Chemotherapy alone versus surgery followed by chemotherapy for stage I/IIElarge-cell lymphoma of the stomach

The optimal treatment of localized large-cell lymphoma of the stomach remai ns controversial, In particular, the role of surgical resection of the prim ary tumor needs to be clearly defined. We have reviewed all patients with a diagnosis of gastric lymphoma and treated in our institutions between 1988 and 1998. Patients fulfilling the following criteria were included in this study: (1) histologically proven large-cell lymphoma of the stomach; (2) a dequate pathological materials and complete clinical information for analys is; (3) clinical stage I/II disease according to the Musshoff modification of Ann Arbor system; and (4) received primary chemotherapy alone with anthr acycline- or anthracenedione-containing regimens (group A) or curative surg ery followed by adjuvant chemotherapy (group B). There were 38 and 21 patie nts in group A and group a, respectively. All pertinent clinicopathologic f eatures were similar between the two groups of patients, except that patien ts of group A had significantly more stage II-2 disease (P = 0.004). Of gro up A. among 36 patients who could be evaluated for response to chemotherapy , there were 29 complete and 1 partial responses, with an overall response rate of 83.3% (95% CI, 71.1-95.5%). The projected 5-year relapse-free survi val (RFS) and overall survival (OS) were 86.0% (95% CI, 73.3-98.7%) and 72. 6% (95% CI, 57.0-88.2%), respectively. On the other hand, the projected 5-y ear RFS and OS of group B were 77.9% (95% CI, 58.0-97.8%) and 77.8% (95% CI , 57.9-97.7%), respectively, not significantly different from that of group A. Our data suggest that systemic chemotherapy alone may be a reasonable a lternative treatment for stage I/II large-cell lymphoma of the stomach. Res ection of the primary tumor before systemic chemotherapy does not appear to improve the cure rate of this group of patients. (C) 2000 Wiley-Liss, Inc.