Introduction: Head and neck is the second most common site of localized
extranodal presentation of non-Hodgkin’s lymphomas and it is at high risk
of CNS recurrence.
Aim of the study: To evaluate the clinical outcome, prognostic factors
and the rate of CNS recurrence in patients with HN-DLBCL.
Patients and Methods: From December 1982 to June 2004, 309 patients
with HN-DLBCL (median age 60 yrs, range 18–91) were referred to 9
international centers. The most common sites were Waldeyer’ring (68%),
nose and paranasal sinuses (10%) and tyroid (8%). Adverse prognostic
features included: stage II (67%), elevated LDH (16%), bulky disease
(11%), No of extranodal sites >1(9%), B symptoms (8%), ECOG-PS >1
(8%) and stage-modified IPI (MIPI) >1 (50%). Two hundred sixty patients
(84%) were given CHOP or CHOP-like regimen ± IFRT. Only few
patients 26/260 (10%) received CNS prophylaxis (Methotrexate 12 mg i.t.;
median of cycles 3, range 1–6).
Results: Two hundred sixty two patients (85%) achieved a complete
remission and 60 (23%) of them eventually relapsed, in the same site
(40%), in other sites (53%) and 7% in both. Only 1/234 (0.4%) patients,
who did not receive prophylaxis, relapsed in CNS. After a median followup of 42 months (range 6–220 months), 5-year estimate of OS, EFS
and DFS was 72%, 55% and 73%, respectively. By Cox multivariate analysis, a risk factor >1 according to MIPI predicted a poor EFS.
Conclusions: The present study showed a very low rate of CNS recurrence in high risk patients, who did not receive adequate prophylaxis,
suggesting that CNS prophylaxis could not be mandatory in HN-DLBCL
patients. This should be confirmed by prospective studies of clinical
outcome
