What is the estimated frequency of upper digestive haemorrhage in Primary Mediastinal B-cell Lymphoma patients after Radiotherapy with and without a PET scan evaluation? Is there clinical significant differences?
Vague question. Firstly, chemotherapy is the preferred treatment for this lymphoma. Secondly, the g.i. tract should not have been radiated even if the mediastinum received radiotherapy . Perhaps there was tumour in the upper g.i. tract which lysed with chemotherapy causing the bleed. A PET scan might show undiagnosed disease and in the context of disease in the g.i. tract might show tumour that was not otherwise suspected.
Hi Jason,
In fact chemotherapy is the preferred treatment. In those patients undergoing consolidation Radiotherapy who have not made a PET scan, is there a tendency to widen the target in comparison with those who made PET, which can be more confined, and hence the possibility of bleeding?
I haven't found much about lymphoma and this kind of side effect (upper GI bleeding), is it because it only appears after methastization?
'Metastasis' in lymphoma is not a proper term, since the normal lymphocytes from which these tumours are derived circulate through the body. For that reason, radiotherapy is usually only used for consolidation of large tumours post chemotherapy. PET scans have limited use for staging NHL since they do tend to be more widespread, but are being used for prognosis and response to chemotherapy. The short answer to the question of PET in relation to g.i. bleed, I believe, would have no association.
I confirm previous data that radiotherapy wasn't the best front therapy in mediastinal NHL. Radiothery is usually used for consolidation. Interm of technic, GI tract is not involved during mediastinal radiotherapy. However, hemorrage could be a complication on oesophagus ulceration from peptic origin.
In our series of 44 patients ith primary mediastinal large B cell lymphoma we studied an alternating chemotherapy regimen based on high-dose methotrexate (Fietz et al.Ann Hematol (2009) 88 : 433-439 ).Our response rates exceeded 90% with an overall survival rate of 80% (8.6 years median follow-up). All patients were schedulded for consolidative IF -.radiation to the initial mediastinal mass.Toxicity grade 3 or 4 were 20% for mucositis mostly due to MTX. We never observed,however,a GI bleeding,and long-term toxicity with a follow-up of maximum 16 years is acceptable as indicated in addition by three uncomplicated pregnancies after treatment. Of course a sufficient interval of at least 4 weeks after chemo has to be applied for radiotherapy.
Dear Jason, I agree with my colleagues. The standard treatment is R-CHOP or R-EPOCH (chemotherapy using monoclonal antibody and classical CHOP or adding etoposide in continuous infusion and also continuous infusion of doxorubicin/ vincristine; Pfreundschuh Ann Oncol 2011; 22:664 and Dunleavy NEJM 2013;368:1408) and radiotherapy as consolidation. However, your direct question about upper digestive bleeding is posible as a side effect of radiotherapy but the new techniques avoid this complication.
We have never seen upper digestive haemorrhage after RT consolidation in PMBL group, only mucositis and pulmonary fibrosis. Did you take any useful information after esophagoscopy?
Just to add a comment. Consider that based in last publications on PMBCL, there is probably little if any place of RT after a PET-complete response to REPOCH