Purpose: In combined modality treatment of early stage, high grade non-Hodgkin's lymphoma disease status after initial chemotherapy was analyzed to evaluate the impact of remission status on survival. Analysis of relapse patterns was performed to assess efficacy of radiation doses and volume.
Patients and methods: Fifty-four patients with early stage high grade non-Hodgkin's lymphoma were treated with radiotherapy alone or with initial chemotherapy followed by involved field irradiation. Overall survival, relapse-free survival and relapse patterns were analyzed.
Results: In patients treated with radiotherapy alone (stage I n = 15, stage II n = 8) overall survival rate was 69%, relapse-free survival was 35% at 3 years. Patients achieving combined modality treatment (stage I n = 5, stage II n = 26) showed an actuarial 3 year overall survival of 78%, relapse-free survival was 62%. Complete remission status after chemotherapy was an important factor for durable disease control. Those patients, who achieved complete remission after chemotherapy showed an actuarial relapse-free survival of 75% at 3 years. Patients with partial remission or progressive disease after chemotherapy had a poor outcome (relapse-free survival 35%). Analysis of the first manifestation of lymphoma progression after radiotherapy in relation to the treatment portals demonstrated radiotherapy to be highly effective in achieving local control. Only 8% of recurrences occurred within the irradiated volume. 56% of failures were found in non-contiguous sites to the former radiation portals.
Conclusion: This analysis suggests that effective chemotherapy in combination with involved field radiotherapy in CS I (with risk factors) and especially in CS II patients is necessary to control extension of non-Hodgkin's lymphoma.