Conservative management of gastric lymphoma: the treatment option of choice.
The study was initiated to assess the safety and effectiveness of primary chemotherapy (CHT) followed by radiotherapy (RT) compared to surgery prior to CHT and/or RT in the management of localized gastric lymphoma. Ninety-two patients treated between 1985 and 2000 were included in a retrospective analysis. Sixty patients received primary CHT followed by extended field or involved field RT. Thirty-two patients had undergone primary surgery prior to referral and were treated with curative or consolidative CHT and/or RT. CHT was carried out according to the CHOP or COP-Blam protocol. Median age was 60 years (29-85). Forty patients had tumor stage IE, 36 II1E and 16 II2E (Musshoff classification). MALT histology was present in 25, diffuse large-cell in 62, lymphoplasmocytic in 4 cases and follicular histology in 1 case. Five-year disease-specific survival was 93% both after primary CHT and after primary surgery (P = 0.8). Five-year relapse-free survival was 91% and 93%, respectively (P = 0.7). No patient experienced gastric perforation or bleeding during CHT. Primary CHT of localized gastric lymphoma is associated with a low risk of treatment-related complications. Survival was similar compared to patients initially treated with surgery. To avoid long-term sequelae after gastric resection, primary CHT is recommended as standard initial treatment in localized gastric lymphoma.
Schmidt
Wolf-Peter
WP
Department of Haematology, Allgemeines Krankenhaus St. Georg, Hamburg, Germany. Ruth.Sonnen@t-online.de
Schmitz
Norbert
N
Sonnen
Ruth
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D015996:Survival Rate