Prospective Clinical Study of Surgical Resection Followed by CHOP in Localized Intestinal Lymphoma.

Background: Due to the rarity of the disease, prospective clinical trials on optimal treatment of intestinal non-Hodgkin’s lymphoma have been scarcely performed.

Methods: Patients with; age > 18 years, pathologically proven diffuse large B cell lymphoma (DLBL), normal bone marrow, liver, renal and cardiac function were eligible. Patients with Burkitt’s lymphoma, lymphoblastic lymphoma, mantle-cell lymphoma, or infection with human immunodeficiency virus were excluded. All patients were staged after surgery according to the Ann Arbor classification modified by Musshoff et al. and Paris staging system (TNM system). Postoperative chemotherapy with CHOP regimen was administered for 6 cycles. CHOP consisted of cyclophosphamide 750 mg/m² d1, doxorubicin 50 mg/m² d1, vincristine 1.4 mg/m² (max 2.0 mg/m²) d1, and prednisolone 100mg d1–5 repeated every 3 weeks.

Results: From 1999 to 2004, 41 patients were enrolled. The median age was 50 years (range, 26 – 84) and male:female ratio was 29:12. All patients had clinical stage I/IIE DLBL and underwent surgical resection. Of the 41 patients, 3 patients refused postoperative CHOP chemotherapy. The 5-year DFS and OS were 83.3% and 89.1%, respectively. Surgicopathologic staging of all patients according to the Ann Arbor classification revealed 34 patients with stage I, 11 patients stage II1, 1 patent stage II2 and 3 patients with stage IIE. The Ann Arbor stage significantly predicted the survival of intestinal DLBL (p = < 0.0001). The T staging according to Paris staging system did not correlate with survival (p = 0.1456) while the N staging showed significant predictability (p = <0.0001).

Conclusion: Surgical resection followed by 6 cycles of CHOP chemotherapy was a highly effective treatment scheme for localized intestinal DLBL patients. The Ann Arbor system seems to predict survival better than the TNM system.