Extranodal lymphoma of the head and neck: a review of 49 consecutive cases.

One thousand and two consecutive patients with lymphoma were referred to the Regional Radiotherapy and Oncology Centre at Weston Park Hospital, Sheffield from 1970 to 1982 inclusive. Four hundred and seventy (47%) of the lymphomas occurred in the head and neck and 49 (10.4%) of these were extranodal. These 49 patients with primary extranodal lymphoma of the head and neck were reviewed with regard to clinical presentation, histological grade, treatment and survival. The specialists involved in the initial diagnosis were, in order of frequency, ear, nose and throat surgeons, general surgeons, ophthalmic surgeons and oral surgeons. Tonsillar and thyroid lymphomas occurred most frequently and constituted 71.0% of this series. All extranodal lymphomas were non-Hodgkin's lymphomas and two-thirds were graded as histologically unfavourable. Clinical staging showed that 65% of tonsillar lymphomas had local lymph node involvement at the time of diagnosis (Stage II); only 25% of lymphomas from other sites were Stage II. Radiotherapy was the primary treatment and was associated with a cumulative survival rate of 46.5%. Most recurrences were within 1 year and at distant sites. Recurrent disease had a poor prognosis with only 10% achieving lasting remission. Further analysis of cumulative survival after 6 years showed 65.7% for clinical Stage I, 40.9% for Stage II and 67.6% for histological Grade I, 29.9% for Grade II.