Thyroid Lymphoma Treatment & Management

Updated: Jan 18, 2017
  • Author: Fernando Cabanillas, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Treatment

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 [hydroxydoxorubicin], vincristine [Oncovin], prednisone) regimen and radiation therapy. As many as 90% of cases are failure-free after this approach. [15] 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%. [16] 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. [17]

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. [18]

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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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