Originally published as JCO Early Release 10.1200/JCO.2005.04.031 on August 29 2005

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Treatment Results in Localized Primary Gastric Lymphoma: Data of Patients Registered Within the German Multicenter Study (GIT NHL 02/96)

From the Departments of Medicine –Hematology and Oncology–Radiation Oncology, and General Surgery, and Institute for Informatics and Biomathematics, Westfälische-Wilhelms-Universität, Münster; Department of Gastroenterology, Zentralklinikum, Augsburg; Department of Hematology/Oncology, Municipal Clinic, and Department of Radiation Oncology, Pius-Hospital, Oldenburg; Departments of Medicine –Hematology and Oncology–and of Radiation Oncology, Ernst-Moritz-Arndt-Universität, Greifswald; Departments of Medicine –Hematology and Oncology and Radiation Oncology–Universität Rostock; Departments of Medicine –Hematology and Oncology, and Radiation Oncology, Universität des Saarlands, Homburg; Department of Radiation Oncology, Mutterhaus der Borromäerinnen, Trier; Department of Radiation Oncology, Charité, Berlin; and Lymph Node Registry at the German Society of Pathology, Department of Hematopathology, Universität von Schleswig-Holstein, Campus Kiel, Kiel, Germany

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

PURPOSE: In the prospective study 02/96 on primary GI lymphoma, we have collected data on histology, clinical features, and treatment results. In particular, in stages I and II localized primary gastric lymphoma (PGL), our objectives were to reduce treatment intensity and to confirm our hypothesis from study 01/92, which maintained that an organ-preserving approach is not inferior to primary surgery.

PATIENTS AND METHODS: Patients receiving radiotherapy and/or chemotherapy were stratified for histologic grade, stage, and whether surgery had been carried out or not (as decided by each participating center). Patients with aggressive PGL received six cycles of CHOP-14 (cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by involved-field radiotherapy (40 Gy). Patients with indolent PGL (including patients experiencing treatment failure with antibiotic therapy for Helicobacter pylori) were treated with extended-field radiotherapy. The volume depended on stage. The irradiation dose was 30 Gy, followed by a boost of 10 Gy (the latter omitted after complete resection) to the tumor region.

RESULTS: Seven hundred forty-seven patients were accrued. Of these patients, 393 with localized PGL were treated with radiotherapy and/or chemotherapy only or additional surgery between December 1996 and December 2003. The survival rate at 42 months for patients treated with surgery was 86% compared with 91.0% for patients without surgery.

CONCLUSION: In this nonrandomized study (02/96), we reproduced the previous results of study 01/92 showing no disadvantage for an organ-preserving treatment. Therefore, primary stomach resection should be questioned.

Supported by Amgen and Hoffmann-LaRoche AG, Germany.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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