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Bai Z, Zhou Y. A systematic review of primary gastric diffuse large B-cell lymphoma: Clinical diagnosis, staging, treatment and prognostic factors. Leuk Res 2021; 111:106716. [PMID: 34627052 DOI: 10.1016/j.leukres.2021.106716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/19/2021] [Accepted: 09/26/2021] [Indexed: 01/05/2023]
Abstract
Primary gastric lymphoma (PGL) is a rare clinical entity accounting for the majority of extra-nodal non-Hodgkin lymphoma (EN-NHL). The most common histological subtype is the primary gastric diffuse large B-cell lymphoma (PG-DLBCL) with a media age of 50-60 years old, mostly in male. Pathogenesis is often related to some bacterial infection such as Helicobacter pylori (H. pylori) infection. However, due to various available staging system, there is still no consensus on the staging of PG-DLBCL. The international prognostic index (IPI) is the most valuable used for the stratification of almost all subtype of NHL and as well as for PG-DLBCL. As for treatment strategies, surgery, chemotherapy, radiation therapy and antibiotic therapy in various combinations have been applied in clinical treatment. There are a few well-known prognostic factors and some of them may constitute prognostic models. Due to the increasing incidence of this neoplasm, it is necessary for clinicians to make deep insight of the diagnosis, staging, treatment and prognostic factors of PG-DLBCL.
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Affiliation(s)
- Zhimin Bai
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| | - Yong Zhou
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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A Heterogeneity Radiomic Nomogram for Preoperative Differentiation of Primary Gastric Lymphoma From Borrmann Type IV Gastric Cancer. J Comput Assist Tomogr 2021; 45:191-202. [PMID: 33273161 DOI: 10.1097/rct.0000000000001117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aimed to preoperatively differentiate primary gastric lymphoma from Borrmann type IV gastric cancer by heterogeneity nomogram based on routine contrast-enhanced computed tomographic images. METHODS We enrolled 189 patients from 2 hospitals (90 in the training cohort and 99 in the validation cohort). Subjective findings, including high-enhanced mucosal sign, high-enhanced serosa sign, nodular or an irregular outer layer of the gastric wall, and perigastric fat infiltration, were assessed to construct a subjective finding model. A deep learning model was developed to segment tumor areas, from which 1680 three-dimensional heterogeneity radiomic parameters, including first-order entropy, second-order entropy, and texture complexity, were extracted to build a heterogeneity signature by least absolute shrinkage and selection operator logistic regression. A nomogram that integrates heterogeneity signature and subjective findings was developed by multivariate logistic regression. The diagnostic performance of the nomogram was assessed by discrimination and clinical usefulness. RESULTS High-enhanced serosa sign and nodular or an irregular outer layer of the gastric wall were identified as independent predictors for building the subjective finding model. High-enhanced serosa sign and heterogeneity signature were significant predictors for differentiating the 2 groups (all, P < 0.05). The area under the curve with heterogeneity nomogram was 0.932 (95% confidence interval, 0.863-0.973) in the validation cohort. Decision curve analysis and stratified analysis confirmed the clinical utility of the heterogeneity nomogram. CONCLUSIONS The proposed heterogeneity radiomic nomogram on contrast-enhanced computed tomographic images may help differentiate primary gastric lymphoma from Borrmann type IV gastric cancer preoperatively.
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Thein AW, Myint AA, Khaing SH, Shinde SV, Maw M. Chemotherapy versus surgery with or without adjuvant chemotherapy and radiotherapy for localised primary gastric diffuse large B-cell lymphoma. Hippokratia 2016. [DOI: 10.1002/14651858.cd009914.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Aung Win Thein
- Melaka-Manipal Medical College; Department of Surgery; Jalan Batu Hampar, Bukit Baru Melaka Melaka Malaysia 75150
| | - Aye Aye Myint
- Monash University; Department of Medicine; Johor Bahru Johor Malaysia 80100
| | - Saw Hla Khaing
- Melaka-Manipal Medical College; Department of Surgery; Jalan Batu Hampar, Bukit Baru Melaka Melaka Malaysia 75150
| | - Shyamkant Vithal Shinde
- Melaka-Manipal Medical College; Department of Paediatrics; Jalan Batu Hampar Bukit Baru Melaka Melaka Malaysia 75150
| | - Myat Maw
- Melaka-Manipal Medical College; Department of Surgery; Jalan Batu Hampar, Bukit Baru Melaka Melaka Malaysia 75150
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Tarella C, Arcaini L, Baldini L, Barosi G, Billio A, Marchetti M, Rambaldi A, Vitolo U, Zinzani PL, Tura S. Italian Society of Hematology, Italian Society of Experimental Hematology, and Italian Group for Bone Marrow Transplantation Guidelines for the Management of Indolent, Nonfollicular B-Cell Lymphoma (Marginal Zone, Lymphoplasmacytic, and Small Lymphocytic Lymphoma). CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:75-85. [DOI: 10.1016/j.clml.2014.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 12/19/2022]
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Kim JS, Rou WS, Ahn BM, Moon HS, Kang SH, Sung JK, Jeong HY, Song KS. [Gastric perforation caused by primary gastric diffuse large B cell lymphoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 65:43-7. [PMID: 25603853 DOI: 10.4166/kjg.2015.65.1.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Spontaneous gastric perforation is a rare complication of gastric lymphoma that is potentially life threatening since it can progress to sepsis and multi-organ failure. Morbidity also increases due to prolonged hospitalization and delay in initiating chemotherapy. Therefore prompt diagnosis and appropriate treatment is critical to improve prognosis. A 64-year-old man presented to the emergency department with severe abdominal pain. Chest X-ray showed free air below the right diaphragm. Abdominal CT scan also demonstrated free air in the peritoneal cavity with large wall defect in the lesser curvature of gastric lower body. Therefore, the patient underwent emergency operation and primary closure was done. Pathologic specimen obtained during surgery was compatible to diffuse large B cell lymphoma. Fifteen days after primary closure, the patient received subtotal gastrectomy and chemotherapy was initiated after recovery. Patient is currently being followed-up at outpatient department without any particular complications. Herein, we report a rare case of gastric lymphoma that initially presented as peritonitis because of spontaneous gastric perforation.
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Affiliation(s)
- Ju Seok Kim
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Woo Sun Rou
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Byung Moo Ahn
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hee Seok Moon
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun Hyung Kang
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Kyu Sung
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun Yong Jeong
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kyu-Sang Song
- Departments of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
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Treatment modalities in primary gastric lymphoma: the effect of rituximab and surgical treatment. A study by the Anatolian Society of Medical Oncology. Contemp Oncol (Pozn) 2014; 18:273-8. [PMID: 25258586 PMCID: PMC4171466 DOI: 10.5114/wo.2014.40556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 01/22/2014] [Accepted: 01/29/2014] [Indexed: 01/22/2023] Open
Abstract
Aim of the study Gastrointestinal lymphoma is the most common type of extranodal lymphoma and commonly involved site is the stomach. We have compared the superiority between treatment modalities for primary gastric lymphoma and we want to investigate efficacy of rituximab in gastric lymphoma. Material and methods Between April 2002 and December 2011, 146 patients with a histologically confirmed primary gastric lymphoma, initially diagnosed at eight different Cancer Centers within Turkey were evaluated retrospectively. According to the treatment modality, the patients were divided into chemotherapy (CT) alone, chemotherapy and radiotherapy (CRT), surgery and chemotherapy (SCT), surgery along with chemotherapy and radiotherapy (SCRT), and surgery (S) alone groups. Results Median follow-up period was 25.5 months. The 5-year EFS (event free survival) and OS (overall survival) rates for the patients were 55% and 62.3% respectively. In Log rank analysis of OS and EFS, we have identified levels of albumin and hemoglobine, IPI score, stage at diagnosis as factors influencing survival. In multivariate analysis of OS and EFS, only albumin and stage at diagnosis were factors independently contributing to survival. There was no statistically significant difference in terms of survival between different treatment modalities (p = 0.707 in EFS and p = 0.124 in OS). In analysis of patients treated with chemotherapy alone, there was no a statistically significant difference in terms of EFS and OS between chemotherapy regimens with or without rituximab in localized and advanced stage groups (p = 0.264 and p = 0.639). There was no statistical difference in survival rate (EFS and OS) between surgical or non-surgical treatment modalities for localized/advanced stage gastric lymphoma groups (p = 0.519 / p = 0.165). Conclusions There are several treatment options due to similar results in different treatment modalities. Also benefit of rituximab treatment in gastric lymphoma is still a controversial subject. Additional prospective trials are definitely required in order to clarify use of rituximab in treatment of extranodal gastric lymphoma.
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Sharma P, Suman SKC, Singh H, Sharma A, Bal C, Malhotra A, Kumar R. Primary gastric lymphoma: utility of 18F-fluorodeoxyglucose positron emission tomography-computed tomography for detecting relapse after treatment. Leuk Lymphoma 2012; 54:951-8. [PMID: 23043310 DOI: 10.3109/10428194.2012.717694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to evaluate the role of 18F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) in detecting relapse in patients with primary gastric lymphoma (PGL) post-treatment. Data of 39 previously treated patients with PGL (age: 50.3 ± 13.8 years; male: 24) who underwent 71 (18)F-FDG PET-CT studies for suspected relapse (n = 53) or routine follow-up (n = 18) were retrospectively evaluated. PET-CT images were evaluated both qualitatively and quantitatively (standardized uptake value [SUVmax]). A combination of clinical/imaging follow-up, endoscopy and/or histopathology was taken as the reference standard. The per patient based sensitivity of PET-CT was 96%, specificity 91% and accuracy 93%. The lymph node was the commonest site of relapse on PET-CT. Mean lesion SUVmax was 5.9 ± 3.1 (2.3-13.6). Accuracy was similar in suspected relapse and routine follow-up groups (90.5% vs. 100%; p = 0.409). Based on the data, (18)F-FDG PET-CT appears to be highly accurate for the detection of relapse in patients with PGL post-treatment.
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Affiliation(s)
- Punit Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Wang N, Fu Q, Wang YJ. Advances on the treatment of gastric mucosa-associated lymphoid tissue lymphoma. Shijie Huaren Xiaohua Zazhi 2007; 15:860-868. [DOI: 10.11569/wcjd.v15.i8.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastric mucosa-associated lymphoid tissue (MALT) lymphomas are rare in the gut, and its occurrence rate was 1% to 5% of the malignant tumors. In histological type, most of them are non-Hodgin's lymphomas, while Hodgin's lymphomas are seldom seen. There have been a lot of controversies on the optimal treatments of gastric MALT lymphomas for a long time. Surgery was traditionally considered as the most important approach to cure the disease. However, anti-H. pylori therapy has been regarded as an alternative method since H. pylori infection was found to be relevant with the pathogenesis of gastric MALT lymphomas. In this article, we reviewed the current status and recent advances on the treatment of this disease.
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Avilés A, Neri N, Nambo MJ, Huerta-Guzman J, Cleto S. Surgery and chemotherapy versus chemotherapy as treatment of high-grade MALT gastric lymphoma. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2006. [PMID: 16720930 DOI: 10.1385/mo: 23: 2: 295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Treatment of high-grade MALT (mucosa-associated lymphoid tissue) gastric lymphoma remains uncertain. To assess efficacy and toxicity of the most common therapies--surgery followed by chemotherapy or chemotherapy alone--we began a controlled clinical trial in patients in early stage (I and II 1). METHODS One hundred and two patients were randomized to be treated with surgery followed by six cycles of CEOP-Bleo (cyclophosphamide, epirubicin, vincristine, prednisone, and bleomycin at standard doses) (52 cases) or with chemotherapy alone (49 cases). RESULTS Complete response rates were 94% [95% confidence interval (CI): 88-99%] and 96% (93-100%), respectively. Actuarial curves at 5 yr showed that event-free survival were 70% (95% CI: 59-74%) in patients treated with surgery and chemotherapy, that were not statistically significant to 67% (95% CI: 51-69%) in the patients who received chemotherapy (p = 0.5). Also, overall survival that was not statistically significant: 78% (95% CI: 70-88%) in the combined treatment and 76% (95% CI: 70-87%) in chemotherapy (p = 0.8). Acute and late toxicity were mild and well controlled. No acute leukemia or second neoplasm has been observed. CONCLUSIONS The use of surgery and chemotherapy did not improve outcome in patients with early-stage high-grade gastric MALT lymphoma. It is apparent that chemotherapy alone is sufficient treatment in this select group of patients.
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Affiliation(s)
- Agustín Avilés
- Oncology Research Unit, National Medical Center, IMSS, México, D.F. Mexico.
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Avilés A, Neri N, Nambo MJ, Huerta-Guzman J, Cleto S. Surgery and chemotherapy versus chemotherapy as treatment of high-grade MALT gastric lymphoma. Med Oncol 2006; 23:295-300. [PMID: 16720930 DOI: 10.1385/mo:23:2:295] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 11/30/1999] [Accepted: 10/04/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Treatment of high-grade MALT (mucosa-associated lymphoid tissue) gastric lymphoma remains uncertain. To assess efficacy and toxicity of the most common therapies--surgery followed by chemotherapy or chemotherapy alone--we began a controlled clinical trial in patients in early stage (I and II 1). METHODS One hundred and two patients were randomized to be treated with surgery followed by six cycles of CEOP-Bleo (cyclophosphamide, epirubicin, vincristine, prednisone, and bleomycin at standard doses) (52 cases) or with chemotherapy alone (49 cases). RESULTS Complete response rates were 94% [95% confidence interval (CI): 88-99%] and 96% (93-100%), respectively. Actuarial curves at 5 yr showed that event-free survival were 70% (95% CI: 59-74%) in patients treated with surgery and chemotherapy, that were not statistically significant to 67% (95% CI: 51-69%) in the patients who received chemotherapy (p = 0.5). Also, overall survival that was not statistically significant: 78% (95% CI: 70-88%) in the combined treatment and 76% (95% CI: 70-87%) in chemotherapy (p = 0.8). Acute and late toxicity were mild and well controlled. No acute leukemia or second neoplasm has been observed. CONCLUSIONS The use of surgery and chemotherapy did not improve outcome in patients with early-stage high-grade gastric MALT lymphoma. It is apparent that chemotherapy alone is sufficient treatment in this select group of patients.
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Affiliation(s)
- Agustín Avilés
- Oncology Research Unit, National Medical Center, IMSS, México, D.F. Mexico.
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Hamaloglu E, Topaloglu S, Ozdemir A, Ozenc A. Synchronous and metachronous occurrence of gastric adenocarcinoma and gastric lymphoma: A review of the literature. World J Gastroenterol 2006; 12:3564-74. [PMID: 16773713 PMCID: PMC4087572 DOI: 10.3748/wjg.v12.i22.3564] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The occurrence of both primary gastric lymphoma and gastric adenocarcinoma in the same patient is a rare entity. The possible causative factors of synchronous or metachronous occurrence of both malignancies and varieties in the treatment modalities are reviewed according to published cases in English language medical literature.
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Affiliation(s)
- Erhan Hamaloglu
- Department of Surgery, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
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12
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Waisberg J, André EA, Franco MIF, Abucham-Neto JZ, Wickbold D, Goffi FS. Curative resection plus adjuvant chemotherapy for early stage primary gastric non-Hodgkin's lymphoma: a retrospective study with emphasis on prognostic factors and treatment outcome. ARQUIVOS DE GASTROENTEROLOGIA 2006; 43:30-6. [PMID: 16699615 DOI: 10.1590/s0004-28032006000100009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is controversy regarding the optimal therapy for primary non-Hodgkin gastric lymphoma with some authors defending surgical extirpation either alone or in association with radiotherapy and or chemotherapy, especially in relation to the earlier stages of the disease. AIM To analyze the clinical-pathological features and the results of management approaches for patients with primary early-stage non-Hodgkin's lymphoma of the stomach operated in Surgical Gastroenterology Department, "Hospital do Servidor Público Estadual", São Paulo, SP, Brazil. The literature is reviewed to highlight the aspects of diagnosis, prognostic factors and role of the various treatment regimens. METHOD Sixteen patients with primary early-stage gastric lymphoma underwent curative surgical treatment. The variables analyzed were age, sex, location, size, type of surgery, number of lesions, depth of invasion, histological type in accordance with Kiel's classification, involvement of lymph nodes, Ann Arbor stage classification modified by Musshoff and Schmidt-Vollmer, histological grade, margins, adjuvant therapy, clinical course and survival. RESULTS Ten patients (62.5%) underwent subtotal gastrectomy and six (37.5%) underwent total gastrectomy. The majority (9/56.2%) of the lesions were located in the antrum. Single lesions (10/62.5%) were more frequent than multiple lesions (6/37.5%). Thirteen patients (81.2%) were classified as stage IE and three (18.7%) as stage IIE1. Primary gastric lymphoma classified histologically as low or high grade was presented by 10 (62.5%) and 6 (37.5%) patients, respectively. The most frequent histological types were the lymphoplasmocytic cytoid (4/25.0%) and centroblastic (4/25.0%). Ten patients (62.5%) received adjuvant treatment (chemotherapy and/or radiotherapy). Nine patients (56.2%), all in stage IE, reached a survival greater than 5 years and of these eight (50.0.%) had received adjuvant therapy. Two (12.5%) patients with stage IIE1 presented peritoneal relapse and died 3.0 years and 3.5 years after their respective operations. The mean overall survival was 42.5 months. CONCLUSIONS Among the patients with primary early-stage gastric lymphoma (IE and IIE1), the gastric resection enabled an accurate clinicopathological staging, in addition to obtaining sufficient material for histopathological study and extirpation of the lesion. Furthermore, for patients with stage IE disease, the gastric resection combined with adjuvant therapy was associated with a greater than 5-year survival. Until prospective randomized studies are realized in order to evaluate the real efficacy of the different types of treatment for primary early-stage gastric lymphoma, management approaches should be individually tailored.
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Affiliation(s)
- Jaques Waisberg
- Surgical Gastroenterology Department, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil.
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Chang MC, Huang MJ, Su YW, Chang YF, Lin J, Hsieh RK. Clinical outcome of primary gastric lymphoma treated with chemotherapy alone or surgery followed by chemotherapy. J Formos Med Assoc 2006; 105:194-202. [PMID: 16520834 DOI: 10.1016/s0929-6646(09)60305-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of surgical resection in the treatment of primary gastric lymphoma (PGL) remains unclear. This retrospective study evaluated the clinical outcome of PGL treated with chemotherapy alone or surgery followed by chemotherapy. METHODS During 1986-2003, 59 patients with PGL (other than mucosa-associated lymphoid tissue type lymphoma) were identified from hospital files. The medical records, pathologic sections, radiographic images and treatment modalities of these patients were reviewed. Patients were categorized into localized (stage IE and IIE-1) and advanced (stage IIE-2 or beyond) stage groups. Survival was estimated by the Kaplan-Meier method. RESULTS The study included 55 patients who received treatment at the same institute. Among them, 32 had localized PGL (15 stage IE, 17 stage IIE-1) and 23 had advanced disease. The median survival of the localized stage group was not reached during a mean follow-up of 168.1 +/- 16.7 months (95% confidence interval [CI], 135.4-200.8 months), while that of the advanced stage group was 33.0 +/- 6.8 months (95% CI, 19.7-46.5; p < 0.001, log-rank test). Among patients with localized PGL, the 5-year overall survival rate of those receiving chemotherapy alone (n = 19) or combination therapy (surgery followed by chemotherapy, n = 13) was 73.4% and 87.5%, respectively (p = 0.229). The 5-year disease-free survival was 68.4% and 84.6%, respectively (p = 0.540). However, post-chemotherapy life-threatening hemorrhage occurred in five of the 32 patients (15.6%) in the localized stage group: four in the chemotherapy-alone group, and one in the combination therapy group, all of whom had failed to achieve complete response. CONCLUSION 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.
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Affiliation(s)
- Ming-Chih Chang
- Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
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Yoshino T, Nakamura S, Matsuno Y, Ochiai A, Yokoi T, Kitadai Y, Suzumiya J, Tobinai K, Kobayashi Y, Oda I, Mera K, Ohtsu A, Ishikura S. Epstein-Barr virus involvement is a predictive factor for the resistance to chemoradiotherapy of gastric diffuse large B-cell lymphoma. Cancer Sci 2006; 97:163-6. [PMID: 16441428 PMCID: PMC11159897 DOI: 10.1111/j.1349-7006.2006.00155.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Primary gastric diffuse large B-cell lymphomas are generally well controlled by non-surgical treatment with combination chemotherapy followed by radiotherapy. We have previously reported that over 90% of patients achieved complete response (CR) with this therapeutic strategy: three cycles of cyclophosphamide, adriamycin, vincristine and prednisone followed by radiotherapy (40.5 Gy). Although the CR rate was very high, some patients still showed resistance to this combination therapy. In order to clarify the factors related to therapy resistance, we examined the relationship between Epstein-Barr virus (EBV), which was examined using an in situ hybridization technique, and the patients' clinical courses. Out of the 50 patients, four were EBV positive; over half of lymphoma cells were positive for EBV by in situ hybridization. Of the three EBV-positive patients, two showed progressive disease and one achieved partial response (PR). Two of the patients died of disease progression. The other patient achieved CR, but the lymphoma recurred with distant metastasis in the cerebellum 3 months after remission. In the present study, eight patients did not achieve CR or they relapsed, four patients showed progressive disease, one patient achieved PR, and three patients achieved CR with recurrence. Therefore, half of these unfavorable patients were EBV positive. This finding strongly indicated that EBV-associated gastric diffuse large B-cell lymphomas frequently show resistance to standard chemoradiotherapy, although some other adverse factors remain unclear.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cerebellar Neoplasms/secondary
- Cerebellar Neoplasms/therapy
- Cerebellar Neoplasms/virology
- Cyclophosphamide/therapeutic use
- Disease Progression
- Doxorubicin/therapeutic use
- Drug Resistance, Neoplasm
- Epstein-Barr Virus Infections/drug therapy
- Epstein-Barr Virus Infections/radiotherapy
- Epstein-Barr Virus Infections/virology
- Female
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- In Situ Hybridization
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/radiotherapy
- Lymphoma, B-Cell/virology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/virology
- Neoplasm Staging
- Prednisone/therapeutic use
- Prognosis
- RNA, Viral/analysis
- Radiation Tolerance
- Remission Induction
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/radiotherapy
- Stomach Neoplasms/virology
- Survival Rate
- Vincristine/therapeutic use
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Affiliation(s)
- Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1, Shikata-cho, Okayama 700-8558, Japan.
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Avilés A, Nambo MJ, Neri N, Talavera A, Cleto S. Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach: results of a controlled clinical trial. Med Oncol 2005; 22:57-62. [PMID: 15750197 DOI: 10.1385/mo:22:1:057] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2004] [Accepted: 08/25/2004] [Indexed: 12/22/2022]
Abstract
Treatment of patients with early stage gastric mucosa-associated lymphoid tissue (MALT) remains undefined. We began a controlled clinical trial to evaluate efficacy and toxicity of the most common therapies. Two hundred and forty-one patients with gastric low-grade MALT lymphoma in early stage (IE and IIE) were randomized to surgery (80 cases), radiotherapy (78 cases), and chemotherapy (83 cases). With a median follow-up of 7.5 yr, actuarial curves at 10 yr showed that event-free survival was 52% in patients treated with surgery, 52% in radiotherapy arm, and 87% in the chemotherapy group (p < 0.01). However, overall survival did not showed any statistical differences: 80%, 75% and 87%, respectively (p = 0.4). Acute and late toxicities were mild. No death-related treatments were observed. No clear differences were observed between the most common therapies in patients with primary gastric MALT lymphoma in early stages, probably because this type of lymphoma has an high response rate to salvage treatment after failure to local treatment (surgery and radiotherapy). Thus considered, chemotherapy alone is an effective and safe therapeutic approach in this setting of patients. Surgery or radiotherapy will be reserved to patients that are not candidates for chemotherapy.
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Affiliation(s)
- Agustin Avilés
- Oncology Research Unit, National Medical Center, IMSS, México.
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Avilés A, Nambo MJ, Neri N, Talavera A, Cleto S. Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach: results of a controlled clinical trial. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2005. [PMID: 15750197 DOI: 10.1385/mo: 22: 1: 057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Treatment of patients with early stage gastric mucosa-associated lymphoid tissue (MALT) remains undefined. We began a controlled clinical trial to evaluate efficacy and toxicity of the most common therapies. Two hundred and forty-one patients with gastric low-grade MALT lymphoma in early stage (IE and IIE) were randomized to surgery (80 cases), radiotherapy (78 cases), and chemotherapy (83 cases). With a median follow-up of 7.5 yr, actuarial curves at 10 yr showed that event-free survival was 52% in patients treated with surgery, 52% in radiotherapy arm, and 87% in the chemotherapy group (p < 0.01). However, overall survival did not showed any statistical differences: 80%, 75% and 87%, respectively (p = 0.4). Acute and late toxicities were mild. No death-related treatments were observed. No clear differences were observed between the most common therapies in patients with primary gastric MALT lymphoma in early stages, probably because this type of lymphoma has an high response rate to salvage treatment after failure to local treatment (surgery and radiotherapy). Thus considered, chemotherapy alone is an effective and safe therapeutic approach in this setting of patients. Surgery or radiotherapy will be reserved to patients that are not candidates for chemotherapy.
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Affiliation(s)
- Agustin Avilés
- Oncology Research Unit, National Medical Center, IMSS, México.
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Avilés A, Nambo MJ, Neri N, Talavera A, Cleto S. Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach: results of a controlled clinical trial. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2005. [PMID: 15750197 DOI: 10.1385/mo::22:1:057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Treatment of patients with early stage gastric mucosa-associated lymphoid tissue (MALT) remains undefined. We began a controlled clinical trial to evaluate efficacy and toxicity of the most common therapies. Two hundred and forty-one patients with gastric low-grade MALT lymphoma in early stage (IE and IIE) were randomized to surgery (80 cases), radiotherapy (78 cases), and chemotherapy (83 cases). With a median follow-up of 7.5 yr, actuarial curves at 10 yr showed that event-free survival was 52% in patients treated with surgery, 52% in radiotherapy arm, and 87% in the chemotherapy group (p < 0.01). However, overall survival did not showed any statistical differences: 80%, 75% and 87%, respectively (p = 0.4). Acute and late toxicities were mild. No death-related treatments were observed. No clear differences were observed between the most common therapies in patients with primary gastric MALT lymphoma in early stages, probably because this type of lymphoma has an high response rate to salvage treatment after failure to local treatment (surgery and radiotherapy). Thus considered, chemotherapy alone is an effective and safe therapeutic approach in this setting of patients. Surgery or radiotherapy will be reserved to patients that are not candidates for chemotherapy.
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Affiliation(s)
- Agustin Avilés
- Oncology Research Unit, National Medical Center, IMSS, México.
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Ishikura S, Tobinai K, Ohtsu A, Nakamura S, Yoshino T, Oda I, Takagi T, Mera K, Kagami Y, Itoh K, Tamaki Y, Suzumiya J, Taniwaki M, Yamamoto S. Japanese multicenter phase II study of CHOP followed by radiotherapy in stage I-II, diffuse large B-cell lymphoma of the stomach. Cancer Sci 2005; 96:349-52. [PMID: 15958057 PMCID: PMC11159192 DOI: 10.1111/j.1349-7006.2005.00051.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) followed by radiotherapy is regarded as standard care for localized aggressive lymphoma; however, prospective confirmation of its applicability to localized primary gastric lymphoma is inadequate, and most patients in Japan have been initially treated with gastrectomy. We conducted a multicenter phase II study to evaluate the feasibility and efficacy of the non-surgical treatment. Eligibility criteria required primary gastric diffuse large B-cell lymphoma, stage I-II(1), age 20-75, performance status 0-1 and adequate organ function. Treatment consisted of three cycles of CHOP followed by radiotherapy 40.5 Gy. Fifty-five patients were enrolled between December 1999 and February 2003, and 52 eligible patients were analyzed. Patient characteristics were as follows: median age, 61 years; 28 men, 24 women; 36 with stage I, 16 with stage II(1); 47 with a low International Prognostic Index (IPI) and five with a low-intermediate IPI. All but one patient completed planned treatment. No serious complications including massive hemorrhage or perforation were observed. A complete response was achieved in 48 of the 52 patients (92%, 95% confidence interval: 82-98%) and progressive disease in three. Two patients underwent salvage gastrectomy due to disease persistence or recurrence. With a median follow-up period of 28 months, 2-year progression-free and overall survivals were 88 and 94%, respectively. CHOP followed by radiotherapy is safe and highly effective in localized gastric diffuse large B-cell lymphoma. This organ-preserving treatment should be considered as a very reasonable therapeutic option.
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Affiliation(s)
- Satoshi Ishikura
- Radiation Oncology Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan.
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Ruskoné-Fourmestraux A. Les lymphomes gastriques du MALT. Rev Med Interne 2004; 25:573-81. [PMID: 15276289 DOI: 10.1016/j.revmed.2004.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 02/02/2004] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The stomach is the most common site involved in primary gastrointestinal lymphoma. Gastric lymphoma originates from the mucosa-associated lymphoïd tissue so called MALT. It comprises a group of distinctive clinicopathological entities which are important to consider for clinical management. CURRENT KNOWLEDGE AND KEY POINTS In recent years, new diagnostic tools and new treatment strategies have improved the overall prognosis. One of the most exciting recent discoveries is the hypothesis that an infection by a bacterium, Helicobacter pylori has a decisive role in gastric lymphoma. FUTURE PROSPECTS AND PROJECTS Recent advances, essentially due to molecular biology and cytogenetic studies may emerge with the understanding of pathogenesis and new prognostic factors of these different types of gastric lymphomas. It is the aim of our oncoming studies together with the evaluation of the new therapeutic options such as radiotherapy and monoclonal antibodies in prospective studies.
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Affiliation(s)
- A Ruskoné-Fourmestraux
- Service de gastroentérologie, Hôtel-Dieu AP-HP, 1, place du parvis-Notre-Dame, 75004 Paris, France.
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Avilés A, Nambo MJ, Neri N, Huerta-Guzmán J, Cuadra I, Alvarado I, Castañeda C, Fernández R, González M. The role of surgery in primary gastric lymphoma: results of a controlled clinical trial. Ann Surg 2004; 240:44-50. [PMID: 15213617 PMCID: PMC1356373 DOI: 10.1097/01.sla.0000129354.31318.f1] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We began a controlled clinical trial to assess efficacy and toxicity of surgery (S), surgery + radiotherapy (SRT), surgery + chemotherapy (SCT), and chemotherapy (CT) in the treatment of primary gastric diffuse large cell lymphoma in early stages: IE and II1. SUMMARY BACKGROUND DATA Management of primary gastric lymphoma remains controversial. No controlled clinical trials have evaluated the different therapeutic schedules, and prognostic factors have not been identified in a uniform population. PATIENTS AND METHODS Five hundred eighty-nine patients were randomized to be treated with S (148 patients), SR (138 patients), SCT (153 patients), and CT (150 patients). Radiotherapy was delivered at doses of 40 Gy; chemotherapy was CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) at standard doses. International Prognostic Index (IPI) and modified IPI (MIPI) were assessed to determine outcome. RESULTS Complete response rates were similar in the 4 arms. Actuarial curves at 10 years of event-free survival (EFS) were as follows: S: 28% (95% confidence interval [CI], 22% to 41%); SRT: 23% (95% CI, 16% to 29%); that were statistically significant when compared with SCT: 82% (95% CI, 73% to 89%); and CT: 92% (95% CI, 84% to 99%) (P < 0.001). Actuarial curves at 10 years showed that overall survivals (OS) were as follows: S: 54% (95% CI, 46% to 64%); SRT: 53% (95% CI, 45% to 68%); that were statistically significant to SCT: 91% (95% CI, 85% to 99%); CT: 96% (95% CI, 90% to 103%)(P < 0.001). Late toxicity was more frequent and severe in patients who undergoing surgery. IPI and MIPI were not useful in determining outcome and multivariate analysis failed to identify other prognostic factors. CONCLUSION In patients with primary gastric diffuse large cell lymphoma and aggressive histology, diffuse large cell lymphoma in early stage SCT achieved good results, but surgery was associated with some cases of lethal complications. Thus it appears that CT should be considered the treatment of choice in this patient setting. Current clinical classifications of risk are not useful in defining treatment.
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Affiliation(s)
- Agustin Avilés
- Oncology Research Unit, Oncology Hospital, National Medical Center, IMSS, México.
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Delchier JC. Reply to Letter to the Editor on “Surgical resection plus chemotherapy versus chemotherapy alone: comparison of two strategies to treat diffuse large B-cell gastric lymphoma”, byM. Binn, A. Ruskoné-Fourmestraux, E. Lepage et al. (Ann Oncol 2003; 14: 1751–1757). Ann Oncol 2004. [DOI: 10.1093/annonc/mdh181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abali H, Barista I. Comments on "Surgical resection plus chemotherapy versus chemotherapy alone: comparison of two strategies to treat diffuse large B-cell gastric lymphoma" by M. Binn, A. Ruskoné-Fourmestraux, E. Lepage et al. (Ann Oncol 2003; 14: 1751-1757). Ann Oncol 2004; 15:841-2; author reply 842. [PMID: 15111356 DOI: 10.1093/annonc/mdh180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Binn M, Ruskoné-Fourmestraux A, Lepage E, Haioun C, Delmer A, Aegerter P, Lavergne A, Guettier C, Delchier JC. Surgical resection plus chemotherapy versus chemotherapy alone: comparison of two strategies to treat diffuse large B-cell gastric lymphoma. Ann Oncol 2004; 14:1751-7. [PMID: 14630680 DOI: 10.1093/annonc/mdg495] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The usefulness of chemotherapy to treat gastric diffuse large B-cell lymphomas (DLBCL) is well known. Whether or not chemotherapy should be performed as the only treatment or after surgical resection is debated. The aim of this study was to compare two strategies: surgical resection plus chemotherapy versus chemotherapy alone. PATIENTS AND METHODS Between January 1988 and December 1996, 58 patients included in the trials promoted by the Groupe d'Etude des Lymphomes de l'Adulte (GELA) (LNH-87 and LNH-93) received chemotherapy and 48 included in the protocol of the Groupe d'Etude des Lymphomes Digestifs (GELD) underwent surgical resection followed by chemotherapy. They all presented with localized DLBCL (stage IE and IIE according to the Ann Arbor classification). From the GELA group, seven patients received additional radiotherapy. Gastrectomy was total in 27 of the 48 patients in the GELD group. In both groups chemotherapy included anthracyclin and alkylating agents. Chemotherapy was more intensive in the GELA group than in the GELD group. RESULTS In the GELA and the GELD groups, distribution according to sex ratio, age (>60 or < or = 60 years), ECOG performance status (> or = 2 or <2) and staging (IE or IIE) was similar. Univariate analysis comparing prognostic factors in both groups showed significant differences: serum lactate dehydrogenase level above normal (28.6% versus 2.4%, P = 0.001), tumor size >10 cm (28.6% versus 12.5%, P = 0.04), patients with International Prognostic Index (IPI) >1 (21.4% versus 11.1%, P = 0.168) and 5-year survival (79% versus 90%, P = 0.03). Multivariate analysis of prognostic factors with a Cox model showed that IPI was the only independent prognostic factor (odds ratio 3, P = 0.03). Consequently, patients with IPI 0-1 were selected for comparison between the GELA group (44 patients) and the GELD group (40 patients). There was no significant difference between the two groups. Median follow-up was 59 months (range 3-128). Estimates of 5-year survival rates and event-free survival rates were 90.5% versus 91.1% (P = 0.303) and 85.9% versus 91.6% (P = 0.187), respectively. In the GELA group, seven of 44 patients died: five from a lymphoma-unrelated cause and two from tumor progression. In the GELD group, four of 40 patients died: two of unrelated causes and two from tumor progression. CONCLUSIONS This study shows that in localized gastric DLBCL with IPI 0-1, a similar 5-year survival rate (>90%) is to be expected with either surgery plus chemotherapy or chemotherapy alone.
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Affiliation(s)
- M Binn
- Hôpital Henri Mondor, Gastroentérologie, Créteil, Val de Marne, France
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Kong SH, Kim MA, Park DJ, Lee HJ, Lee HS, Kim CW, Yang HK, Heo DS, Lee KU, Choe KJ. Clinicopathologic features of surgically resected primary gastric lymphoma. World J Gastroenterol 2004; 10:1103-9. [PMID: 15069707 PMCID: PMC4656342 DOI: 10.3748/wjg.v10.i8.1103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To analyze the clinicopathologic characteristics of surgically resected gastric lymphoma patients.
METHODS: We retrospectively analyzed 57 surgically resected gastric lymphoma patients, dividing them into 2 subgroups: Low grade MALToma (the LG group), High grade MALToma and Diffuse large B cell lymphoma (the HG group).
RESULTS: The numbers of patients were: 20 in the LG group, 37 in the HG group. The diagnostic rate of gastroscopy was 34.8% at primary diagnosis and 50% including differential diagnoses. The positive rates of H pylori were similar between the 2 groups (68% vs 77%). Multiple lesions were found in 19.3%. The proportion of mucosal and submucosal lesions was 80.0%(16/20) in the LG group, and 24.3%(9/37) in the HG group (P<0.001). Lymph node invasion rates were 10.5%(2/19) in the LG group and 44.1%(15/34) in the HG group (P = 0.031). The numbers of recurred patients were none in the LG group, and 8 in the HG group. By univariant analysis, group (P = 0.024) and TNM stage (stage I, II vs stages III, IV, P = 0.002) were found to be the significant risk factors. There was a tendency of higher recurrence rate in the subtotal gastrectomy group than in the total gastrectomy group (P = 0.50).
CONCLUSION: The HG groups had a more advanced stage and a higher recurrence rate than the LG group. Although there was no difference between subtotal and total gastrectomies, more careful assessments of multiplicities and radical resections with lymph node dissections seem to be needed because of multiplicity and LN invasion even in LG group.
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Affiliation(s)
- Seong-Ho Kong
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
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Abstract
AIM: The purpose of this review is to describe the various aspects of primary gastric lymphoma and the treatment options currently available.
METHODS: After a systematic search of Pubmed, Medscape and MDconsult, we reviewed and retrieved literature regarding gastric lymphoma.
RESULTS: Primary gastric lymphoma is rare however, the incidence of this malignancy is increasing. Chronic gastritis secondary to Helicobacter pylori (H pylori) infection has been considered a major predisposing factor for MALT lymphoma. Immune histochemical marker studies and molecular biology utilizing polymerase chain reaction have facilitated appropriate diagnosis and abolished the need for diagnostic surgical resection. Advances in imaging techniques including Magnetic Resonance Imaging (MRI) and Endoscopic Ultrasonography (EUS) have helped evaluation of tumor extension and invasion. The clinical course and prognosis of this disease is dependent on histopathological sub-type and stage at the time of diagnosis. Controversy remains regarding the best treatment for early stages of this disease. Chemotherapy, surgery and combination have been studied and shared almost comparable results with survival rate of 70%-90%. However, chemotherapy possesses the advantage of preserving gastric anatomy. Radiotherapy alone has been tried and showed good results. Stage IIIE, IVE disease treatment is solely by chemotherapy and surgical resection has been a remote consideration.
CONCLUSION: We conclude that methods of diagnosis and staging of the primary gastric lymphoma have dramatically improved. The modalities of treatment are many and probably chemotherapy is superior because of high success rate, preservation of stomach and tolerable complications.
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Affiliation(s)
- Ahmad M Al-Akwaa
- Gastroenterology Division, Neelam Siddiqui Oncology Division, Department of Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
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Abstract
The ability to make treatment recommendations for patients with gastrointestinal lymphoma is hampered by a lack of prospective trials and by a lack of uniformity in classification and staging. Patients with gastric diffuse large B-cell lymphoma have traditionally been treated with surgery and many physicians continue to recommend this approach. However, recent data suggest that these patients can be treated with combination chemotherapy regimens in the same manner as patients with nodal presentations of diffuse large B-cell lymphoma. There is evidence to suggest that adjuvant radiotherapy may improve the outcome for these patients. The recognition that extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue is a distinct clinicopathologic entity and the elucidation of the pathogenic role of Helicobacter pylori has revolutionized the treatment of these gastric lymphomas. Patients with localized disease should be managed with antibiotic therapy initially. Radiation therapy is extremely effective for these patients, but it should probably be reserved for patients who fail anti-H. pylori treatment.
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MESH Headings
- Adult
- Aged
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Digestive System Surgical Procedures/methods
- Female
- Gastrointestinal Neoplasms/mortality
- Gastrointestinal Neoplasms/pathology
- Gastrointestinal Neoplasms/therapy
- Humans
- Lymphoma, B-Cell/mortality
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, B-Cell, Marginal Zone/mortality
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Risk Assessment
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Philip J Bierman
- University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198, USA.
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Yasuda K, Shiraishi N, Adachi Y, Kitano S, Kashima K, Hata A. Surg Laparosc Endosc Percutan Tech 2001; 11:372-374. [DOI: 10.1097/00019509-200112000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Yasuda K, Shiraishi N, Adachi Y, Kitano S, Kashima K, Hata A. Laparoscopy-assisted distal gastrectomy for gastric malignant lymphoma. Surg Laparosc Endosc Percutan Tech 2001; 11:372-4. [PMID: 11822862 DOI: 10.1097/00129689-200112000-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although the best treatment for gastric malignant lymphoma remains a controversial matter, surgery is the first choice for localized malignant lymphoma without lymph node metastasis and invasion to the adjacent organ. We report a case of gastric malignant lymphoma that was managed with laparoscopy-assisted distal gastrectomy. A 47-year-old man was referred to our department for management of gastric lymphoma. After preoperative examination revealed a tumor confined to the gastric wall but no lymph node metastasis, we performed laparoscopy-assisted Billroth I gastrectomy. Histopathologic examination confirmed that the tumor was follicular center lymphoma limited to the submucosa with no lymph node metastasis. The postoperative course was good. This is the first reported case of laparoscopic gastrectomy-treated gastric malignant lymphoma. Because it involves minimal access and invasiveness, this procedure may be an effective method of treatment of localized malignant lymphoma of the stomach.
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Affiliation(s)
- K Yasuda
- Department of Surgery I, Oita Medical University, Japan.
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