GASTRIC LYMPHOMAS - CHEMOTHERAPY AS A PRIMARY-TREATMENT

Twenty‐one of 65 patients with gastric lymphoma have been treated with combination chemotherapy; 17 patients had chemotherapy as primary treatment, and 4 had it for residual disease after incomplete surgical resection. Three of these patients were in stage III and 18 were in stage IV of the disease, according to the TNM Staging Classification. CHOP‐Bleo or CHOP combination was given to 17 patients, and the COPP‐Bleo regimen to three; the last one was treated with COP. Sixteen of the 18 stage IV patients entered into complete remission after 6 to 10 courses of CHOP or COPP‐Bleo; there was one partial response and one failure. Six complete responders had a surgical restaging performed and none of them had gross evidence of residual disease; all of them had partial gastrectomy and in five cases there was no microscopical evidence of disease; in one of the resected stomachs, a focus of residual disease was discovered involving the submucosa but without compromise of the serosa. Fourteen (77.7%) of these patients are alive with no evidence of disease 1–10 (X = 3.8 years); one patient died with recurrent disease at 30 months; another patient died of other causes after 3 years; one patient is alive with disease at 18+ months. All the remaining 16 stage IV patients who were not given chemotherapy have died, median survival time being 5 months. Seventeen stage I–II patients were treated by surgery alone and 12 of them (70%) are alive and free of disease at 5 years; five patients died of causes not related to lymphoma. Six (42.8%) of the 14 stage III patients were alive at 5 years; 12 patients of this group underwent gastric resections and only 3 of them have been treated with combination chemotherapy: one of them lived for 9 years and another one for more than 4 years; seven patients were not given any type of complementary treatment, and only 1 is alive and free of disease at 5 years. All three patients who were given chemotherapy after surgical resection are alive and free of recurrence 14–28 months after the operation. Copyright © 1990 Wiley‐Liss, Inc., A Wiley Company