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Tonsil Lymphoma on the Right

PET Scan of Lymphoma in Tonsil

Treatment of non-Hodgkin’s lymphoma of Waldeyer’s ring: radiotherapy versus chemotherapy versus combined therapy.

Aviles A, Eur J Cancer B Oral Oncol. 1996 Jan;32B(1):19-23.

Department of Hematology, Oncology Hospital, National Medical Center, Mexico.

Treatment of stage IA non-Hodgkin’s lymphoma (NHL) of Waldeyer’s ring remains controversial, probably because of the small number of patients and the scarcity of controlled studies. Between 1981 and 1991, 316 patients with stage I NHL of Waldeyer’s ring were randomised for treatment with radiotherapy alone (extended fields), 101 patients; combined chemotherapy with a regimen of CHOP (cyclophosphamide, vincristine, doxorubicin, and prednisone) or CHOP-like (epirubicin instead of doxorubicin), 106 patients; and combined therapy (radiotherapy followed by the same combination chemotherapy), 109 patients. Median follow-up was 6.8 years. Complete response was achieved in 93, 87 and 97%, respectively. Relapses were least frequent in patients treated with combination therapy. The 5-year rate for failure-free survival was 48% for radiation therapy, 45% for the patients who were treated with chemotherapy, which was statistically significantly less than the 83% for patients treated with combined therapy (P < 0.001). Overall survival was also better in the combined therapy arm: 90%, statistically different to 58% for the patients treated with chemotherapy alone and 56% for patients treated with radiation therapy (P < 0.001). Toxicity was mild and late side-effects were not observed in any patients. From these results combined therapy should be considered as the best therapeutic approach in patients with localised NHL of Waldeyer’s ring. Non-Hodgkin’s lymphomas of the tonsil: a retrospective analysis of twenty-eight patients with primary tonsillary lymphoma. Barista I, Tumori. 1995 Jul-Aug;81(4):234-7. Department of Medical Oncology, Hacettepe University, Ankara, Turkey. AIMS: To analyze the clinical and therapeutic aspects of patients with primary tonsillary non-Hodgkin’s lymphoma. METHODS: Twenty-eight patients with primary tonsillary non-Hodgkin’s lymphoma who had been followed in the Hacettepe Oncology Institute between 1974 and 1992 were retrospectively analyzed. Fifteen patients were male, 13 were female. Median age was 55 years. RESULTS: Constitutional symptoms were present in 10 patients (35.7%). Stages according to the Ann Arbor classification were I and II in 12 and 16 patients, respectively. According to the Rappaport classification, poorly differentiated lymphocytic was the most common pathologic subgroup (42.9%). Grades according to the Working Formulation were low, intermediate and high in 3, 22 and 3 patients, respectively. Twenty-two patients had received chemotherapy. Cyclophosphamide, vincristine and prednisone (CVP), and cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) were the regimens most commonly employed. Eighteen patients received radiotherapy to Waldeyer’s ring and neck. Eight patients achieved remission with chemotherapy plus radio-therapy, 7 patients with chemotherapy alone, and 5 patients with radiotherapy alone. In addition to the 20 patients who achieved complete remission, 3 patients achieved partial remission; the overall response rate was 82.1%. The response rates and survival attained with the combined modality, chemotherapy, or radiotherapy alone were not statistically different (P > 0.05). The median follow-up was 14 months. Overall and disease-free survival at 5 years were 62.6% and 77.6%, respectively. Pathologic grade was the most important prognostic factor influencing overall survival in the Cox multivariate model. CONCLUSIONS: Poorly differentiated lymphocytic lymphomas were the most common pathologic subtype, and pathologic grade was the most important prognostic factor to influence survival in the present study. Although combined modality treatment did not appear to be superior to chemotherapy or radiotherapy alone, a larger number of patients is needed to draw definite conclusions.

A state-by-state analysis by the Commonwealth Fund, a philanthropic research group, found the average annual family health premium in California in 2003 was $9,091, which was slightly lower than the national average of $9,249.

By 2010, those premiums jumped to $13,819 in California, on par with the national average. Premiums for families nationwide rose an average of 50 percent during that same time period to $13,871.

The report examines the period of time leading to the passage of the federal health overhaul law in March 2010. The authors say if insurance keeps rising at the current rate, the cumulative impact will result in a 72 percent increase in premiums and push the average family premium to almost $24,000 by 2020.

“Costs vary by state, but no matter where you live – whether it’s Wyoming, Texas, West Virginia, California, New York – health insurance is expensive,” said Cathy Schoen, senior vice president of the Commonwealth Fund and lead author of the report.

In a growing number of states, including California, premiums already equal or exceed 20 percent of the median income, the study found.

Outpacing income

In 2003, health premiums in California amounted to 14.9 percent of income but jumped to consume 21.5 percent in 2010. Twenty-three states shared that distinction last year, while just seven years earlier, West Virginia was the only state to top that 20 percent threshold.

Premiums outpace income in virtually every state, but Schoen said they take a bigger bite out of overall income in states that have lower median incomes.

In California, the study reported, the median family income in 2009-10 was $61,162, which is lower than the average national median income of $67,357 for families.

The report also found that the annual amount employees pay toward their health insurance policies increased nationally an average of 68 percent for individuals and 63 percent for families between 2003 and 2010. In California, the amount increased by 121 percent for individuals and 68 percent for families.

Anthony Wright, executive director of the consumer advocacy coalition Health Access California, said it’s hard to say why employer-backed individual policies jumped so much. Family coverage has long been hit with increases, so employers may have turned toward increasing the share individuals pay in recent years, he said.

The liberal-leaning Commonwealth Fund notes that the federal health law has the potential and opportunity to lower premium growth.

Effects of law

Wright, a backer of the federal law, said some provisions – such as subsidies provided to lower- and middle-income people to buy health insurance – will by definition curb the percentage of income people have to devote to health insurance. It’s unclear whether many of the elements will lower costs, he said.

The health law “almost certainly doesn’t do everything we need it to do to bring down the cost of health,” he said. “At the same time, it’s the most any Congress has ever done to try.”

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