Surgical resection and limited chemotherapy for abdominal undifferentiated lymphomas

Fourteen patients (less than or equal to 35 years of age) with intra-abdominal undifferentiated lymphomas, without evidence of disease elsewhere, were treated by surgical resection and six cycles of combination chemotherapy which included cyclophosphamide, vincristine, doxorubicin, prednisone, and 42-hour methotrexate infusion with leucovorin rescue. One patient with very extensive retroperitoneal disease prior to surgery had rapid tumor regrowth and subsequently died. One patient has relapsed twice, but is currently alive and has been disease-free for 2 years. All other patients have remained in complete remission for 25-63 months from presentation. The major toxic effects encountered in this protocol were mucositis (which necessitated a reduction in methotrexate duration in two patients) and fever and neutropenia (which complicated chemotherapy in 15 of the total of 79 cycles delivered). There were three documented infections; all were diagnosed before chemotherapy was started, and all resolved with appropriate antibiotic treatment. The 92% actuarial survival rate in this protocol is comparable to results with more prolonged chemotherapy or a combination of prolonged chemotherapy and irradiation. Since prolonged maintenance therapy and irradiation were not utilized in our protocol, they appear to be unnecessary for patients with intra-abdominal undifferentiated lymphoma whose disease can be at least 90% resected.