Radiation therapy of Waldeyer's ring lymphoma

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Abstract
Forty‐nine patients with biopsy‐proven Waldeyer's ring lymphoma were treated with radiation therapy between 1968 and 1979; 45 to 50 Gy were given to Waldeyer's ring structures with a 5‐ to 10‐Gy boost to the primary site. Uninvolved low cervical nodes received 40 to 50 Gy. Chemotherapy was reserved for treatment failures. Actuarial 5‐year survival was 53%, disease‐free survival was 48%, and local control was 98%. Patients with Stage I disease fared better than patients with Stage II disease, and unilateral adenopathy conferred a better prognosis than bilateral adenopathy. When classified by the Rappaport system, nodular lymphomas had a better prognosis than diffuse lymphomas, and of the diffuse lymphomas, histiocytic lymphoma was a more lethal disease than lymphocytic lymphoma. Patients with diffuse undifferentiated lymphomas in the Rappaport system, or high‐grade lymphomas in the Working Formulation, fared poorly. Most relapses were systemic, and actuarial 5‐year survival after salvage was only 20%. A logical approach to the treatment of this disease can be based on these prognostic features.