Evaluating the impact of surgical removal of tumors in non-Hodgkin lymphoma.

This study examined the effectiveness of complete surgical removal of aggressive non-Hodgkin lymphoma (NHL). The authors found that in young patients with diffuse large B-cell lymphoma (DLBCL) may benefit from complete surgical removal of the tumor before immunochemotherapy (ICT). 

Lymphoma is a cancer that comes from white blood cells. Developing a lymphoma can cause the immune system in the body to function incorrectly. Surgical removal of NHL was previously only used in a diagnostic fashion. It has been replaced by a less invasive core needle biopsy approach. Unlike other tumors, NHL is usually treated with systemic therapy (drug therapy that spreads throughout the body to kill cancer cells). ICT in one type of systemic therapy that involves both chemotherapy and immunotherapy drugs.

New imaging techniques such as PET-scans have enabled an evaluation of the tumor burden. A negative PET scan indicates that a tumor has completely disappeared.

Previous trials have indicated that surgical removal of tumors may have an important role in increasing the remission rate of patients with aggressive forms of NHL such as DLBCL and T-cell lymphoma (TCL). However, the evidence so far is limited.

This analysis looked at patients with NHL who had a negative PET-scan. There were 67 patients in total included in this analysis. 56 patients had DLBCL. 52 of these patients had complete surgical removal of their tumors carried out. 11 patients had TCL. 8 of these patients had complete surgical removal of their tumors carried out. All patients received ICT with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) plus rituximab (Rituxan). The average follow-up was 4.4 years.

Patients with DLBCL with a complete surgical removal of their tumor had a significantly higher remission rate compared to patients without complete surgical removal of tumors (100% vs. 66%). The response rate to systemic therapy was also higher in the complete surgical removal group (100% vs. 91.5%).

In patients younger than 60, survival without disease worsening at 2 years was higher in patients with completely resected lymphoma compared to the control group (100% vs. 92.2%). However, in patients aged 60 or older this rate was similar between the completely resected group and control group (83.6% vs. 85.3%).

In patients with TCL, there was no difference in improved outcomes between those with completely removed tumors and those without completely removed tumors.

The authors concluded that younger patients with DLBCL may benefit from the complete surgical removal of their tumor before starting ICT. 

This study had a small number of participants. Other information such as genetic abnormalities were not included in this analysis.