CHICAGOLow-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 disease.
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 lymphoma.