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During a 26-year period (1961–1987), a total of 18 patients with primary non-Hodgkin's lymphoma (NHL) of the paranasal sinuses and nasal cavity received radiation therapy at (University of California at Los Angeles) UCLA Medical Center. At the time of diagnosis and using the available diagnostic methods, none of these patients had clinically detectable disease beyond the paranasal sinuses. All 18 patients were staged IE by the Ann-Arbor system. When the patients were staged according to the AJC staging system for epithelial tumors, half presented with advanced T3–4 disease. Diffuse histiocytic lymphoma was the most common histology (eight cases) and maxillary sinus, the most common site of origin (11 cases). All nine Tl-2 tumors received radiation therapy alone, while radiation and chemotherapy was used in seven of nine advanced T3–4 staged tumors. The mean follow-up was 71 months. At last follow-up, eight of nine Tl-2 patients were rendered disease-free. In contrast, only four of nine T3–4 patients had long-term disease-free survival. Seventy-five percent of the failure occurred within 2 years. Radiation therapy alone achieves high local control in small tumors (Tl-2), while large tumors (T3–4) require aggressive combined treatment, i.e., radiation and chemotherapy.