THREE COURSES OF CHEMOTHERAPY AND RADIOTHERAPY COMBINATION IN EARLY STAGE (STAGE I-II) AGRESSIVE LYMPHOMA OF THE HEAD AND NECK

From November 1992 through November 1996, 20 patients with lymphoma present with diffuse histology in the head and neck treated with three courses of CHOP followed by involved field radiation therapy. There were 13 males and 7 females with a median age of 58 years. Extranodal involvement in the patients with Ann Arbor stage I and II was 70%, and Waldeyer's ring was the most common site. Histologic types according to the Working Formulation were diffuse mixed, diffuse large-cell and immunoblastic lymphomas. Fourteen patients achieved a complete response and 6 patients a partial response at the end of three courses chemotherapy. Acute toxicity was observed in 3 patients during chemotherapy, in one patient vincristine dosage was reduced, and the other two patients had a delay in the treatment program. Approximately 3 weeks after the completion of chemotherapy program, patients received 40-50 Gy radiation therapy; to the head and neck region. All of the patients who achieved a partial response with chemotherapy attained a complete response after the completion of radiotherapy. No Grade 3 toxicity was observed. One patient developed a relapse in the head and neck region but outside the irradiated areas after 3 months. Although the number of patient is small and the follow-up is short, we concluded that this combined treatment modality can be an effective method in early stage agressive lymphoma of the head and neck.