Stomach conservation in stages IE and IIE gastric non-Hodgkin's lymphoma.

Abstract

Thirty-four patients with stages IE and IIE gastric lymphoma were treated with chemotherapy and radiotherapy combinations without stomach resection. In 20 patients, the diagnosis was established by endoscopic biopsy only; the other 14 had laparotomy and biopsy. No patient had a gastrectomy before treatment. Nineteen patients had stage IE disease and 15 had stage IIE. Lymphoma diagnoses were: diffuse large-cell, 26; immunoblastic, three; diffuse well-differentiated, three; nodular mixed, one; and unclassified, one. The treatment plan was to deliver an initial four cycles of chemotherapy, followed by radiotherapy, and finally, more chemotherapy. Thirty-three patients received cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-Bleo). Four patients with stage IIE disease received cyclophosphamide, methotrexate, etoposide, and dexamethasone (CMED). Twenty-three patients (68%) never had a relapse. Three patients had successful salvage therapy, one for local recurrence and two for tumor dissemination. Five patients died of recurrent abdominal disease, and one died of tumor dissemination. Two died of treatment-related complications, one of sepsis during treatment with CMED and one of bleomycin-induced lung fibrosis. No patient developed stomach perforation or bleeding as a result of chemotherapy or radiotherapy. Twenty-four of the 26 surviving patients were able to retain their stomachs. One patient required a gastrectomy for progressive disease during chemotherapy, and another required a subtotal gastrectomy for relief of an obstruction caused by cicatrization. These data show that surgery is not a necessary procedure in gastric lymphoma. Favorable results can be achieved by combining effective chemotherapy and local radiation.

Results with chemotherapy comprised of cyclophosphamide, doxorubicin, vincristine, and prednisone followed by radiotherapy with or without prechemotherapy surgical debulking for patients with bulky, aggressive lymphoma

“…However, the overall survival rate achieved in patients who underwent debulking surgery and CHOP chemotherapy in that study (5-year rate, 79%) was similar to the overall survival rate observed in patients who were treated at the M. D. Anderson Cancer Center with chemotherapy and radiotherapy without undergoing debulking surgery (5-year rate, 73%). 19 In the latter study, none of the 34 patients developed stomach perforation or bleeding after nonsurgical treatment, and 24 of 26 surviving patients (92%) were able to retain their stomachs. Similarly, Perren et al 20 have recommended chemotherapy and radiotherapy without surgery for women with bulky lymphomas involving the cervix or upper vagina.…”

Primary gastrointestinal lymphoma in Japan

“…[13][14][15][16][17][18]30,31,45,46 Although past studies showed that surgical resectability was of significance, recent studies have demonstrated that nonsurgical strategies and surgery-based modalities had an equivalent efficacy. 30,31,45 Based on all these observations, and taking patients' quality of life into consideration, nonsurgical treatment is an alternative and optimal therapeutic modality for gastrointestinal lymphoma. Further randomized prospective studies with a large number of patients are still needed to establish …”

Non-Hodgkin's Lymphoma of Mucosa-Associated Lymphoid Tissue

“…Mortality directly related to total gastrectomy can be as high as 4% [81]. Favorable experiences with local radiotherapy, chemotherapy, and antibody therapy, allowing for gastric preservation, have limited the role of surgery even in patients failing primary therapy, although surgery may still be required for complications [82].…”