Extranodal lymphoma of the head and neck area

Records of 64 patients with extranodal lymphoma of the head and neck area treated at this institution between 1965 and 1982 have been reviewed. Of these cases, 78% had Stage I-EA disease, 20% had Stage II-EA disease, and 2% had Stage III-EA disease. Excluded from this study were patients of the pediatric age, patients with previous chemotherapy and surgery, patients in whom extranodal involvement has been a terminal manifestation of wide-spread disease, and patients with nodal involvement with extension of disease outside the lymph nodes. Patients with a histiocytic histology accounted for 63%, 28% were of lymphocytic histologies, 4.5% were of mixed histologies, and in 4.5% a diagnosis of lymphoma or benign lymphocytic proliferation had been made. The paranasal sinuses, nasal cavity, and oral cavity were the most frequent sites of involvement, making up 39% of the cases--with the orbit, central nervous system, nasopharynx, salivary glands, thyroid, skin, and larynx following in that order of frequency. All patients received a definitive course of radiotherapy, except patients with CNS involvement. In no case was chemotherapy given concomitantly with the radiation therapy. One-third of the patients did require chemotherapy at a later time for progression of disease. No patients were lost to follow-up. Seven patients with primaries of the brain were inevaluable for response; however, all patients having visible or palpable tumors achieved a complete response (100%), and there was no recurrence or persistent disease in the field of therapy. The next area of disease involvement depended on the site of the primary. Nodal involvement following extranodal disease carried a poor prognosis.