Non-Hodgkin's lymphoma of the stomach

Thirty-seven patients with non-Hodgkin's lymphoma of the stomach were treated with curative intent by several single and combined modality regimens. Twenty-two patients presented with stage IE and 15 with stage IIE disease. All but three patients underwent laparotomy. Of all diagnostic procedures used, x-ray of the upper gastrointestinal tract proved to be most helpful in diagnosing malignant lesions (87%). Gastric cytology was suspicious or diagnostic of malignancy in 35% of the patients. Twelve of 34 evaluable patients (35%) developed recurrence. Distant metastases (75%) was the most common mode of failure. The recurrence rates varied by the type of therapy and also the extent of initial disease. Four of 12 patients (33%) were salvaged with retreatment. The 5-year actuarial no evidence of disease survival for the entire group was 61% (stage IE-57%; stage IIE-67%). Patients receiving combined modality therapy had significantly (p = less than 0.05) higher survival than patients treated with single modality treatment. Three of 29 patients (10%) died of surgical complications after gastrectomy. Radiation treatment was well tolerated. Our data and a critical review of the literature do not support the reportedly high incidence of gastric perforation after radiation treatment. We recommend the use of adjuvant radiation for stage IE and adjuvant radiation plus chemotherapy for stage IIE gastric lymphoma.