Results with chemotherapy comprised of cyclophosphamide, doxorubicin, vincristine, and prednisone followed by radiotherapy with or without prechemotherapy surgical debulking for patients with bulky, aggressive lymphoma

Abstract

BACKGROUNDThe authors performed a case–control analysis of local control, progression free survival, and overall survival in patients with Stage I–II aggressive lymphomas measuring ≥ 7 cm in greatest dimension who were treated initially with or without surgical debulking: All patients then received cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)‐based chemotherapy followed by involved‐field radiotherapy.METHODSFrom May 1975 through May 1996, 50 patients were treated with (n = 25 patients) or without (n = 25 patients) resection of > 80% of their bulky lymphomas. Chemotherapy consisted of 3–12 cycles of CHOP. In general, patients who underwent debulking received three cycles of chemotherapy, whereas patients who did not undergo debulking received at least six cycles of chemotherapy. The total radiotherapy dose was 40.8 grays (Gy) ± 4.2 Gy (mean ± standard deviation).RESULTSThe median follow‐up was 62 months. Patients who underwent debulking were similar prognostically to patients who did not. There was a trend toward improved local control (5‐year rates: 96% vs. 80%; P = 0.10) and overall survival (5‐year rates: 83% vs. 71%; P = 0.18) in patients who underwent debulking compared with patients who did not, respectively. Progression free survival was significantly better for patients who underwent debulking compared with patients who did not (5‐year rates: 88% vs. 62%, respectively; P = 0.04).CONCLUSIONSBecause this study was retrospective, selection bias may account for the observed difference in progression free survival. Because it is unlikely that a trial randomizing patients with bulky, aggressive lymphoma to surgery will be conducted, the authors' current efforts are focused on escalation of the total radiotherapy dose as a possibly less costly and less morbid approach toward improving progression free survival for these patients. Cancer 2002;94:601–5. © 2002 American Cancer Society.DOI 10.1002/cncr.10260

Impact of complete surgical resection on outcome in aggressive non‐Hodgkin lymphoma treated with immunochemotherapy

“…Overall survival at 7 years was significantly better in patients undergoing debulking surgery (93% versus 35%). This finding was confirmed by Wilder et al 15 lymphoma patients treated with CHOP and radiotherapy. At 5 years, local control rate (96% versus 80%), progression-free survival (88% versus 62%), and overall survival (83% versus 71%) were better after debulking than after chemoradiotherapy alone.…”

Some design issues of strata‐matched non‐randomized studies with survival outcomes

“…However, in scenarios where chances of performing a randomized trial is slim [e.g. for ÿnding the value of prechemotherapy surgical debulking for patients with bulky, aggressive lymphoma [12]; Role of high-dose chemotherapy with peripheral blood stem cell transplantation for patients with primary systemic amyloidosis as opposed to standard chemotherapy [7], etc. ], the evidence from well performed non-randomized trial are adopted for treatment decision making, specially if the outcomes can be conÿrmed on a series of such studies yielding results of similar magnitude and directionality.…”

A Case of Primary Diffuse Large B Cell Lymphoma of the Maxillary Sinus Presenting as Epiphora

“…For maxillary sinus DLBCL, the main purpose of surgery is for biopsy, but it has the effect of maximally reducing tumor cells before radiation therapy to be performed later, and has the effect of alleviating the symptoms complained by the patient. Therefore, during surgery, it is necessary to reduce the size of the tumor tissue as much as possible to the extent that the surrounding tissues can be preserved and to collect sufficient specimens for biopsy [8]. For the case of this study, all tissues that were able to be observed with endoscopy during the surgery were removed, and after the surgery, the patient's symptoms such as epiphora, facial pain, and eye pain improved immediately, and an accurate diagnosis was possible through biopsy.…”