Approach Considerations
The management of thyroid lymphoma does not differ significantly from that of any other lymphoma presenting in a nodal site, and is similarly sensitive to combined-modality therapy of chemotherapy and radiation therapy (RT). 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).
In a multicentric retrospective study of 58 patients with primary DLBCL of the thyroid, Yi et al reported that the patients who received chemotherapy with RT had better survival than those treated with chemotherapy only or surgical excision alone; 5-year overall survival (OS) and progression-free survival rates (PFS) were 81.2% and 77.8%, respectively, for the 25 patients who received chemotherapy plus RT, 60.9% and 53.9% for the 18 patients who received chemotherapy alone, and 35.3% and 31.6% for the 15 patients who underwent surgical excision. In addition, OS and PFS rates were higher in patients whose chemotherapy regimens included rituximab (R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone] versus CHOP). [16]
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 the aforementioned study of 58 patients with primary thyroid DLBCL, only 10 patients experienced relapse of disease and had to receive different lines of chemotherapy. [16]
After 3 years of follow-up, the probability of cure in a patient with diffuse large-cell lymphoma is greater than 90%. In contrast, the risk of recurrence for the low-grade (ie, indolent) lymphoma types does not decline as sharply after 2 years of observation.
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Rapidly enlarging thyroid mass occurring in association with neck adenopathy.
