Clinical Outcome of Primary Gastric Lymphoma Treated with Chemotherapy Alone or Surgery Followed by Chemotherapy

Chang, Ming‐Chih; Huang, Ming-Jer; Su, Yu‐Jang; Chang, Yi-Fang; Lin, Johnson; Hsieh, Ruey‐Kuen

doi:10.1016/s0929-6646(09)60305-3

Cited by 13 publications

(13 citation statements)

References 34 publications

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“…In our series, all five patients who developed gastric perforation were in the chemotherapy-alone group, and eventually died of this complication. In contrast, none of the patients receiving the combination therapy had this complication, suggesting an important role for surgery in selected patients [4]. Of note, five patients of major complication, four in the chemotherapyalone group and one in the combination therapy group, developed gastro-intestinal bleeding at the time of disease progression.…”

Section: The Controversies Of Primary Treatment Of Pglmentioning

confidence: 90%

“…The recent publications gave even better results with 5-year OS over 90% [1,2]. However, for bulky tumors, the advantage of chemotherapy is offset by the potential tumor bleeding and gastric perforation [4]. In 1999 there was a publication of international survey to investigate the treatment consenus [24].…”

Section: The Controversies Of Primary Treatment Of Pglmentioning

confidence: 99%

“…In the recent 10 years chemotherapy combined with anti-CD20 monoclonal antibody such as rituximab, achieved higher complete response rate and more than 80% are long-term survival [1]. The role of surgical resection prior to chemotherapy is controversial and not commonly applied in recent publications [1][2][3][4]. Among the gastric malignancies PGL has the most favorable outcome not only in localized disease but also in stage IIb/IV disease.…”

Section: Introductionmentioning

confidence: 99%

“…It is highly sensitive to chemotherapy and anti-CD20 immunotherapy [1][2][3]. The primary role of surgery or chemotherapy remains the mainstay is an issue of debate [4]. However, there is, as yet, no randomized control trial to define the primary treatment of PGL, either surgery or chemotherapy or combined modality.…”

Section: Introductionmentioning

confidence: 99%

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Current Treatment and Controversy of Primary Gastric Lymphoma

Chang¹

2013

JCT

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Primary gastric lymphoma (PGL) is not a common cancer and account for 10% of malignant lymphoma and 5% of gastric cancer. The correlation with Helicobacter pylori (H. pylori) infection with mucosa associated lymphoepithelial tumor (MALT) is now well documented and some of the low grade MALT can be cured sorely by triple agent eradication therapy. The most common type of PGL is diffuse large B cell lymphoma which now can be successfully treated with chemotherapy alone. There is still no consensus on the optimal treatment for PGL. In the recent 10 years chemotherapy combined with anti-CD 20 monoclonal antibody such as rituximab, achieved higher complete response rate and more than 80% are long-term survival. The so-called R-CHOP (rituximab, cyclophosphamide, vincristin, prednisolone) now become the new gold standard therapy. The role of surgical resection prior to chemotherapy is controversial and not commonly applied in recent publications. Yet some cases of suboptimal response to R-CHOP or patient is too fragile to tolerate the immuno-chemotherapy will be feasible to surgical resection as a salvage or alternative therapy. The radiotherapy as an adjuvant therapy is less commonly considered. Patients with advanced PGL with high international prognostic index risk and along with co-morbidity diseases are prone to get treatment related complications from above-mentioned modality of treatment, such as GI perforation, neutropenic septicemia, pulmonary infection, fulminate heaptitis B reactivation, respiratory and cardiac impairment can be seen.

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Section: The Controversies Of Primary Treatment Of Pglmentioning

confidence: 90%

Section: The Controversies Of Primary Treatment Of Pglmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Current Treatment and Controversy of Primary Gastric Lymphoma

Chang¹

2013

JCT

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“…The current standard therapy for DLBCL with gastric lesions (DLBCL‐GL) is six to eight cycles of R‐CHOP or three cycles of R‐CHOP followed by involved‐field radiation therapy (IFRT) for early‐stage disease. Some reports showed the outcome of primary gastric DLBCL after R‐CHOP therapy while others reported that gastric complications such as bleeding, perforation, and stenosis, occurred under chemotherapy in 0%‐26% . However, the detailed features of these gastric complications were not well documented.…”

Section: Introductionmentioning

confidence: 99%

Complications and outcomes in diffuse large B‐cell lymphoma with gastric lesions treated with R‐CHOP

et al. 2019

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Standard therapy for gastric diffuse large B‐cell lymphoma (DLBCL) is considered to be chemotherapy with or without involved‐field radiation therapy. Although R‐CHOP therapy alone is widely used for DLBCL with gastric lesions (DLBCL‐GL), the outcome and incidence of treatment‐related gastric complications following R‐CHOP are not well known. This study aimed to evaluate the outcome after R‐CHOP therapy in patients with gastric DLBCL including gastric complications and to identify risk factors for the complications. Consecutive patients with newly diagnosed DLBCL‐GL treated with R‐CHOP between 2003 and 2014 were retrospectively evaluated. DLBCL‐GL was defined only when pathologically confirmed in the stomach. Of the 96 patients with DLBCL‐GL, 63 patients were diagnosed with gastric symptoms. Eighty‐eight patients (92%) completed six to eight cycles of R‐CHOP. The complete remission (CR) rate was 86%, and 3‐year and 5‐year overall survival rates were 80% and 73%, respectively. Patients were well stratified according to the Revised International Prognostic Index (R‐IPI). Complication rate was 8% (8/96); seven patients had bleeding and three had stenosis. No patients had gastric perforation. Bleeding occurred during the first cycle of R‐CHOP in five patients (5/7, 71%). Patients with gastric complications had a lower R‐CHOP completion rate (50%, P = 0.001) and a lower CR rate (25%, P < 0.001) than those without complications. A low serum albumin level at diagnosis was the only risk factor identified for gastric complications (P = 0.001) and six of the eight patients with complications were shown to be at stage IV. Further studies of DLBCL‐GL are warranted to identify patients at high risk for gastric complications and to provide better treatment strategies.

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Chemotherapy versus surgery with or without adjuvant chemotherapy and radiotherapy for localised primary gastric diffuse large B-cell lymphoma

Thein¹,

Myint²,

Khaing³

et al. 2012

Cochrane Database of Systematic Reviews

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Clinical Outcome of Primary Gastric Lymphoma Treated with Chemotherapy Alone or Surgery Followed by Chemotherapy

Abstract: The clinical outcome of localized PGL treated by chemotherapy alone is similar to that treated by surgery followed by chemotherapy in terms of tumor response, disease-free survival and overall survival, suggesting that surgery be reserved for those with residual tumors after chemotherapy.

Cited by 13 publications

References 34 publications

Current Treatment and Controversy of Primary Gastric Lymphoma

Current Treatment and Controversy of Primary Gastric Lymphoma

Complications and outcomes in diffuse large B‐cell lymphoma with gastric lesions treated with R‐CHOP

Chemotherapy versus surgery with or without adjuvant chemotherapy and radiotherapy for localised primary gastric diffuse large B-cell lymphoma

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