Chemotherapy alone versus surgery followed by chemotherapy for stage I/IIE large‐cell lymphoma of the stomach

Abstract

The optimal treatment of localized large-cell lymphoma of the stomach remains controversial. In particular, the role of surgical resection of the primary tumor needs to be clearly defined. We have reviewed all patients with a diagnosis of gastric lymphoma and treated in our institutions between 1988 and 1998. Patients fulfilling the following criteria were included in this study: (1) histologically proven large-cell lymphoma of the stomach; (2) adequate pathological materials and complete clinical information for analysis; (3) clinical stage I/II disease according to the Musshoff modification of Ann Arbor system; and (4) received primary chemotherapy alone with anthracycline-or anthracenedionecontaining regimens (group A) or curative surgery followed by adjuvant chemotherapy (group B). There were 38 and 21 patients in group A and group B, respectively. All pertinent clinicopathologic features were similar between the two groups of patients, except that patients of group A had significantly more stage II-2 disease (P = 0.004). Of group A, among 36 patients who could be evaluated for response to chemotherapy, there were 29 complete and 1 partial responses, with an overall response rate of 83.3% (95% CI, 71.1-95.5%). The projected 5-year relapse-free survival (RFS) and overall survival (OS) were 86.0% (95% CI, 73.3-98.7%) and 72.6% (95% CI, 57.0-88.2%), respectively. On the other hand, the projected 5-year RFS and OS of group B were 77.9% (95% CI, 58.0-97.8%) and 77.8% (95% CI, 57.9-97.7%), respectively, not significantly different from that of group A. Our data suggest that systemic chemotherapy alone may be a reasonable alternative treatment for stage I/II large-cell lymphoma of the stomach. Resection of the primary tumor before systemic chemotherapy does not appear to improve the cure rate of this group of patients. Am.

Primary gastric lymphoma

“…None of the patients experienced acute treatment related morbidity or mortality from local complications [68] . In three recent trials with variable chemotherapy regimens, the survival rates of 82%-88% in stage IE and IIE, high grade lymphoma with only few and manageable complications were found [65,67,68] . In other series, chemotherapy alone compared with surgical resection alone, has shown no significant difference in the matter of survival.…”

“…In patients with comorbid factors and increased risk of surgery-related morbidity and mortality, chemotherapy offered an effective or equally effective mode of treatment to surgical resection 57% vs 58% [71] . The fear of chemotherapy-related complications, for instance, bleeding and perforation, has been disputed, and less significant compared with surgical resection [65,[67][68][69] . Some authors reported the incidence of chemotherapy-related bleeding between zero and three percent and no perforation [60,72] .…”

“…Early stages of the disease regardless of the histological grade may be controlled by chemotherapy or chemotherapy and radiotherapy with the advantage of gastric conservation and avoidance of post-operative mortality and morbidity [54,62,[65][66][67]69,74] . On the other hand, surgery is advocated as the first option with adequate control of the disease [57][58][59]61] , and occasionally with the necessity of wide resection and extensive lymph node dissection [15,78] , however, adjuvant chemotherapy is indicated to control the local and distant disease if any [75,78] .…”

Comparison of MALT and non-MALT primary large cell lymphoma of the stomach

“…It has been our policy to administer systemic chemotherapy comprised of anthracycline‐ or anthracenedione‐containing regimens as the initial therapy for all patients who have primary high grade gastric lymphoma 15. Surgery and local radiation are reserved for patients whose disease does not respond well to chemotherapy or who develop treatment‐related complications that prohibit further treatment.…”

Prognostic value of flow cytometry in surgically treated primary gastric lymphoma

“…There is considerable controversy concerning gastric lymphoma treatment since there are several therapeutic options. Surgical resection, the classical treatment associated with good results, is increasingly being replaced by chemotherapy (2,3), also showing good results but lacking long-term follow-up. Its pathogenesis has been associated with Helicobacter pylori (H. pylori) infection and thus these patients have also been exclusively treated with H. pylori eradication therapy, with complete remission in high percentages (62-91,6%) (4,5).…”