P-0153 Primary Gastointestinal Lymphoma-Incidence, Management and Outcome a Retrospective Study from Tertiary Centre In India

Abstract

ABSTRACT Introduction Gastrointestinal tract (GI) is the most frequently involved extranodal site in non Hodgkin's lymphoma (40%),but it is only 1-2% of all GI malignancies. Primary GI lymphomas (PGIL) are defined as lesions those are predominantly present in GI tract or those which present with GI symptoms. Methods Total 579 cases of lymphoma were registered at our centre in between January 2005 to December 2008, out of which 58 were diagnosed as PGIL. 47 males and 11 females (m:f=4.27:1), age group ranged from 3 to78 years with a mean of 38 years. 16 patients received some surgical treatment (laparotomy, resection, colectomy, gastrectomy and anastomosis), followed by chemotherapy, total 41 patients received chemotherapy 6-8 cycles of [CHOP, CVP, MINE, BFM90 (for pediatric patients)]. Rituximab was given according to affordability, only 3 patients received radiotherapy (40-45GY/25#).13 patients were drop outs. Post treatment patients were followed up at regular intervals total duration of follow up 82 months (6 years 10 months), mean of 46 months. Results Abdominal pain (78%) and dyspepsia (27%) were the chief complaints. Stomach was the most common site of involvement 28/58 (48.2%), followed by small intestine 21/58 (36.2%), large intestine was involved in 7/58 (12%) and 1patient of esophageal lymphoma was also treated. Only 4/28 patients of gastric lymphoma (14.3%) were found to have H. pylori in their samples. 26/58 (44.82%) showed regional lymphadenopathy only 1 showed distant lymph node involvement. Most commonly patient presented according to modified Ann Arbor staging in stage 3 (36.2%), stage 2 (31%), stage 4 (24.1%), stage 1 (8.6%). 56/58 (96.5%) were of pure B type histology (CD20 +), 2/58 (3.5%) had T cell component (CD3 +) also. Diffuse large B cell lymphoma (DLBCL) was the most common variant 29/58 50%), followed by NHL b type unclassified21/58(36.2%). During follow up 32 patients were having complete response (CR) 55.17%), 4/58 (6.9%) showed partial response (PR), 8/58 (13.8%) showed progressive disease. 13 patients dropped out did not took complete treatment. Conclusion Incidence of PGIL is on a rise around 10% of all registered lymphomas were of PGIL type in our study. It affects all age groups most commonly in between 3rd to 5th decade. Stomach is the most common site of involvement (previously stated Indian studies had small intestine). None of the MALT type lymphoma was found in our study. No or weak association with H. pylori for gastric lymphoma was seen in our subset of patients. PGIL are chemosensitive tumors with a good response rate with low and manageable toxicity 56% complete response in 5 years follow up. Radiotherapy can be used later for relapse and recurrence cases, instead of using it for primary management. Surgery remains the mainstay management for intestinal lymphomas.