title: [A case of primary malignant lymphoma of the duodenum successfully treated with dose escalating chemotherapy].
abstract: A 65-year-old woman with diabetes mellitus was hospitalized for heart failure and anemia in August 2001, and recovered with conservative treatment. An endoscopic examination revealed an ulcerative mass located in the duodenal bulb to the 2nd portion. Abdominal CT scan demonstrated tumor involvement in the pancreas head. The diagnosis of a diffuse large B-cell lymphoma, clinical stage IIE, was made by endoscopic biopsy. Although surgical resection of the localized intestinal tumor would have been a common choice for initial treatment, polychemotherapy was selected; the patient had diabetes mellitus and preferred polychemotherapy to surgical operation. Because of bulky intestinal mass, transmural disease and sensitive histological type, standard-dose chemotherapy was considered to include a high risk of intestinal perforation. We performed dose-escalating chemotherapy: A half dose of THP-COP (pirarubicin, cyclophosphamide, vincristine) was given at the start in October 2001, 60% THP-COP as the next cycle, 80% THP-COP as the 3rd cycle and thereafter. Without serious complications of the intestine, she received a total of 6 cycles of chemotherapy and subsequent involved field radiation. There has been no evidence of recurrence of disease 14 months from the start of chemotherapy. When conditions make surgical treatment difficult, dose-escalating chemotherapy in a treatment cycle may be considered as an alternative.
authors.affiliation: 2nd Dept. of Internal Medicine, Faculty of Medicine, University of the Ryukyus.
authors.forename: Aya
authors.initials: A
authors.lastname: Oshiro
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Nagasaki
authors.forename: Ayako
authors.initials: A
authors.lastname: Nakachi
authors.forename: Nobufumi
authors.initials: N
authors.lastname: Uchima
authors.forename: Hiroo
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Nakazato
authors.forename: Manabu
authors.initials: M
authors.lastname: Nakamoto
authors.forename: Nagisa
authors.initials: N
authors.lastname: Kinjo
authors.forename: Fukunori
authors.initials: F
authors.lastname: Kinjo
authors.forename: Naoya
authors.initials: N
authors.lastname: Taira
authors.forename: Masato
authors.initials: M
authors.lastname: Masuda
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takasu
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004317:Doxorubicin / Q000031:analogs & derivatives / Q000627:therapeutic use*; D004379:Duodenal Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use*; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use*
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone