INTERMEDIATE AND HIGH-GRADE GASTRIC NON-HODGKINS-LYMPHOMA - A PROSPECTIVE-STUDY OF NONSURGICAL TREATMENT WITH PRIMARY CHEMOTHERAPY, WITH ORWITHOUT RADIOTHERAPY

The role of surgery as initial treatment in gastric lymphoma remains c ontroversial. We have prospectively evaluated a stomach conservation s trategy in histologically aggressive gastric lymphoma, using primary a driamycin-containing chemotherapy, followed by involved-field radiothe rapy in patients with limited disease. Twenty-six patients (median age 69 years) were entered in this study; 15 had stage I disease, 7 had s tage II disease and 4 had stage IV disease. The chemotherapy combinati ons were CHOP (18 patients) and ProMACE/MOPP (8 patients). Radiotherap y was given to 11 patients. Of the 24 patients evaluated for response, 18 (75%) achieved endoscopically-confirmed complete response and 4 (1 7%) partial response. During follow-up (median 22 months), none of the complete responders developed recurrent lymphoma. Gastric resection w as performed in 1/26 patients who did not respond to primary chemother apy. There were no cases of perforation, but three patients (12%) deve loped acute gastro-intestinal bleeding a few days after the onset of c hemotherapy, one of whom required a surgical devascularization procedu re. There was no treatment-related mortality. These data further suppo rt the non-surgical approach in histologically aggressive gastric lymp homa, using primary chemotherapy with or without radiation therapy.