Radiotherapeutic management of small intestinal lymphoma with malabsorption

Small intestinal lymphoma with malabsorption is usually fatal within a year. The usual therapy for malabsorption is not helpful, and response to cytotoxic drugs has been disappointing. A man with severe malabsorption and immunoglobulin abnormalities for 7 years suffered two episodes of perforation of the ileum within 21/2 weeks. Laparotomy revealed histiocytic lymphoma involving multiple sites of the small intestine and mesenteric nodes. He was treated with total abdominal irradiation by a technique which delivered 3,525 rads in 50 days to most of the gut and abdominal node regions, 1,760 rads to the kidneys, and 1,760–2,475 rads to the right lobe of the liver. No further perforation occurred. Malabsorption and immunoglobulin abnormalities cleared and he gained 37.4 kg in 2 years. Repeat laparotomy 26 months later revealed no evidence of lymphoma. He remains well 32 months following total abdominal irradiation. Aggressive radiation therapy can result in dramatic improvement and possible cure of this otherwise hopeless situation.