Patterns of failure in treatment of stage I and II diffuse malignant lymphoid tumors

Fifty-nine patients with Stage I and II diffuse malignant lymphoid tumors were irradiated between 1966 and 1979. Seventeen had primary lymph node disease and 42 had extranodal presentations. Local recurrence was noted in 1 of 14 evaluable lymph node presentations and 8 of 36 extranodal distributions. Failures occurred in unirradiated lymph nodes (contiguous or transdiaphragmatic) in 3 of 17 patients with lymph node disease and 6 of 42 with extranodal disease. Dissemination occurred in 4 of 17 lymph node presentations and 6 of 42 extranodal tumors. Local recurrence was low, particularly among lymphatic tumors. There was no identifiable dose effect for local control. Extension to contiguous or distant lymph nodes occurred in 15% of cases. The authors suggest that the transdiaphragmatic lymph nodes be included when treating patients with lymph node tumors. The role of adjuvant chemotherapy remains unproved.