Stages IE and IIE non-Hodgkin's lymphomas of the stomach: Comparison of treatment modalities

Abstract

Seventy‐nine patients with Stages IE and IIE non‐Hodgkin's lymphomas of the stomach were treated between 1953 and 1980. The histopathologic classification was as follows: diffuse large cell, 61 (of which 23 were immunoblastic sarcomas [plasmacytoid]); diffuse well‐differentiated lymphocytic, 6; diffuse mixed, 1; undifferentiated non‐Burkitt's, 1; nodular, 9; and unclassifiable, 1. Thirty‐five patients had Stage IE disease and 44 had Stage IIE. Treatment modalities included surgery, radiotherapy, chemotherapy, and combinations thereof. Sixty‐six patients had a laparotomy for diagnosis and/or management. Of these, only 42 had a gastrectomy. The stomach was considered to be unresectable in the other 24 patients. There were 5 postoperative deaths among 31 patients who had a laparotomy or gastrectomy at our institution. The overall 5‐year actuarial survival was 56%; the disease‐free survival was 54%. For patients with Stage IE disease the survival was 76%, and for those with Stage IIE, 42%. Promising results were obtained in 13 patients who were treated on a multimodality program consisting of four cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus bleomycin (Bleo), which was alternated with involved field radiotherapy. All 13 patients had no evidence of disease as of this report. Only one patient had a relapse (Waldeyer's ring), and he was salvaged with radiotherapy. Six of these 13 were diagnosed by endoscopic biopsy and did not have a laparotomy, 3 were found to have unresectable disease at laparotomy, and 4 had a resection. Biopsy with the flexible fiberscope and treatment with CHOP‐Bleo and radiotherapy can avoid the morbidity and mortality of gastrectomy.

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

“…The gastrointestinal tract is the site most frequently affected at diagnosis accounting for about 4-18% of all extranodal forms of NHLs (Freeman et al, 1972;Reddy et al, 1980;Ho et al, 1984;Lewin et al, 1978;Isaacson et al, 1979;Herrmann et al, 1980;Hande et al, 1978;Strauss et al, 1983;Gospodarowicz et al, 1983;Siegert et al, 1985;Carnevali et al, 1987). While several studies have emphasised the effectiveness of the complete surgical resection of localised lesions (Siegert et al, 1985;Fleming et al, 1982;Maor et al, 1984;Paulson et al, 1983), the majority of authors consider this therapeutic approach as non-curative. The clinical efficacy of adjuvant postoperative radiotherapy remains controversial (Herrmann et al, 1980;Hande et al, 1978;Gospodarowicz et al, 1983;Siegert et al, 1985;Paulson et al, 1983;Weingrad et al, 1982;Lim et al, 1977;Shimm et al, 1983;Herrera et al, 1985;Dragosics et al, 1985;Rao et al, 1984;Mittal et al, 1983;Ampil, 1987).…”

“…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

“…These results are not superior to our survival rate and disease-free survival rate obtained by surgery plus adjuvant chemotherapy. Although combination chemotherapy as an initial treatment has been shown to be useful in PGLs (Maor et al, 1984;Salles et al, 1991), data are not available concerning the treatment of localized PGL with chemotherapy alone.…”

“…Although localized (stage I and II) primary gastric lymphoma (PGL) has been treated by various modalities, including surgery (Shiu et al, 1982), chemotherapy (Maor et al, 1984: Salles et al, 1991, surgery plus radiotherapy (Shiu et al, 1982;Gospodarowicz et al, 1983;Taal et al, 1993), surgery plus chemotherapy (Paulson et al, 1983;Sheridan et il, 1985;Shepherd et al, 1988;Bellesi et al, 1989;Pasini et al, 1994) and radiotherapy plus chemotherapy (Burgers et al, 1988;Dragosics et al, 1985, Maor et al, 1990Tondini et al, 1993), the best management for this disease is still unclear.…”

Outcome of patients with non-Hodgkin's lymphoma of the stomach after gastrectomy: clinicopathologic study and reclassification according to the revised European-American lymphoma classification

“…However, although primary gastric lymphomas are resectable, several studies have documented that nonsurgical treatment has yielded reasonable outcomes [2,5]. This dilemma over management is further compounded by reports of massive hemorrhage or perforation of nonresected, medically treated lesions.…”