Roentgen Therapy of Primary Gastrointestinal Lymphoma

Since the earliest applications of roentgen therapy, that modality has been accepted as the preferred method of treatment for the majority of patients afflicted by the various entities in the lymphoma group. It is the purpose of this paper to consider those cases from this group that appear to originate within the gastrointestinal tract or mesentery, in which roentgen therapy was the primary method of treatment. In an attempt to evaluate these cases satisfactorily, a comparison with our entire series of lymphomas will be made, particularly lymphosarcoma and reticulum-cell sarcoma. This parallelism will be stressed because it is believed that a better insight into the problems of care and therapy of these patients can thus be obtained. Material and Classification The entire series of the lymphomas, excluding the leukemias, treated by roentgen therapy at Harper Hospital (Detroit, Mich.) from 1922 through mid 1961 comprises 1,014 cases. Of this number, there are 66 which fit the above criteria, i.e., the malignant process appears to have originated within the mesentery or gastrointestinal tract and has been treated primarily by roentgen therapy. Unfortunately, it is often impossible to make an absolute differentiation of the various types of malignant lymphoma (17, 20); even microscopic sections from the same patient procured at different times may result in different tissue diagnoses. However, of the 66 cases with primary gastrointestinal involvement, 2 were considered to be giant follicular lymphoma, 5 Hodgkin's disease, 14 reticulum-cell sarcoma, and 45 lymphosarcoma. This material is presented in Table I. Of the total group of 1,014 cases, 395 were classified as lymphosarcomas, of which 11.4 per cent originated within the gastrointestinal tract or mesentery. Of 137 reticulum-cell sarcomas almost the same proportion, 10.2 per cent, met the above criteria. With Hodgkin's disease and giant follicular lymphoma the percentage is markedly less. In this presentation an attempt will be made to classify the stage of disease only as to relative localization or generalization at the time of referral. Thus, Stage I includes involvement of a single lymphatic region or two proximal lymphatic regions, but without symptoms of generalized disease. Stage II includes detectable clinical involvement of two or more proximal lymphatic regions, with symptoms of generalization, or involvement of two or more distant lymphatic regions. The division into two stages was used because our treatment technic was essentially based on localized or generalized involvement. The survival dates are computed from the time the patient was first referred for roentgen therapy until death or loss to follow-up. There have been no exclusions because of failure of follow-up, and patients thus lost are presumed dead. Diagnosis There are no pathognomonic features of gastrointestinal lymphoma.