Annals of Oncology Advance Access originally published online on October 11, 2007
Annals of Oncology 2008 19(2):233-241; doi:10.1093/annonc/mdm471
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hematologic malignancies |
Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group
1 Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
2 Istituto Europeo di Oncologia, Milan, Italy
3 Bernhoven Hospital, Oss, The Netherlands
4 Princess Margaret Hospital, Toronto, Canada
5 Royal Adelaide Hospital, Adelaide, Australia
6 Royal Victoria Infirmary, Newcastle upon Tyne, UK
7 Istituto Nazionale Tumori, Milan, Italy
8 Southampton General Hospital, Southampton, UK
9 Universitatsklinikum Eppendorf, Hamburg, Germany
10 Royal Brisbane Hospital, Brisbane, Australia
11 Ospedale Casa Sollievo della Soffarenza, Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Giovanni Rotondo, Italy
12 National Cancer Centre, Singapore
13 University of Nebraska Medical Center, Omaha, NE, USA
14 Christie Hospital, Manchester, UK
15 Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
* Correspondence to: Dr G. Ryan, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia. Tel: +61-3-9656-1111; Fax: +61-3-9656-1424; E-mail: gail.ryan{at}petermac.org
Background: Primary diffuse large B-cell lymphoma (DLBCL) of breast is rare. We aimed to define clinical features, prognostic factors, patterns of failure, and treatment outcomes.
Patients and methods: A retrospective international study of 204 eligible patients presenting to the International Extranodal Lymphoma Study Group-affiliated institutions from 1980 to 2003.
Results: Median age was 64 years, with 95% of patients presenting with unilateral disease. Median overall survival (OS) was 8.0 years, and median progression-free survival 5.5 years. In multifactor analysis, favourable International Prognostic Index score, anthracycline-containing chemotherapy, and radiotherapy (RT) were significantly associated with longer OS (each P 
0.03). There was no benefit from mastectomy, as opposed to biopsy or lumpectomy only. At a median follow-up time of 5.5 years, 37% of patients had progressed—16% in the same or contralateral breast, 5% in the central nervous system, and 14% in other extranodal sites.
Conclusions: The combination of limited surgery, anthracycline-containing chemotherapy, and involved-field RT produced the best outcome in the pre-rituximab era. A prospective trial on the basis of these results should be pursued to confirm these observations and to determine whether the impact of rituximab on the patterns of relapse and outcome parallels that of DLBCL presenting at other sites.
Key words: anthracycline-based chemotherapy, breast, large B-cell lymphoma, radiotherapy
Received for publication June 13, 2007. Revision received August 23, 2007. Accepted for publication September 3, 2007.
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