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Thyroid Lymphoma Treatment & Management

  • Author: Fernando Cabanillas, MD; Chief Editor: Emmanuel C Besa, MD  more...
 
Updated: Aug 12, 2014
 

Chemotherapy and Radiation Therapy

Large-cell lymphoma

The management of thyroid lymphoma does not differ significantly from that of any other lymphoma presenting in a nodal site. Data suggest that the best results are obtained with combined-modality therapy that includes the CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) regimen and radiation therapy. As many as 90% of cases are failure-free after this approach.[12] The number of courses of chemotherapy administered can be limited to three for patients with localized stage I-II, especially those with good prognostic features (ie, an International Prognostic Index [IPI] of 0 and tumor less than 5 cm in diameter).

Radiation therapy is used to consolidate the response to CHOP for those receiving only three courses. Currently, rituximab is given as part of the CHOP regimen (R-CHOP). However, patients with an IPI greater than 1 should be managed with six courses of R-CHOP, based on the results discussed below.

In the LNH-98.5 study, conducted in 399 patients 60-80 years of age with diffuse large B-cell lymphoma, 10-year progression-free survival was 36.5% with R-CHOP, versus 20% for CHOP alone, and 10-year overall survival rates were 43.5% versus 27.6%.[13] The results can be applied to primary thyroid lymphoma. Although the study did not include patients younger than 60 years, another study found that such patients have also benefitted from rituximab.[14]

Radiation therapy is most commonly delivered after three to six courses of R-CHOP chemotherapy. The radiation fields most commonly used are either involved field or modified mantle, which includes the thyroid, the bilateral neck and supraclavicular region, and the mediastinum.[15]

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Long-Term Monitoring

Follow-up care for patients with thyroid lymphoma is similar to that for patients with any other lymphoma. In brief, patients should be seen approximately every 3 months during the first year and every 4 months during the second year. After the second year, the risk of relapse diminishes substantially for patients with tumors of the large-cell (ie, aggressive) types.

In contrast, the risk of recurrence for the low-grade (ie, indolent) lymphoma types does not decline as sharply after 2 years of observation. After 3 years of follow-up, the probability of cure in a patient with diffuse large-cell lymphoma is greater than 90%.

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Contributor Information and Disclosures
Author

Fernando Cabanillas, MD Professor of Medicine, University of Puerto Rico School of Medicine; Adjunct Professor of Medicine, MD Anderson Cancer Center, University of Texas Medical School at Houston; Adjunct Professor, Moffitt Cancer Center; Medical Director, Auxilio Mutuo Cancer Center, Puerto Rico

Fernando Cabanillas, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association for Cancer Research, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, New York Academy of Sciences, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Acknowledgements

Lodovico Balducci, MD Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute

Disclosure: Nothing to disclose.

Wendy Hu, MD Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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