENL treated in our institute from 2001-2012. The charts were reviewed and the demographic, treatmentdetails and outcome of HNENL patients were retrieved using predesigned pro-forma.
Results: We retrieveddata of 75consecutive patients HNENL. Median age was 47years (Range: 8-76 years). Of the 75 patients 51 weremale and 24 were female. 55patients were evaluable. The patient and tumor characteristics are summarizedin 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 combinationmulti-agent CT with CHOP being the commonest regimen. 42 patients received 4 or lesser number of cycles ofchemotherapy whereas 24received more than 4 cycles chemotherapy. Post radiotherapy, 41 out of 42 patientshad a complete response at 3 months. Only 21patients had a complete response after chemotherapy. All patientsreceived radiation (mostly involved field radiation) as a part of the treatment. The median radiation dose was45 Gray (Range: 36 Gray-50 Gray). The radiation was planned by 2D fluoro simulation based technique in37cases and by 3 Dimensional conformal radiation therapy (3DCRT) in 36 cases. Two patients were planned bythe intensity modulated radiation therapy (IMRT) technique. IMRT was planned for one thyroid and one nasalcavity primary. 5 patients experienced relapse after a median follow up of 19 months. The median survival wasnot 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 tobe significantly associated with worse progression free survival. 5 patients progressed (relapse or primary diseaseprogression) after treatment. Of the 5 patients, two patients were primary orbital NHL, two patients had NHLnasal cavity and one was NHL thyroid.
Conclusions: Combined modality treatment in HNENL confers excellentdisease control with acceptable side effects.