Lymphoepithelioma is a rare tumor of the head and neck region, the optimal management of which remains to be defined. We evaluated and report on management outcomes from a large cohort of patients with modern management for this diagnosis.
Ron R. Allison, MD, Sharon A. Salenius, MPH, Andrej Hnatov, MD, Cynthia Ballenger, MD, Steven E. Finkelstein, MD, Constantine A. Mantz, MD, Eduardo Fernandez, MD, PhD, Daniel E. Dosoretz, MD; 21st Century Oncology
Background: Lymphoepithelioma is a rare tumor of the head and neck region, the optimal management of which remains to be defined. Treatment may include surgery, radiation, and chemotherapy. We evaluated and report on management outcomes from a large cohort of patients with modern management for this diagnosis.
Materials and Methods: An institutional review board (IRB)-approved retrospective chart review for primary lymphoepithelioma of the head and neck region returned 28 histologically proven cases diagnosed and treated between January 2001 and July 2012. Patient age ranged from 19–81 years, including 18 males and 10 females, with the majority being Caucasian. Most patients presented with an enlarging mass. Tumor originated in the nasopharynx in 12 patients (43%); tonsil in 5 (18%); base of tongue in 3; and 1 each in the pharynx, pyriform sinus, submandibular gland, and vallecula. Four patients presented with unknown primaries. Surgery beyond biopsy was undertaken in 54% (15 patients), including excision of the primary alone in 7 patients, with neck dissection in 6 additional patients, and nodal excision alone in 2 patients. All patients underwent photon external beam radiation (EBRT), most commonly intensity-modulated radiation therapy (IBRT) (75%), and with image guidance in 32%. The mean XRT dose was 67 Gy, with 10 patients receiving more than 70 Gy. Chemotherapy was delivered to 24 patients (86%), and was most commonly platinum-based.
Results: All patients have been followed a mean of 45 months. Acute treatment-related complications were generally grade 1/2 (57%), most commonly radiation dermatitis (61%), mucositis (50%), and dysphagia (36%). Late complications were all grade 1/2, most commonly xerostomia (32%). At last follow-up, 21 patients (75%) had no evidence of disease. One patient experienced locoregional failure alone, three had distant metastases alone, and three had both locoregional and distant failure. Statistical analysis reports chemotherapy as the only variable improving survival (P = .02).
Conclusions: Based on this series, modern management for lymphoepithelioma appears to favor definitive chemoradiation, as this allows for high local control and survival rates. Radiation dose escalation did not improve local control or survival. The addition of chemotherapy offered a statistically improved outcome and, if possible, appears to be part of any curative treatment regimen. Distant failure for this diagnosis is relatively high and needs to be addressed to improve outcomes.