title: R-CHOP with dose-attenuated radiation therapy could induce good prognosis in gastric diffuse large B cell lymphoma.
abstract: BACKGROUND
  The treatment strategy for gastric diffuse large cell lymphoma (DLBCL) has not been standardized in such as to the cycles of chemotherapy, dose of radiation, or necessity for the surgery. Although the results of CHOP or R-CHOP treatments have demonstrated the good prognosis, the treatments have been controversial in many cases.
  
  
  METHODS
  We retrospectively analyzed 40 gastric DLBCL patients receiving chemotherapy with or without radiation in our institute. Those in stages II-IV were treated with six cycles of R-CHOP without radiation; for those in stage I, we administered three cycles of R-CHOP with radiation.
  
  
  RESULTS
  The three-year overall survival (OS) and progression-free survival (PFS) rates were 95.2 and 91.8%, respectively. Those in stage I obtained 100% of OS. The radiation dose prescribed was 30.6 Gy for CR cases and 39.6 to 40 Gy for PR after chemotherapy. Although survival rates tended to correlate with staging groups or age-adjusted IPI classifications, multivariate statistical analysis did not show clear differences. All 14 patients with initial bleeding were successfully managed without surgery during treatment.
  
  
  CONCLUSIONS
  R-CHOP therapy was very effective for gastric DLBCL. It may be not necessary to use more than 30.6 Gy of radiotherapy in the highly chemo-sensitive cases. Less toxic treatments should be made available to gastric DLBCL patients.
authors.affiliation: Division of Hematology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. khatake@jfcr.or.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Mishima
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Terui
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yokoyama
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishimura
authors.forename: Sakura
authors.initials: S
authors.lastname: Sakajiri
authors.forename: Kyoko
authors.initials: K
authors.lastname: Ueda
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kuboki
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakano
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Suzuki
authors.forename: Eriko
authors.initials: E
authors.lastname: Nara
authors.forename: Naoko
authors.initials: N
authors.lastname: Tsuyama
authors.forename: Kengo
authors.initials: K
authors.lastname: Takeuchi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Oguchi
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Hatake