Non-Hodgkin's lymphoma of the stomach: a prospective pilot study of surgery plus chemotherapy in early and advanced disease.

Abstract

A prospective pilot study of 23 patients with non-Hodgkin's lymphoma involving the stomach was undertaken to assess the efficacy of surgical resection followed by chemotherapy with adjuvant cyclical cyclophosphamide, vincristine, and prednisolone (CVP) in early stage disease, and cyclical cyclophosphamide, vincristine, prednisolone, and doxorubicin (CHOP) in advanced disease. One of 18 evaluable patients died postoperatively; 17 of 18 completed therapy and are alive and disease-free at a median follow-up of 41 months after surgery (range, 5 to 111 months), including four patients with stage IV disease who remain in complete remission 19 to 47 months after surgery. There was one postoperative death, giving an actuarial survival rate of 94% in the study group. Three of five inoperable patients were treated with CHOP, with two achieving complete remission. Two untreated patients died. Overall actuarial disease-free survival was 82.6%. Surgical resection plus chemotherapy is capable of producing long-term remission and cure in both localized and advanced non-Hodgkin's lymphoma of the stomach. Intensive supportive care plus chemotherapy may salvage a proportion of patients with inoperable tumors.

Combined surgery and chemotherapy for the treatment of primary gastrointestinal intermediate- or high-grade non-Hodgkin's lymphomas

“…Probably, the better prognosis of resected patients depends not only on the presence of a smaller post-operative tumour mass, but also on the lower rate of gastrointestinal perforation or haemorrhage, which are rather frequent complications of non-resected lymphomas (Hande et al, 1978;Fleming et al, 1982;Weingrad et al, 1982;Liang et al, 1987;Naqvi et al, 1969). We had no such complication during chemotherapy, in keeping with several previous reports using a chemotherapeutic treatment (Paulson et al, 1983;Sheridan et al, 1985;Liang et al, 1987;Janus et al, 1984).…”

“…This relapse rate seems to be lower in patients treated with chemotherapy (Paulson et al, 1983;Economopoulos et al, 1985;Sheridan et al, 1985;Janus et al, 1984;Shepherd et al, 1988). Hence, our findings (e.g.…”

“…(Gospodarowicz et al, 1983;Fleming et al, 1982;Paulson et al, 1983;Herrera et al, 1985;Dragosics et al, 1985;Ampil, 1987;Rosenfelt & Rosemberg, 1980;Economopoulos et al, 1985;Sheridan et al, 1985;Liang et al, 1987;Steward et al, 1985;Janus et al, 1984;List et al, 1988;Shepherd et al, 1988). Our study indicates that chemotherapy following surgical resection of gastrointestinal lymphomas is highly effective: we obtained 81% CRs in patients treated with partial or palliative resection, and an overall 76% 10-year causespecific survival, which are results comparable with those of other recently published reports (Paulson et al, 1983;Sheridan et al, 1985;Liang et al, 1987;Janus et al, 1984;List et al, 1988;Shepherd et al, 1988). The extent of tumour resection was a major determinant of prognosis in our patients and was unequivocally identified by the multivariate analysis of survival and disease-free data.…”

“…In some investigations, chemotherapy alone (Hande et al, 1978;Siegert et al, 1985;Paulson et al, 1983;Rosenfelt & Rosemberg, 1980;Sheridan et al, 1985;Liang et al, 1987;Shepherd et al, 1988) or combined with radiotherapy (Maor et al, 1984;Paulson et al, 1983;Herrera et al, 1985;Economopulos et al, 1985;Liang et al, 1987;Omar et al, 1985;Steward et al, 1985) have ensured improved survival rates. However, it is generally agreed that the role of chemotherapy in localised NHL also requires further study.…”

A prospective study of surgery and adjuvant chemotherapy for primary gastric lymphoma stage II

“…Favourable results for stage I and II PGL using surgical resection followed by chemotherapy have been reported by several authors (Paulson et al, 1983;Sheridan et al, 1985;Shepherd et al, 1988;Bellesi et al, 1989;Pasini et al, 1994), but these reports failed to discriminate between stage I and stage II disease. In the present study, we focused on stage II PGL because the results obtained from a previous study (Takenaka et al, 1981) suggested that: (a) stage I PGL is cured by gastrectomy alone; and (b) stage II PGL relapses occasionally without adjuvant chemotherapy.…”