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.

Therapeutic Comparison of Chemotherapy and Surgery for Early Stage Diffuse Large B-cell Gastric Lymphoma

“…In contrast to those treated by surgery, the most common complication following chemotherapy was neutropenia (8.5 - 71%), accompanied by sepsis in 5.6% of the cases 16,17. Gastrointestinal bleeding was reported in 3 - 5.6% of the cases,10,16 and perforation occurred in 5% of the cases 10. In Gobbi's report, 5 of 188 patients (2.7%), who underwent stomach-preservation treatment, died of gastrointestinal bleeding or perforation 15…”

“…However, Gobbi et al reviewed 682 cases and redefined perioperative mortality as 7.2% (49 cases) 15. Anastomosis leakage was observed in 1.5 - 5% of the cases,10,14 and gastrointestinal bleeding from the remnant stomach or from the anastomosis site was observed in 1.5 - 10% of the cases 10,14. The most common late post-surgical complications were 'dumping syndrome' (6.4%) and malabsorption (5.5%) 11.…”

Quality of life one year after chemoradiotherapy for localized primary gastric diffuse large B-cell lymphoma

“…The vast majority of primary gastric lymphomas, independent of the grade of the malignancy, present as localized stage I/II disease [3,4]. Prior to the recent findings that primary treatment with chemotherapy with/without radiotherapy [5][6][7] for gastric diffuse large B-cell lymphoma (DLBCL) is just as effective as surgery, the initial treatment for this group of patients was Won Seog Kim and Yeon Hee Park have contributed equally to this work. gastrectomy [8].…”

Spontaneous perforation of primary gastric B‐cell lymphoma of MALT: a case report and literature review

“…In a time surgery is now limited to cases of perforation, hemorrhage, or obstruction due to the tumor, it is no longer the cornerstone of treatment with its mortality rate reaching up to 8% . As shown in Table , chemotherapy has surpassed surgery in terms of benefits and complications . Ohkura et al summarized 15 cases requiring gastrectomy between 1985 and 2013 in Japan .…”