Non-Hodgkin lymphoma is diagnosed by a tissue biopsy. If there is an enlarged, painless lymph node, without of an infection, a biopsy will be needed.
To perform a lymph node biopsy a doctor will cut into the lymph node to remove a sample of tissue or remove the entire lymph node. If the biopsy shows non-Hodgkin lymphoma, further testing will be needed to determine the specific type as well as to determine the stage of disease. Depending on your specific symptoms, the type of the lymphoma, its...
Standard Treatment Options for Aggressive, Stage I and Contiguous Stage II Adult NHL
Standard treatment options for aggressive, stage I and contiguous stage II adult NHL include the following:
R-CHOP with or without IF-XRT.
R-CHOP with or without IF-XRT
Four prospective randomized trials have evaluated the comparison of CHOP or more intensive CHOP-based chemotherapy alone versus combined–modality therapy with CHOP and IF-XRT.[1,2,3,4,5]
Evidence (CHOP vs. CHOP with IF-XRT):
In a randomized trial with 7 years' median follow-up, 576 patients older than 60 years with early-stage disease received four cycles of CHOP with or without IF-XRT; there was no difference in 5-year event-free survival (EFS) (61% vs. 64%, P = .5) or overall survival (OS) (72% vs. 68%, P = .6).[Level of evidence: 1iiA]
A randomized trial of 401 patients comparing eight cycles of CHOP to three cycles of CHOP with IF-XRT was initially reported as having an OS advantage for the combined–modality arm at 5 years, but a re-evaluation for OS at 9 years showed no difference in either arm of the study.[Level of evidence: 1iiA]
A randomized study (EST-1484) of 210 patients who attained a radiologic complete remission after eight cycles of CHOP compared IF-XRT with no further therapy; there was no difference in OS at 10 years (68% vs. 65%, P = .24).[Level of evidence: 1iiA]
A randomized trial of 631 patients younger than 60 years compared more intensive CHOP-based chemotherapy versus three cycles of CHOP with IF-XRT; with 4 years' median follow-up, the intensive chemotherapy was superior in 5-year EFS (82% vs. 74%, P > .001) and 5-year OS (90% vs. 81%, P = .001).[Level of evidence: 1iiA]
The confirmation of efficacy for rituximab in advanced-stage disease as evidenced in SWOG-S0014 (NCT00005089), for example, has suggested the use of R-CHOP with or without radiation therapy but its use is only supported by retrospective comparisons.[Level of evidence: 3iiiDiii]
R-CHOP (rituximab + cyclophosphamide + doxorubicin + vincristine + prednisone); four to six cycles.
R-CHOP (three to six cycles) + IF-XRT.
Evidence (R-CHOP vs. CHOP):
A randomized study (DSHNHL-1999-1A) of 1,222 patients older than 60 years compared R-CHOP given every 2 weeks for six or eight cycles to CHOP given every 2 weeks for six or eight cycles. Although patients with early stage disease were included in this trial, most patients had advanced stage disease.
With a median follow-up of 72 months, the EFS favored R-CHOP given every 2 weeks for six or eight cycles (EFS at 6 y, 74% vs. 56%; P < .001).
The OS favored R-CHOP for only six cycles because of increased toxicity in the eight-cycle arm (OS at 6 y, 90% vs. 80%, P = .0004.[Level of evidence: 1iiA]
There has been no comparison to standard R-CHOP or CHOP given every 3 weeks. There are no comparative studies to establish an optimal number of chemotherapy cycles for patients with early stage disease.