Radiotherapy of at least 40 Gyis the main treatment of thyroid lymphomawhen the disease is limited to the thyroid(Stage 1 Disease). It should only be used alone in stage 1 disease. This view has been confirmed by areview in 2007 from the Royal Marsden Hospital inLondon which treated91 patients between 1936 and 1996. The disease may shrink away after one or two treatments. It is essential that the patient completes the course of 16-20 treatments or the disease may come back. In any patient with more than stage 1 disease radiation mustbe combined with chemotherapy.
Chemotherapy is used when there is extensive disease outside the thyroid and usually lasts for six months. The treatments used vary from centre to centre but the common regimen used is CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone.) Even though the disease is extensive, cure is still possible with chemotherapy.
Surgery has a limited role in the management and should be limited to obtaining tissue (biopsy) so as to fully assess the tumour; a core biopsymay be necessary.This may need to be done under general anaesthetic, although local anaesthetic is usually adequate.
A patient with proven lymphoma of the thyroid who has respiratory obstruction should be treated wherever possible by endotracheal intubation and chemotherapy with possible radiotherapy and steroids. Such a regimen usually results in a rapid shrinkage of the tumour and will avoid an unnecessary tracheostomy, which should be avoided at all costs.