Prospective clinical study of surgical resection followed by CHOP in localized intestinal diffuse large B cell lymphoma
Introduction
Primary gastrointestinal (GI) lymphomas represent the largest group among all extranodal non-Hodgkin's lymphomas (NHL) [1]. Approximately two-thirds of the GI lymphomas are located in the stomach, whereas intestinal lymphomas account for the remaining one-third [2], [3], [4]. Despite intestinal lymphomas are distinct from gastric lymphomas in terms of pathologic distribution, clinical features and treatment outcome, majority of studies included intestinal lymphomas as a subgroup of GI lymphomas. Although primary resection has been long considered as a standard treatment of choice for localized intestinal lymphomas, there is no direct evidence from prospective studies to support primary resections in this subset of patients. The addition of post-surgical abdominal radiation showed a high local control rate with 5-year disease-free survival rates ranging from 35 to 85% [1]. Adjuvant CHOP chemotherapy demonstrated survival benefit in GI lymphoma patients [5], [6]. We have recently reported that a primary surgical extirpation of the tumor may improve failure-free survival in localized intestinal lymphoma patients [7]. In the current trial, we conducted a prospective, non-randomized study to assess the feasibility and efficacy of the initial surgical resection followed by post-operative CHOP chemotherapy in localized intestinal lymphomas. In order to minimize any potential bias from pathologic variations, we included only patients with confirmed diffuse large B cell lymphoma (DLBL) in this study.
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Patients
From January 1999 to December 2004, a prospective, non-randomized study was performed. Criteria for entry into the study included: age greater than 18, adequate bone marrow function (absolute neutrophil count > 1500/μl, platelet count > 75,000/μl), normal renal and hepatic functions (serum creatinine < 1.5 mg/dl, total bilirubin < 3.0 mg/dl, serum transaminase less than 2.5 times the normal level), and sufficient cardiac function. The stage work-up for each patient included patients’ history and physical
Patient characteristics
From January 1999 to December 2004, 45 patients were initially enrolled. Of the 45 patients, five patients were excluded from the study; one patient was lost to follow-up after surgery; three patients were confirmed of T cell lineage lymphomas at their surgical specimens; and one patient, who was initially diagnosed of DLBL, was later confirmed of marginal zone cell lymphoma at surgical specimen. The median age was 50 years with a range of 26–84 (Table 1). Sixty-three percent of the patients
Discussion
Primary intestinal lymphoma including small intestine, colon, and rectum represent approximately 15–20% of primary gastrointestinal lymphomas [13]. Because most studies included intestinal lymphomas as a subset of GI lymphomas, the optimal treatment for intestinal lymphomas has not been established yet. Randomized prospective trials are difficult to conduct since intestinal lymphomas are relatively rare with wide diversity in histology. In this prospective study, we attempted to define the role
Acknowledgements
Contributions: Jeeyun Lee wrote the manuscript, analyzed and interpreted data. Won Seog Kim interpreted data and contributed to the concept and design. Kihyun Kim, Jin Seok Ahn, Chul Won Jung, Ho-Yeong Lim, Won Ki Kang, Keunchil Park provided study patients and helped in data collection. Young H. Ko, Young Ho Kim, Chimin Park, Sung Hyun Yoon, Woo Yong Lee, and Ho Kyung Chun also provided study patients and helped in data collection.
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