Management of localized (stage I and II) clinically aggressive lymphomas

The treatment for non-Hodgkin's lymphomas is chiefly dependent on the histologic type and the anatomic extent of the disease, reflected by the stage. In the past 30 years, the treatment of localized large cell lymphomas has evolved from the use of radiotherapy (RT) alone to the routine use of combined modality therapy (CMT). Randomized controlled trials have shown superiority of the CMT approach as compared to RT alone, or chemotherapy alone. The data will be critically appraised in this review. Currently, approximately two-thirds of patients with stage I and II clinically-aggressive lymphomas will be cured with initial planned combined modality therapy. The clinical prognostic factors predicting refractory or relapse disease are now clearly recognized, and they are: older age, stage II disease, high lactate dehydrogenase (LDH), poor performance status, and bulky disease. Patients with poor-risk features are candidates for clinical trials to examine the potential benefits of initial treatment intensification programs. Elderly patients over the age of 60 years account for about half of the patients with lymphoma, and they may tolerate therapy less well. They are a special subgroup where prospective studies are required to determine the optimal management.