A prospective study of surgery and adjuvant chemotherapy for primary gastric lymphoma stage II

Abstract

Summary The standard management of primary gastric lymphoma (PGL) (stage 11) has not been established despite the use of various treatment modalities. The present prospective trial of combined surgery and chemotherapy for the treatment of PGL (stage 11) included 25 consecutive patients treated between July 1978 and December 1993. Twenty-one patients were treated with total gastrectomy and four with partial gastrectomy; this was followed by post-operative chemotherapy with m-VEPA (vincristine, cyclophosphamide, prednisolone and doxorubicin), followed by consolidation chemotherapy with VEMP (vindesine, cyclophosphamide, methotrexate and prednisolone) or VQEP (vindesine, carbazilquinone, cyclophosphamide and prednisolone). Twenty-one of the 25 patients who completed post-operative chemotherapy were free of relapse 26-203 (median 94) months after the gastrectomy. Of the four patients who did not complete the projected chemotherapy, two relapsed and died of lymphoma. Another patient with recurrent lymphoma died in an accident, and the fourth patient was in remission at 54 months after surgery. The post-operative overall and disease-free survival rates at 10 years for the 25 evaluable patients were 81.6% and 92.0% respectively. Major surgical complications and treatment-related death after chemotherapy were not observed. PGL (stage 11) appears to be curable when treated with gastrectomy and adjuvant chemotherapy.

Pancreaticoduodenectomy for Perforated Gastric Malignant Lymphoma: Report of a Case

“…Takenaka et al showed that the best treatment for the non-perforated stage I and II gastric malignant lymphoma is a gastrectomy combined with chemotherapy. 3 The frequency of complications such as bleeding or a perforation in unresected tumors with gastrointestinal malignant lymphoma has been reported to be between 12% and 20%, 2,11 and the rate of perforation of the gastric malignant lymphoma was 0%-5%. 1,2,9 Since this complication often occurs after chemotherapy, the prognosis of patients with a perforation is poor.…”

Clinicopathological features of primary gastric lymphoma

“…The principal reason for this is a low radical resection rate: 20% in stage II 1E and 0% in stage IVE, and of course the fact that no formal adjuvant therapy regimen has been used in these patients. This figure necessitates more intense attention in the future and surgical management must be followed by a planned adjuvant therapy that may produce complete remission and long-term disease-free survival in patients with stage II disease [18] or even in patients with relapse [19].…”

Gastric Lymphoma

“…Patients whose disease was clinical stage I E and is pathologic stage II should receive postresection chemotherapy to enhance long-term freedom from recurrence. Some series report a 90% to 100% freedom from recurrence rate and a 70% to 90% long-term survival rate with this combination approach [18,19]. Gastric perforation or uncontrolled hemorrhage at presentation is an indication for surgery.…”

“…Results vary from a success rate less than 50% to a long-term disease-free survival rate of 70% [16•,17]. Chemotherapy adds to the long-term recurrence-free survival rate in patients treated initially with primary surgery whose pathologic disease stage is II or higher [3,18,19]. Standard regimen The most common regimen used to treat large-cell lymphoma is known by the acronym CHOP and consists of intravenous cyclophosphamide, 750 mg/m2, on day 1; intravenous doxorubicin, 50 mg/m2, on day 1; intravenous vincristine, 1.4 mg/m2, on day 1 (maximum dose, 2 mg); and oral prednisone, 100 mg daily on days 1 through 5.…”