Esophageal Lymphoma Treatment & Management

Updated: Jan 18, 2017
  • Author: Victor Velocci, MD; Chief Editor: BS Anand, MD  more...
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Treatment

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). [19] 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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