title: Surgery and chemotherapy versus chemotherapy as treatment of high-grade MALT gastric lymphoma.
abstract: OBJECTIVE
  Treatment of high-grade MALT (mucosa-associated lymphoid tissue) gastric lymphoma remains uncertain. To assess efficacy and toxicity of the most common therapies--surgery followed by chemotherapy or chemotherapy alone--we began a controlled clinical trial in patients in early stage (I and II 1).
  
  
  METHODS
  One hundred and two patients were randomized to be treated with surgery followed by six cycles of CEOP-Bleo (cyclophosphamide, epirubicin, vincristine, prednisone, and bleomycin at standard doses) (52 cases) or with chemotherapy alone (49 cases).
  
  
  RESULTS
  Complete response rates were 94% [95% confidence interval (CI): 88-99%] and 96% (93-100%), respectively. Actuarial curves at 5 yr showed that event-free survival were 70% (95% CI: 59-74%) in patients treated with surgery and chemotherapy, that were not statistically significant to 67% (95% CI: 51-69%) in the patients who received chemotherapy (p = 0.5). Also, overall survival that was not statistically significant: 78% (95% CI: 70-88%) in the combined treatment and 76% (95% CI: 70-87%) in chemotherapy (p = 0.8). Acute and late toxicity were mild and well controlled. No acute leukemia or second neoplasm has been observed.
  
  
  CONCLUSIONS
  The use of surgery and chemotherapy did not improve outcome in patients with early-stage high-grade gastric MALT lymphoma. It is apparent that chemotherapy alone is sufficient treatment in this select group of patients.
authors.affiliation: Oncology Research Unit, National Medical Center, IMSS, México, D.F. Mexico. agavilés@avantel.net
authors.forename: Agustín
authors.initials: A
authors.lastname: Avilés
authors.forename: Natividad
authors.initials: N
authors.lastname: Neri
authors.forename: M Jesús
authors.initials: MJ
authors.lastname: Nambo
authors.forename: Judith
authors.initials: J
authors.lastname: Huerta-Guzman
authors.forename: Sergio
authors.initials: S
authors.lastname: Cleto
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001761:Bleomycin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000401:mortality / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D012074:Remission Induction; D013274:Stomach Neoplasms / Q000401:mortality / Q000628:therapy*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D015251:Epirubicin; D014750:Vincristine; D003520:Cyclophosphamide; D011241:Prednisone