Non-Hodgkin's Lymphoma of Waldeyer's Ring in Children: Outcome using Chemotherapy and Involved Field Radiotherapy

Abstract 

Aim

To evaluate the prognostic factors and treatment outcome of children with non-Hodgkin's lymphoma (NHL) of Waldeyer's ring treated at a single institution.

Materials and methods

Thirty-two children with NHL of Waldeyer's ring treated at our institute between January 1990 and December 2001 were included in this analysis. The median age at presentation was 14 years, and most of the patients (87%) were boys. The most common histological subtype was diffuse large B-cell lymphoma (75%), 25% patients had stage I and 75% had stage II disease. Treatment comprised a combination of chemotherapy and radiotherapy in most of the patients (75%). Among these patients, 71% received a radiotherapy dose of ≥45Gy.

Results

After a median follow-up of 45 months, the 5-year disease-free and overall survival rates were 76.5 and 83.2%, respectively. Age >10 years (P=0.032), bulky tumours (P=0.001) and the presence of B-symptoms (P=0.004) had a negative influence on disease-free survival. Patients treated with a combination of chemotherapy and radiotherapy had a better outcome than patients treated with chemotherapy alone (disease-free survival: 87.1% vs 56.2%, P=0.056). The complete response (P=0.003), disease-free survival (P=0.001) and overall survival (P=0.001) rates were significantly better for patients receiving a radiotherapy dose ≥45Gy.

Conclusion

The age at diagnosis, the size of the tumour, and the presence of B-symptoms significantly influenced the outcome of children with NHL of Waldeyer's ring in this study. A combined modality treatment, comprising chemotherapy and radiotherapy, resulted in a satisfactory outcome in patients with this rare neoplasm.

Key words: Children, extranodal lymphoma, non-Hodgkin's lymphoma, Waldeyer's ring