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Esophageal Lymphoma Treatment & Management

  • Author: Vivek V Gumaste, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Apr 14, 2016
 

Approach Considerations

Data vary regarding therapy and prognosis in primary esophageal lymphoma. Choice of therapy depends on the histologic grade of the tumor and the extent of esophageal involvement. The initial therapy for primary esophageal lymphoma has included chemotherapy, surgical resection, and radiotherapy. Studies have indicated that nonsurgical approaches have had equivalent outcomes to those of surgical strategies in patients with GI lymphoma.

Some authors prefer combined therapy, with local resection plus chemotherapy and/or radiotherapy as the initial therapy. Others prefer chemotherapy alone as the therapeutic modality of choice.

Surgical resection

Surgical resection is reportedly curative in some cases of primary GI lymphoma, though surgery is primarily used for the diagnosis and treatment of complications. The role of surgery greatly depends on the stage of disease at the time of diagnosis and on the underlying medical condition of the patient.

A 2014 case report of a Japanese patient with esophageal mucosa-associated lymphoid tissue (MALT) lymphoma appeared to be successfully treated with endoscopic submucosal dissection (ESD).[16] The authors suggested that this procedure may be superior to endoscopic mucosal resection for early esophageal MALT lymphoma with respect to the lateral and vertical margins of the resected specimen.

Outpatient care

Carefully monitor adverse effects of chemotherapy or radiotherapy. In addition, carefully follow the patient's nutritional status. Consider placement of a gastric or jejunal feeding tube if the patient cannot maintain his or her nutritional status because of dysphagia or odynophagia.

Transfer

Transfer to a specialized cancer center may be required for further treatment (eg, chemotherapy, radiotherapy, surgical intervention).

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Chemotherapy and Radiotherapy

Chemotherapy

The chemotherapy regimen most commonly used is a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (a regimen referred to as CHOP). Other chemotherapy regimens have been used, but none have demonstrated greater efficacy than CHOP. Data indicate that the addition of rituximab, a chimeric anti-CD20 IgG1 monoclonal antibody approved by the US Food and Drug Administration (FDA) for use in various B-cell lymphoma subtypes, results in higher response rates and improved survival rates, although the experience is limited in primary GI lymphoma.

The regimen can be modified, depending on the patient's performance status and other comorbid conditions.

Radiotherapy

Radiotherapy can be used as a single modality, but it is most often used in conjunction with chemotherapy. Risks of radiotherapy include development of esophagotracheal or esophago-aortic fistulae.

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Contributor Information and Disclosures
Author

Vivek V Gumaste, MD Associate Professor of Medicine, Mount Sinai School of Medicine of New York University; Adjunct Clinical Assistant, Mount Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center at Elmhurst; Program Director of GI Fellowship (Independent Program); Regional Director of Gastroenterology, Queens Health Network

Vivek V Gumaste, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Manoop S Bhutani, MD Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch; Director, Endoscopic Research and Development, The University of Texas MD Anderson Cancer Center

Manoop S Bhutani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Rebecca C Dunphy, MD Consulting Staff, Centers for Gastroenterology

Rebecca C Dunphy, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Marco G Patti, MD Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine

Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American Surgical Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, Western Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Maurice A Cerulli, MD Program Director, Division of Gastroenterology and Hepatology, Program in Gastroenterology at Long Island Jewish Medical Center, Associate Professor of Clinical Medicine, Albert College of Medicine

Maurice A Cerulli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, and New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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