Head-and-neck stages I and II extranodal non-Hodgkin's lymphomas: Real classification and selection for treatment modality

Purpose: We re-evaluated histopathological specimens of head and neck early-stage extranodal non-Hodgkin's lymphoma (NHL) using the revised European and American lymphoma (REAL) classification, and also investigated the relationship between the clinical characteristics and histopathological classification in an attempt to evaluate the usefulness of this new classification system in selecting treatment modalities. Materials and Methods: Between 1979 and 1995, 117 patients with histologically confirmed stages I and II NHL of head and-neck extranodal regions were treated. Of these patients, 110 specimens were available for reevaluation. Sixty-four patients had Stage I, and 46 had Stage II diseases. All but 3 had received radiation therapy, and 59 patients were also treated with intensive combination chemotherapy. Results: There were 32 extranodal marginal-zone B-cell lymphomas, 57 diffuse large B-cell lymphomas, II peripheral T/NK-cell lymphomas, and 10 others. The 5- and 10-year cause-specific survival rates for all patients were 72% and 62%, respectively. Patients with extranodal marginal-zone B-cell lymphoma or other low-grade B-cell lymphomas demonstrated higher survival rates than patients,vith other lymphomas. Patients with peripheral T/NK lymphomas showed the lowest survival rate. Conclusion: The REAL classification accurately indicated the prognosis of patients with NHL. These results suggest that appropriate treatment modalities can be selected using this classification. (C) 2000 Elsevier Science Inc.