[Digestive localizations of non Hodgkin's malignant lymphoma. Clinical, therapeutic and prognostic aspects. Apropos of 29 cases].

29 cases of non Hodgkin's lymphoma (L.N.H.) involving the gastrointestinal (G.I.) tract were reviewed. Primary G.I. involvement was found in 15 patients (2 occurred after Hodgkin's disease), secondary G.I. involvement in 14 patients. Clinical, barium x-ray studies and endoscopic data, prognostically features, mode and results of therapy were analysed in the two groups. Patients were staged using modified (stage IIE) Ann Arbor system; tumors were classified by the "working formulation of N.H.L. for clinical use" (1982). Patients with primary G.I. stage I E - II E N.H.L. were treated with surgery and radiotherapy or surgery with systemic multiple drugs therapy for patients at high risk for recurrence. Disseminated disease and secondary G.I. N.H.L. were treated by chemotherapy; palliative surgery, with high mortality rate, and radiotherapy were occasionally indicated. 3 patients died and 3 had recurrences (5/6 within 2 years) in the first group. Only 2 patients achieved complete remission in secondary G.I.N.H.L. (median survival time: 14 months). Coeliotomy is necessary for unproved diagnosis or emergencies. This study would indicate that the role of surgery remains important in primary localized G.I. stage I E - II E N.H.L.: although diagnosis might be clearly established on endoscopic biopsies; despite results of primary chemotherapy or radiotherapy on controlling local tumor as reported by others authors. Surgical exploration was an essential step in establishing the extent of disease to plan therapy. Resection prevented the possible local complication associated with primary radiotherapy or chemotherapy. The relative risk of treatment induced second malignancies must be considered in the design of adjuvant therapy.