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>Journals >Revista de Hematología >Year 2015, Issue 1


Figueroa-Sandoval F, Jesús-Alva MA
Which is the best treatment for extranodal lymphomas?
Rev Hematol Mex 2015; 16 (1)

Language: Español
References: 69
Page: 17-27
PDF: 352.69 Kb.


Full text




ABSTRACT

Background: Extranodal primary lymphomas should meet the following criteria: a) absence of superficial adenomegalies in the physical exam, b) without adenomegalies at mediastinum assessed by thorax radiography, computed axial tomography or positron emission tomography, c) dominant lesion at extranodal site, d) it may be adenomegalies in proximity to primary lesion, e) cytometric studies, chemical hepatic, of bone marrow and the remaining studies of extension normal or negative. In the last two decades it has been an increased incidence of extranodal primary lymphomas, in literature there are several reports related to a determined organ, but there are only 10 reports related, in group, to epidemiology, pathology and behavior and this one is the first in Mexico in comment the multidisciplinary treatment of extranodal primary lymphomas.
Objective: To report the experience of extranodal lymphomas, attended from 1989 to 2003, with emphasis on the established treatment.
Material and method: A retrospective study done at Specialties Hospital of CMNO, Mexico, in which patients with extranodal lymphomas were included.
Results: Forty-one patients (22 men) were included, with a mean age of 45 years (limits of 19 and 65), 39 patients were immunocompetent and 2 immunocompromised. The site of localization was distributed as follows: 11 at central nervous system, 12 craniofacial, 6 at orbit, 5 gastric, 2 of breast, 2 of femur, one at small bowel, one of cervix and one of urinary bladder. Patients with primary lymphoma of central nervous were treated with biopsy and chemotherapy with CHOP and/or methotrexate, plus steroid and radiotherapy. In patients with lymphomas of stomach and jejunum the treatment included surgery, six cycles of chemotherapy and radiotherapy. Lymphomas of paranasal sinuses were treated with chemotherapy plus radiotherapy. Patients with lymphomas of femur, after biopsy, were given chemotherapy and radiotherapy. Patients with lymphomas of breast, after biopsy, received chemotherapy and radiotherapy. In patients with lymphomas of orbit, the treatment included biopsy plus radiotherapy with or without chemotherapy. Patients with lymphoma of cervix were submitted to surgery plus radiotherapy. Lymphomas of urinary bladder were treated with biopsy and radiotherapy. Control was obtained in 27% of lymphomas of central nervous system, in 47% of craniofacial, in 50% of femur and in 100% of orbit, gastric, breast, cervix, urinary bladder and small bowel.
Conclusion: In primary lymphomas of central nervous system there are a therapeutic arsenal, it should be selected that with high index of initial and long-term response and that provokes the less neuropsychologic toxicity. Trend is the treatment including rituximab + methotrexate + procarbazine + vincristine, followed by consolidation of radiotherapy at dose of 23 Gy + citarabine. Prescription of radiotherapy is supported by longer time of survival free of disease compared to the series administering exclusively chemotherapy.


Key words: brain extranodal lymphomas, orbit, paranasal sinuses, breast, stomach, small bowel, cervix, urinary bladder, femur, chemotherapy, radiotherapy, surgery.


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