Stage IA non-Hodgkin's lymphoma of the Waldeyer's ring. Limited chemotherapy and radiation therapy versus radiation therapy alone.
Seventeen patients with stage IA non-Hodgkin's lymphoma of the Waldeyer's were treated with radiation therapy with or without chemotherapy. All lesions were judged as having intermediate grade malignancy in the Working Formulation. Eight patients received combined treatment with three cycles of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) and radiation therapy with 30 to 40 Gy. Another 9 patients were treated with radiation therapy 40 to 60 Gy alone. After a median follow-up of 69 months, all 8 patients, treated with combined modality were alive and relapse-free, whereas 4 of the 9 treated with irradiation alone had relapsed. All relapses occurred trans-diaphragmatically. Two of the 4 relapsing patients were saved, but the other two died of the disease. The 5-year relapse-free and cause-specific survival rates were 100% and 100% in the combined modality group, and 56% and 76% in the radiation therapy alone group (relapse-free: p = 0.04, cause-specific: p = 0.16). There were no serious complications related to the treatment, although most patients complained of mouth dryness and most patients given CHOP had paresthesia. Our opinion was that the total impact of these two side-effects on quality of life was less pronounced after combined modality than after radiation therapy alone. Limited chemotherapy and radiation therapy seemed to be more beneficial than radiation therapy alone not only in relapse-free survival but also in quality of life after treatment.