TREATMENT OF PATIENTS WITH LYMPHOMAS OF THE UTERUS OR CERVIX WITH COMBINATION CHEMOTHERAPY AND RADIATION-THERAPY

Background. Primary lymphomas of the uterus or cervix are so rare that treatment series of single institutions consist of very small numbers of patients, making standard treatment difficult to define. The outco me of patients treated with a combination of chemotherapy and radiatio n therapy was analyzed for all but patients with the most advanced dis ease. Methods. From 1976 to 1992, 16 patients received definitive trea tment. Thirteen patients had intact uteri (group 1) and 3 presented wi th paracolpal lymphomas after previous hysterectomies (group 2). Twelv e of the patients received chemotherapy and external irradiation. The remaining four underwent only chemotherapy. The overall survival and f reedom from disease progression were analyzed according to Kaplan-Meie r methods. Prognoses were related to the International Index, Ann Arbo r stage, and International Federation of Gynecology and Obstetrics sta ge. Results. Five-year survival and freedom from disease progression w ere 77 and 67%, respectively, for group 1, and all patients in group 2 were cured. A statistically significant correlation of survival with scores of the International Index was found in group 1. For patients w ith scores in the low or low-intermediate range (n = 10), 5-year survi val was 90%. All patients who scored in the high-intermediate or high range (n = 3) died by 66 months after their diagnosis (P = 0.0153). Th e Ann Arbor stage had less predictive value, with 5-year survival of 8 9% for Stage I and II patients (n = 9), compared with 50% survival for the four Stage III and IV patients (P = 0.0701). International Federa tion of Gynecology and Obstetrics staging did not predict outcome. Con clusions. The combination of chemotherapy and irradiation is the most effective treatment regimen for all uterine and cervical lymphomas. Th e International Index is most predictive of outcome.