>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)
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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
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
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
||brain extranodal lymphomas, orbit, paranasal sinuses, breast, stomach, small bowel, cervix, urinary bladder, femur, chemotherapy, radiotherapy, surgery.
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>Revista de Hematología
>Year 2015, Issue 1