Stage I and II aggressive B-cell lymphomas of the head and neck: radiotherapy alone as a treatment option and the usefulness of the new prognostic index B-ALPS.

Abstract

To evaluate the outcome according to treatment modality and prognostic factors in clinical Stage I and II intermediate- or high-grade B-cell lymphomas of the head and neck. We analyzed 155 patients treated between 1983 and 1997, excluding those with the Working Formulation low-grade lymphomas. Of these patients, 88 had Stage I and 67 had Stage II disease. Forty-one patients were treated with radiotherapy (RT) alone, and 114 patients were treated with a combination of RT and chemotherapy. Most of the chemotherapy regimens included anthracycline derivatives. More patients with Stage I disease and more patients with poor performance status were treated with RT alone. The treatment results were evaluated according to the new prognostic index B-ALPS, consisting of tumor bulk, age, lactate dehydrogenase level, performance status, and stage. The 5-year overall and failure-free survival rate was 71.5% and 68.3%, respectively, for all 155 patients. The 5-year survival rate was 67% for those treated with RT alone and 73% for those treated with radiochemotherapy (p = 0.13). Among the various potential prognostic factors, age >60 years, World Health Organization performance status 2-4, and tumor size >or=6 cm were associated with poorer survival. The 5-year survival rate was 82% for those with no or one B-ALPS factor, 66% for those with two factors, and 49% for those with three or more factors (p <0.0001). The B-ALPS index appeared to predict the prognosis of these patients better than did the International Prognostic Index. No single prognostic factor was useful to identify patient groups more suitable to treatment with RT alone, but in patients with two B-ALPS risk factors, those treated with radiochemotherapy had a better survival rate and tended to have a better failure-free survival rate than those treated with RT alone. A proportion of patients with clinical Stage I or II head-and-neck B-cell lymphoma may be successfully treated with RT alone. B-ALPS is a useful prognostic index in this disease.