Based on the third edition of the International Classification of Disease for Oncology (ICD-O-3) codes for histology (9680) and topography (C09.9), we included patients histologically diagnosed as PT-DLBCL. SEER accounts for cancer registries covering approximately 28% of the U.S. This retrospective cohort study was performed using data from the Surveillance, Epidemiology, and End Results (SEER) 18 registry (1975–2016 varying) database. Based on these evidence, the necessity of applying RT in PT-DLBCL remains controversial and requires further investigation. A retrospective research on the role of consolidative RT after the rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) immunochemotherapy in early-stage DLBCL of Waldeyer’s ring concluded no survival advantage of RT in these patients.
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To our knowledge, the introduction of anti-CD20 antibody rituximab has significantly improved the response, disease free survival and OS of patients with DLBCL since 2002. Moreover, radiation at this special anatomical site of head and neck field may cause acute and chronic events that exhibit negative effect on the quality of patients’ life or survival, such as oral mucositis, dental decay, xerostomia, hypothyroidism and secondary malignancy. Whereas study from the International Extranodal Lymphoma Study Group (IELSG) showed consolidation RT did not prolong lymphoma specific survival in patients with early-stage DLBCL of Waldeyer’s ring in remission after anthracycline-containing CT. An Indian study reported in patients with DLBCL of the tonsil, chemotherapy (CT) + RT resulted in a significantly better outcome than those treated with CT alone and the complete response (CR) and OS rate were significantly better for patients receiving an RT dose ≧ 45 Gy. However, over 40% of these patients relapsed at sites outside the primary radiation field. The majority of PT-DLBCL patients present with localized disease (stage, I/II) and radiation therapy (RT) alone reported as an effective treatment option for these patients, resulting in a 5-year overall survival (OS) of 50%. Patients with PT-DLBCL often present as a sore throat and dysphagia, with sign of tonsillar swelling and cervical adenopathy. Recently, primary tonsil DLBCL (PT-DLBCL) used to be regarded as extranodal lymphoma has been reclassified as nodal lymphoma. The most common histologic subtype of PTL is diffuse large B cell lymphoma (DLBCL). It accounts for more than half of non-Hodgkin’s lymphoma (NHL) in the head and neck and nearly 40–60% of these patients present as primary tonsil lymphoma (PTL). Waldeyer’s Ring is a circular region of lymphoid tissue which consists mainly of nasopharynx, oropharynx, tonsils and the base of tongue. The established nomogram helps to identify high risk patients to improve prognosis. This population-based study encloses the largest sample of PT-DLBCL to date and demonstrates a favorable survival role of RT in early stages rather than advanced stages. Subgroup analysis revealed RT was significantly associated with overall survival in ES patients of PT-DLBCL ( P = 0.001) and in the rituximab era ( P = 0.001) but not in those with AS disease ( P = 0.241). A nomogram was established to predict the potential survival benefit. PSM analysis further validated the survival advantage of RT ( P = 0.002). RT significantly improved overall survival in both univariate ( P < 0.001) and multivariate ( P = 0.002) analyses. 47.4% of patients in ES received RT, whereas 25.1% in AS underwent RT. A decreasing trend of RT utilization in the ES cohort after 2002 was observed. The entire cohort included 1043 patients with early-stage (ES) PT-DLBCL and 171 patients with advanced-stage (AS) disease.
The effect of RT was assessed for the entire cohort and subgroups by stages using univariate, multivariate Cox regression analyses and propensity score matching (PSM).
Materials and methodsĭata of 1214 PT-DLBCL patients diagnosed between 19 were extracted from SEER 18.
The purpose of this study was to evaluate the treatment outcome and establish a prognostic model in PT-DLBCL based on the Surveillance, Epidemiology, and End Results (SEER) database. The role of radiation therapy (RT) in PT-DLBCL is debatable in both the pre- and post- rituximab era. Primary tonsil diffuse large B cell lymphoma (PT-DLBCL) is an uncommon disease entity.
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