Complete remission by chemotherapy in stage IE-IIE primary gastric lymphoma

There are many controversies regarding the treatment for primary gastric non-Hodgkin's lymphoma (PGL). We hypothesized that preoperative chemotherapy and extensive surgery would improve patient survival in the treatment of early stage patients with PGL.

Between 1997 and 2001, we prospectively evaluated 10 patients with stage IE and IIE PGL. The histological diagnoses were established by endoscopic biopsies in all cases. All patients received preoperative chemotherapy, i.e. CHOP or MACOP-B. Upon the completion of chemotherapy, the extensive surgery including total gastrectomy, splenectomy, cholecystectomy, and paraaortic lymphadenectomy were performed. The response rates of preoperative chemotherapy and overall survival were analyzed.

All patients were still alive with no signs of recurrence with a median follow-up of 86 months (range, 40 to 102 months) after surgery. In all patients, microscopic examinations did not reveal residual lymphoma cells in the resected stomach or lymph nodes. Chemotherapy-related preoperative complications such as perforation or intestinal bleeding did not occur in any of the cases. Postoperative complications developed in 30% (3/10) of patients and consisted of 2 pancreatic fistulas, 3 intra-abdominal abscesses, and 1 anastomotic leak.

Primary chemotherapy alone without surgery may produce complete remission in Stage IE-IIE PGL.