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Primary Gastrointestinal Non-Hodgkin’s Lymphoma: II. Combined Surgical and Conservative or Conservative Management Only in Localized Gastric Lymphoma—Results of the Prospective German Multicenter Study GIT NHL 01/92

From the Departments of Medicine, Hematology and Oncology, Radiation Oncology, and General Surgery, and Institute for Medical Informatics and Biomathematics, Westfälische-Wilhelms-Universität, Münster; Municipal Clinic, Department of Hematology/Oncology, and Pius-Hospital, Department of Radiooncology, Oldenburg; Department of Surgery, St-Antonius-Hospital, Kleve; Department of Medicine III–Großhadern, Ludwig-Maximilians-Universität, München; Department of Medicine/Gastroenterology and Oncology, Municipal Clinic, Dortmund; Departments of Medicine, Hematology and Oncology, and Radiation Oncology, Universität des Saarlands, Homburg; Departments of Gastroenterology and Radiation Oncology, Zentralklinikum, Augsburg; Department of Hematology/Oncology, Central Clinic, and Institute of Radiooncology, Minden; and Departments of Hematology/Oncology, Medical Clinic II, and Radiation Oncology, Christian-Albrechts-Universität, and Lymph Node Registry at the German Society of Pathology, Department of Hematopathology, Christian-Albrechts-Universität, Kiel, Germany.

Address reprint requests to Peter Koch, MD, Medizinische Klinik A, Westfälische-Wilhelms-Universität, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany; email: prfkoch{at}aol.com

PURPOSE: The aim of the study was to obtain data on anatomic and histologic distribution, clinical features, and treatment results of patients with primary gastrointestinal non-Hodgkin’s lymphomas, particularly combined surgical and conservative treatment (CSCT) versus conservative treatment (CT) alone for primary gastric lymphoma (PGL) in localized stages.

PATIENTS AND METHODS: Whether the treatment included surgery was left to the discretion of each participating center. Radiotherapy (Rx) and chemotherapy were stratified according to histologic grading, stage, and the inclusion or omission of surgery as follows: patients with low-grade PGL were treated with extended-field (EF) Rx (30 Gy). In case of residual tumor after surgery or in case of CT only (in stage IIE after six cycles of cyclophosphamide, vincristine, and prednisone), an additional boost of 10 Gy was given. All patients with high-grade PGL were treated with four (stage IE) or six (stage IIE) cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone followed by EF Rx (stage IE) or involved-field (IF) Rx (stage IIE). Rx dosage corresponded to low-grade NHL.

RESULTS: Between October 1992 and November 1996, 106 patients had CT only. The survival rate (SR) after 5 years was 84.4% and was influenced neither by patients’ characteristics nor by stage or histologic grade. Seventy-nine patients had CSCT. Their SR was 82.0%. Complete resection of the tumor (R0) was prognostic for the overall survival (P = .0165) as compared with incomplete resection.

CONCLUSION: Although the study was not randomized, a stomach-conserving approach may be favored.

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