Clinico-pathological features and outcome of management of pediatric gastrointestinal lymphoma.
OBJECTIVE
The purpose of this study is to evaluate pediatric GIT lymphomas as regards clinico-pathological features, controversies in surgical treatment, role of chemotherapy and the prognostic features.


METHODS
This study included forty three patients with pediatric GIT Non-Hodgkin's lymphoma collected over 7 years at the NCI Cairo University between January 1997 and December 2003. The data of every patient included: Age, sex, presenting symptoms and signs, preoperative investigations, extent of the disease at diagnosis and the type of resection performed, histopathological examination, details of chemotherapy and state at follow up. Overall and disease free survival were calculated and correlated with all parameters.


RESULTS
The study included 30 boys and 13 girls with median age 5.00 years (range: 0.4:17). The lesions were located in the small intestine (n=15), the large intestine (n=14), the ileocecal region (n=10), stomach (n=2), and multifocally (n=2). Burkitt's lymphoma was the commonest histological type (n=24). The majority were stage IIE and IIIE (22 and 17 respectively). Exploration was done in thirty nine patients (complete resections were done in 23 cases, incomplete resections (debulking) were done in 14 cases and in 2 cases only lymph node biopsies were done). All patients received a sort of systemic chemotherapy. The median follow up duration was 44 months (range 4- 116 months). The only parameters that had significantly affected the overall survival were localized disease, complete resection, earlier stage and response to chemotherapy with p values, (0.005, 0.001, 0.005 and <0.001 respectively). As regards the disease free survival the only significant factor was localized disease (p=0.035).


CONCLUSIONS
The extent of disease at presentation is the most important prognostic factor in pediatric GIT lymphoma. Surgery still plays an important role such as complete resection in localized disease, management of complicated disease and diagnostic biopsy. There is no value of debulking and surgery is not advised for gastric lesions. Chemotherapy represents a cornerstone in the treatment and offers an excellent chance for long term, disease free survival.
Morsi
Ahmed
A
The Department of Surgical Oncology, NCI, Cairo University.
Abd El-Ghani
Abd El-Ghani M
Ael-G
El-Shafiey
Majed
M
Fawzy
Mohamed
M
Ismail
Hoda
H
Monir
Manar
M
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002675:Child, Preschool; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D007223:Infant; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis