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Grade Dictates Treatment of Primary NHL of the Breast

Grade Dictates Treatment of Primary NHL of the Breast

CHICAGO—Low-grade primary non-Hodgkin’s lymphoma (NHL) of the
breast may be treated with local surgical excision with or without radiation
therapy. Intermediate- or high-grade disease requires chemotherapy, however,
said William Wong, MD, radiation oncologist, Mayo Clinic, Scottsdale, Arizona,
at the 86th Annual Meeting of the Radiological Society of North America (RSNA).

Although 55,000 new cases of non-Hodgkin’s lymphoma will be diagnosed in
the United States this year, an extremely small number will involve the breast.
A retrospective study of all patients with non-Hodgkin’s lymphoma of the
breast treated at the Rochester and Scottsdale Mayo Clinics between 1973 and
1998 uncovered only 25 women and one man with breast involvement.

These individuals were studied to gain insight into this rare disease by
identifying relevant patient characteristics and prognostic factors, the
natural history of this form of lymphoma, and the effect of various forms of
treatment, Dr. Wong said.

Most of the patients in the study presented with a palpable breast mass; the
median tumor size was 3.6 cm. Ten patients had lymphoma in the left breast, 14
in the right breast, and two in both breasts.

Based on the Working Formulation, 11 patients were classified as having
low-grade non-Hodgkin’s lymphoma, 14 had intermediate-grade disease, and one
patient had high-grade disease. Using the Ann Arbor staging method, 21 patients
were determined to have stage I non-Hodgkin’s lymphoma and 5 had stage II

Most patients (23) underwent local excision of the breast mass, while three
had mastectomy, Dr. Wong said. Sixteen patients received radiotherapy after
surgery, with the radiation dose ranging from 20 to 50.4 Gy (median, 35 Gy).
Ten patients had radiation field therapy that included the breast, chest wall,
and regional lymph nodes, and four patients had radiation field therapy
confined to the breast.

Ten patients received chemotherapy as part of their initial treatment
strategy. Nine of these patients had combination chemotherapy, and one was
treated with a single chemotherapeutic agent for low-grade non-Hodgkin’s


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