Evaluation and treatment follows guidelines given for the different lymphoma entities. An ENT examination and CT of the region are obligatory. An esophago-gastro-duodenoscopy should be performed. Otherwise patients should have the standard evaluation for lymphoma. Since most patients will receive radiation therapy to the oral cavity and pharynx, they should be examined by a dentist to determine infection foci and be given advice on oral hygiene. Most lymphomas in the salivary glands and eyes are marginal zone B-cell lymphoma and have a very good prognosis. Lymphoma in sinuses is often diffuse large cell B-cell and can destroy bone in near CNS areas. Lymphomas in the nose are usually of nasal T/NK cell type and have a serious prognosis.
In localized stages of PeI and PeII, radiation therapy is given to 2 Gy x 12 for marginal zone lymphomas and follicular lymphomas. Extraosseous plastmacytomas are given 2 Gy x 20. Modeling of the radiation field is done based on a CT-guided dose plan. The nearest draining lymph node station is normally included in the radiation field. For details concerning modeling of the radiation field, see the chapter or radiation therapy. Treatment for different lymphoma entities follows guidelines set for the specific entity. More advanced stages are treated according to principles for indolent lymphomas without a curative intention.
These are treated according to guidelines given in a separate chapter. For lesions near the CNS, it is important to give CNS prophylaxis.