Treatment of patients with lymphomas of the uterus or cervix with combination chemotherapy and radiation therapy

Abstract

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 outcome of patients treated with a combination of chemotherapy and radiation therapy was analyzed for all but patients with the most advanced disease. Methods. From 1976 to 1992, 16 patients received definitive treatment. Thirteen patients had intact uteri (group 1) and 3 presented with paracolpal lymphomas after previous hysterectomies (group 2). Twelve of the patients received chemotherapy and external irradiation. The remaining four underwent only chemotherapy. The overall survival and freedom from disease progression were analyzed according to Kaplan‐Meier Methods. Prognoses were related to the International Index, Ann Arbor stage, and International Federation of Gynecology and Obstetrics stage. Results. Five‐year survival and freedom from disease progression were 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 with scores in the low or low‐intermediate range (n ‐ 10), 5‐year survival 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). The Ann Arbor stage had less predictive value, with 5‐year survival of 89% for Stage I and II patients (n = 9), compared with 50% survival for the four Stage III and IV patients (P = 0.0701). International Federation of Gynecology and Obstetrics staging did not predict outcome. Conclusions. The combination of chemotherapy and irradiation is the most effective treatment regimen for all uterine and cervical lymphomas. The International Index is most predictive of outcome.

Non-Hodgkin's Lymphomas Involving the Uterus: A Clinicopathologic Analysis of 26 Cases

“…The 5-year survival rate was 29%. The results are also similar to those in the literature (Table 4) (5,8,9,12,14,15). Most highstage uterine NHL involve the corpus, the most AUB, abnormal uterine bleeding; CLL, chronic lymphocytic leukemia; DLBCL, diffuse large B-cell lymphoma; T-LBL, precursor T-cell lymphoblastic lymphoma; FCL-F, follicle center lymphoma, follicular; B-SLL, small lymphocytic lymphoma; CT, chemotherapy; RT, radiation therapy; BMT, bone marrow transplant; TAH-BSO, total abdominal hysterectomy-bilateral salpingo-oophorectomy; H, hysterectomy; M, myomectomy; DOD, dead of disease; D, dead; NED, no evidence of disease; A, alive.…”

“…Infrequently, NHL may involve the uterus. Numerous studies of NHL involving the uterus have been reported in the literature, and we have identified at least 15 case series that describe three or more patients (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). However, in most of these studies, clinical follow-up is short and no comparisons are made between cervix and corpus involvement or between primary and secondary neoplasms.…”

Two cases of uterine malignant lymphoma diagnosed by needle biopsy

“…Previous studies have reported that uterine ML leads to secondary hydronephrosis in many cases 9, 13…”

Primary follicular lymphoma of the cervix uteri: a review

“…The most common histological subtype is diffuse large B-cell lymphoma [3]. Only 11 cases with low-grade follicular lymphoma of the cervix were reported comprising 8.5% of the primary cervix lymphomas [2][3][4][5][6][7][8][9].…”

“…Because such located lymphomas are subepithelial and unless there is ulceration and exfoliation, Papanicolaou smear plays a very insignificant role in the diagnosis of cervical lymphoma [7]. Ann Arbor stage, size, and extent of disease, age, number of extranodal sites, performance status, serum lactate dehydrogenase (LDH) values, and grade of lymphoma are significant prognostic features [4,6,11,16].…”