Clinical Features and Prognostic Factors in 135 NHL of the Head and Neck Treated by the GOELAMS 02 Trial.

From November 1984 till April 1996 135 patients (67% M, 33% F) presenting a NHL of the head and neck were treated by the GOELAMS 02 trial (3 VCAP + 40 Gy locoregional irradiation). The median age was 48.5 years (17–69) with 36 patients being 60 or over. The main localization was Waldeyer’s ring (57) including tonsil (35), nasopharynx (14), whole Waldeyer (8), neck (49), nasal cavities (14), thyroid (8) salivary gland (5), mandibular bone (2). According to the WFC, histological subtype were as F (21%), G (57%) and H (20%) and unclassified (2%). Ann Harbor classification included 80 stage 1 and 55 stage II. The IPI score was 0 (49.7%), 1 (22.3%), 2 (10.4%), 3 (2.3%) undetermined (16,3%). PS>2 and bulk (= 5 cm) were observed in 7.5% and 43% of patients respectively. 94% achieved CR. 2 patients died during treatment. Relapses occurred in 23/127 (18.1%) at a median time of 31 months (5.5 – 80). 16 of these relapses occurred before 3 years of CR, 5 between 3 and 6 years and 2 after 6 years of CR. With a median follow up of 65 month (7 – 146) OS and EFS were 81.5% and 77% respectively. In univariate analysis age = 60, extension, PS >2, Bulk = 5 cm, erythrocyte sedimentation rate > 40 and high serum LDH significantly decrease EFS (P= 0.01, 0.047, 0.028, 0.0001, 0.004 and 0.03 respectively). In multivariate analysis only the bulk = 5 cm and the localization to salivary gland significantly decrease EFS( P=0.003 and 0.039 respectively). Even if larger studies are needed to confirm these findings, NHL of the head and neck localized to the salivary gland or having a bulk = 5 cm should already be included in new therapeutic trials in order to improve their outcome.