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The most common site of extra-nodal non-Hodgkin's lymphoma (NHL) is the gastrointestinal tract, of which the stomach is the most common site. With the exception of extra-nodal marginal zone lymphoma of gastric mucosa-associated lymphoid tissue (MALT), where excellent long term results can be achieved by radiotherapy, the published literature lacks high quality studies evaluating the role, optimal dose and technique of such treatment in the management of gastro-intestinal lymphoma. Non-randomised studies support organ preservation and a role for local radiotherapy in gastric lymphoma., (Copyright © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Objective: The objective of this study is to determine outcomes of pediatric patients with primary gastrointestinal tract lymphoma (PGTL) and the impact of surgery or radiation on survival., Methods: The Surveillance, Epidemiology, and End Result database was queried from 1973 to 2006 for patients younger than 20 years with PGTL., Results: 265 patients with PGTL were identified. Overall 5- and 10-year survivals were 84% and 83%, respectively. Tumors of the stomach (9%) and rectum/anus (2%) had the worst and best 10-year survivals, respectively (59% vs 100%, P = .023). There was no significant difference in 10-year survival for patients younger than 10 years of age who had surgical extirpation (83% vs 85% no surgery, P = .958) or radiotherapy (76% vs 85% no radiotherapy, P = .532). However, there was a significantly decreased 10-year survival in patients 10 years or older who had surgical extirpation (79% vs 100% no surgery, P = .013) or radiotherapy (49% vs 87% no radiotherapy, P = .001). Under multivariate analysis, tumor location was an independent predictor of improved survival (small bowel, HR 0.21, P = .002; large bowel, HR 0.23, P = .004)., Conclusion: We found no significant survival advantage for surgical extirpation or radiotherapy in patients younger than 10 years with PGTL, whereas either treatment modality was associated with lower survival in patients 10 years or older., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: The objective of this retrospective study was to report the clinicopathological data and the treatment outcomes in patients with primary gastrointestinal non-Hodgkin's lymphoma., Patients and Methods: We carried out a retrospective analysis of 41 patients (22 females, 18 males, median age 58 and range 18-90 years) who presented to our department with histopathological diagnosis of primary gastrointestinal non-Hodgkin's lymphoma between 1995 and 2004., Results: The stomach was the most common extranodal site and was seen in 25 of 41 (61%) patients. At presentation 28 (68.3%) patients had gastrointestinal symptoms while 27 (65.9%) had B symptoms. The range of follow-up was 2-84 months with a median of 9 months. The overall survival rate was 3 years for 25 (61.2%) patients. The 3-year overall survival rate was better in patients with early-stage disease (stages I and II(1)) who were treated with surgery plus chemotherapy and/or radiation therapy than in those treated with chemotherapy alone (91.6 vs. 50%, p < 0.05). The disease had a significant impact on both the progression-free survival and overall survival rates., Conclusion: Our data showed that surgical resection prior to postoperative chemotherapy was a better option for patients with early-stage disease with better patient survival., (Copyright 2009 S. Karger AG, Basel.)

Primary gastrointestinal lymphoma is the most common extranodal presentation of non-Hodgkin's lymphoma. In this retrospective study, all cases of primary gastrointestinal lymphoma registered at Kuwait Cancer Control Center between January 1992 and December 2001 were reviewed. Patients were diagnosed through an endoscopic biopsy or exploratory laparotomy. Staging procedures included computed axial tomography scan, bone marrow biopsy, barium and follow-through study, as well as routine chemistry (including lactate dehydrogenase) and hemography. There were 46 patients (30 men and 16 women); ages ranged from 16 to 82 years (median age, 43.6 years). The most common site of involvement was the stomach (70%), and the most common histology was large B cell. At least 50% of cases underwent primary radical surgery, and the majority of patients received subsequent chemotherapy and/or local radiation therapy. Chemotherapy consisted of the CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) regimen for large B-cell histology and CVP (cyclophosphamide/vincristine/prednisone) or oral alkylating agents for low-grade histology. Of this cohort, only 12 cases (26%) have had local or distant relapse. Disease-free survival rates for low-grade and high-grade non-Hodgkin's lymphoma were 64% and 81%, respectively. Primary gastrointestinal lymphoma is a potentially curable malignancy.

Gastrointestinal lymphomas are almost exclusively of a non-Hodgkin's type. The Western form is characterized by a higher incidence of stomach location (50%), a MALT type (mucosa associated lymphoid tissue) (40%), a B-cell type (90%), and a high grade (55%). Chronic infection with Helicobacter pylori is an important risk factor. Mediterranean lymphomas form a particular clinical and pathological entity with diffuse involvement of the small bowel and are frequently being associated with a chronic malabsorption disorder. Eradication of Helicobacter pylori in early gastric lymphomas, and the use of tetracyclines in early Mediterranean lymphomas, have been shown to induce durable remissions. For more advanced gastric lymphomas, treatment usually consists of anthracyclin-based chemotherapy followed by involved field radiotherapy. Surgery is usually reserved for complications such as perforation or bleeding, or in some selected cases for salvage after failure of non-surgical therapy. For intestinal lymphomas, surgical resection whenever feasible, followed by anthracyclin-based chemotherapy is the most common treatment. Radiotherapy is usually reserved for consolidation in some clinical situations. The most commonly found prognostic factors are stage, grade, and tumor bulk. Treatment results vary with the presence of adverse prognostic factors and the used treatment combination. In general, patients with favorable disease receiving combined therapy have a 5-year relapse free survival (RFS) approaching 90%, whereas those with unfavorable disease have a RFS of 40-50%.

Background: The study analyses a standardized, risk-adapted radiotherapy for stage IE-IIE primary extranodal lymphoma of the stomach and bowel., Methods: Sixty eight patients (31 females, 37 males, median age 56 years) were treated from 1987-1992 in 15 centers. Fifty six patients had gastric and 12 patients had bowel lymphomas. Gastric lymphomas (low or intermediate grade stage I-II: 38 patients/high grade stage I: 18 patients) were treated by whole abdominal irradiation (25/30 Gy), booster dose to involved field (30/40 Gy) and additional boost to macroscopic residual lymphoma (40/50 Gy). Surgery consisted of gastrectomy (19 patients), partial gastric resection (30) or biopsy (7). In 8/18 stage II patients, supradiaphragmal irradiation was added. In 10/12 patients with bowel lymphoma, segment resection was performed, two received biopsy only. Radiation doses equalled those used for gastric lymphoma:, Results: In 51/56 patients (91%) with gastric lymphoma, the recommended dose for whole abdominal irradiation was given. A total of 40/56 patients (71%) received the required dose to the upper abdominal region, in 22/56 patients (39%) a booster dose for residual disease was applied. Five-year overall survival was 87%, 5-year disease-free survival 84%. Of nine relapses, two were in the gastric stump of low grade patients after reinfection with Helicobacter pylori. Three infield, intraabdominal relapses were observed in intermediate and high grade lymphoma, all other relapses were outfield. Eleven patients experienced late toxicity (bowel obstruction after laparatomy and irradiation, four patients; chronic gastritis, three patients; asymptomatic left kidney atrophy, two patients; asymptomatic hepathopathia, two patients). In bowel lymphoma, 5-year disease-free survival was 65%., Conclusion: This study demonstrates the high efficacy of risk-adapted radiotherapy in gastric lymphoma. In low grade gastric lymphoma, whole abdominal irradiation may be reduced in dose or omitted. Total gastrectomy does not improve results and should therefore be avoided if possible.

Sixty patients treated with whole abdominal radiotherapy who had remained disease-free since completion of treatment participated in a study to assess the late clinical and biochemical effects of bilateral renal irradiation. Minimum follow-up was 5 years with a maximum of 20 years and a median of 9 years. Fifty-two patients in the study group were treated for primary ovarian cancer. Seven had non-Hodgkins lymphoma arising in the gastrointestinal tract and one patient had a carcinoid tumour arising in small bowel. None of the patients received chemotherapy. Abdominal radiation was given using an open beam technique to a mean dose of 22.92 Gy (range 6.68-27.54 Gy) in 1.02 to 1.25 Gy fractions treated once daily. Posterior kidney shields were used in order to limit the renal dose to < 20 Gy. Mean radiation dose to both kidneys (retrospectively calculated) was 19.28 Gy (range 6.68-22.99 Gy). Patients ranged in age from 32-81 years with a median of 61 years. No patient had clinical evidence of renal impairment. Nine patients were hypertensive prior to radiotherapy and a further five patients became hypertensive after treatment. Serum creatinine values ranged from 44-123 mumol/l, with a mean of 87 mumol/l. Creatinine clearance ranged from 0.61-2.38 ml/s (mean 1.28 ml/s). Tubular function tests revealed one borderline high 24-h protein excretion and normal 24-h phosphorous and uric acid. Using a multiple linear regression analysis with creatinine clearance as the endpoint, age was the only significant variable (P < 0.00001) and renal dose and interval from treatment were not independently significant. There was no evidence of late renal toxicity more than 5 years after whole abdominal radiotherapy delivered with this technique and dose/fractionation schedule, and using the clinical and biochemical endpoints assessed in this study.

Primary gastrointestinal Lymphoma is a relatively infrequent tumor, who could be effectively treated with both surgery and chemotherapy or radiotherapy. The design of treatment depends on prognostic factors, namely stage and histologic grade. The most functional staging system seems that of Mushoff, while the recent concept of "Mucosa-associated lymphoid tissue" has allowed to correlate the histologic grading with prognosis. Surgery is the most used therapeutic approach in IE and IIE stages, but both chemotherapy and radiotherapy or their combination seem to have similar activity. Adjuvant chemo- and/or radio-therapy after surgery increases survival compared to surgery alone. Chemotherapy is the treatment of choice in more advanced stages.

A multimodality approach offers the best chance for treatment of Non-Hodgkin lymphoma. Surgery, radiation therapy, and/or chemotherapy when used in combination offer better response and longterm survival rates. Surgical therapy offers good results in stage I and II according to the Ann Arbor classification. Aim is the excision of the tumor with the removal of lymph nodes. The best treatment in stage III and IV is chemotherapy and radiation followed by surgical tumor reduction. Complications like perforation or bleeding occurred while the patients received either chemotherapy or radiotherapy. Resection of the Non-Hodgkin lymphoma prevented the complications of hemorrhage and perforation associated with chemotherapy and radiation.

Forty patients (median age 49.6 years) were treated for primary gastrointestinal lymphoma between 1979 and 1989. There were twenty-three cases of gastric lymphoma and seventeen cases of intestinal lymphoma. Following surgery, seventeen patients received postoperative chemoradiotherapy (ACOP) by the sandwich technique, seven patients received postoperative radiotherapy, and sixteen patients did not receive any other form of adjuvant treatment. Nineteen patients were stage IE and twenty-one were stage IIE. Stage IE disease was more prevalent in the gastric lymphoma group than the intestinal lymphoma group (p less than 0.01). At a median follow-up of 17 months (1-102 + months), 17 of 19 stage IE patients and 15 of 21 stage IIE patients remained alive. The survival rate was 90% in the postoperative chemoradiotherapy group and 83.3% in the postoperative radiotherapy group at five years, and 42.7% in the surgery alone group at four years, which showed statistical significance (p less than 0.01, p less than 0.05, each). Statistically improved survival rates were achieved with a postoperative chemoradiotherapy modality in intestinal lymphoma (p less than 0.01), stage IIE (p less than 0.01), intermediate grade by NCI criteria (p less than 0.01), poorly differentiated lymphocytic lymphoma (p less than 0.05), and diffuse histiocytic lymphoma (p less than 0.01) according to Rappaport classification, compared to those of the surgically treated only group. Three local relapses occurred in the operation alone group, and one in the adjuvant radiotherapy group which occurred simultaneously with distant lymph node recurrence. The pathologic stage of all of these relapsed patients was stage IIE-2. These results suggest that adjuvant chemoradiotherapy in completely resected localized gastrointestinal non-Hodgkin's lymphoma can decrease local and systemic relapse resulting in long-term disease free survival and overall survival compared to operation alone.

Seventy-two patients with gastrointestinal non-Hodgkin's lymphoma treated between 1952 and 1980 are reviewed. The small intestine was involved in 49% of cases and the stomach in 29%. Surgical resection of the tumour was performed whenever feasible. Radiotherapy was used either adjuvantly or for incompletely excised tumours and chemotherapy was more often reserved for advanced, unresected disease. The overall 5 year survival was 36% and the 5 year relapse free survival was 22%. Forty-one (57%) patients relapsed of whom 33 (80%) subsequently died of non-Hodgkin's lymphoma. The histology in each case was reviewed using the British National Lymphoma Investigation criteria and 94% of cases were reclassified as Grade 2 non-Hodgkin's lymphoma.