RADIOTHERAPY FOR TREATMENT OF LOCALIZED GASTROINTESTINAL NON-HODGKINS-LYMPHOMA

Background: The study analyses a standardized, risk-adapted radiothera py for stage IE-IIE primary extranodal lymphoma of the stomach and bow el. 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 (lo w or intermediate grade stage I-II: 38 patients/high grade stage I: 18 patients) were treated by whole abdominal irradiation (25/30 Gy), boo ster dose to involved field (30/40 Gy) and additional boost to macrosc opic residual lymphoma (40/50 Gy). Surgery consisted of gastrectomy (1 9 patients), partial gastric resection (30) or biopsy (7). In 8/18 sta ge II patients, supradiaphragmal irradiation was added. In 10/12 patie nts 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 recommen ded dose for whole abdominal irradiation was given. A total of 40/56 p atients (71%) received the required dose to the upper abdominal region , in 22/56 patients (39%) a booster dose for residual disease was appl ied. Five-year overall survival was 87%, 5-year disease-fret survival 84%. Of nine relapses, two were in the gastric stump of low grade pati ents after reinfection with Helicobacter pylori. Three infield, intraa bdominal relapses were observed in intermediate and high grade lymphom a, all other relapses were outfield. Eleven patients experienced late toxicity (bowel obstruction after laparatomy and irradiation, four pat ients; chronic gastritis, three patients; asymptomatic left kidney atr ophy, two patients; asymptomatic hepathopathia, two patients). In bowe l lymphoma, 5-year disease-free survival was 65%. Conclusion: This stu dy demonstrates the high efficacy of risk-adapted radiotherapy in gast ric lymphoma. Iii low grade gastric lymphoma, whole abdominal irradiat ion may be reduced in dose or omitted. Total gastrectomy does not impr ove results and should therefore be avoided if possible. (C) 1997, Els evier Science Ireland Ltd.