Outcome and Quality of Life Favour a Conservative Treatment of Patients with Primary Gastric Lymphoma

 

 Buy Article Permissions and Reprints

Zusammenfassung

Hintergrund: Sowohl chirurgische als auch konservative Therapiestrategien führen bei Patienten mit Magenlymphomen zu exzellenten Ergebnissen. Einen Vergleich von chirurgischer Resektion mit primärer Bestrahlung oder Chemotherapie in einem prospektiv randomisierten Ansatz gibt es bislang nicht. Ziel: Vergleich von chirurgischer Therapie mit Bestrahlung bei Patienten mit Marginalzonen-B-Zell-Lymphom (MZBZL) des MALT und von Chirurgie plus Chemotherapie mit alleiniger Chemotherapie bei Patienten mit diffusem großzelligen B-Zell-Lymphom (DGBZL) im Hinblick auf langfristigen Therapieerfolg und Lebensqualität. Methode: 49 Patienten (21 männlich und 28 weiblich; Alter 65 (35 – 75) Jahre) mit einem neu diagnostizierten MZBZL des MALT (n = 19) und DGBZL (n = 30) im Stadium I und II wurden eingeschlossen. Therapieerfolg und Lebensqualität, gemessen anhand des SF-36-Gesundheitsfragebogens und des Lebensqualitätsindexes (GLQI), wurden nach einem Beobachtungszeitraum von 74 (7 – 102) Monaten erhoben. Ergebnisse: Eine komplette Remission wurde bei Patienten mit MZBZL des MALT in 88 % nach chirurgischer Resektion und in 89 % nach Bestrahlung erreicht. Bei Patienten mit DGBZL führte eine Operation mit nachfolgender Chemotherapie in 93 % und eine alleinige Chemotherapie in 92 % zu einer kompletten Remission. Die Unterschiede zwischen den Therapiegruppen waren nicht signifikant. Die posttherapeutische Lebensqualität war generell hoch. Die Patienten mit konservativer Therapie wiesen gegenüber denjenigen, die sich einer Operation unterzogen hatten, eine signifikant bessere Lebensqualität auf. Schlussfolgerung: Der langfristige Therapieerfolg ist bei Patienten mit Magenlymphomen exzellent. Dies ist gilt für beide Lymphomentitäten und ist unabhängig davon, ob die Patienten chirurgisch oder konservativ behandelt werden. Vor dem Hintergrund der Lebensqualität sollte einer konservativen Therapiestrategie der Vorzug gegeben werden.

Abstract

Background: Both surgical and conservative treatment strategies offer an excellent outcome to patients with gastric lymphoma. No comparison of surgical resection with primary radiation or chemotherapy on a prospective randomised basis was available up to now. Aims: The aim of this study was to compare surgery with radiation and surgery plus chemotherapy with chemotherapy alone in patients with marginal zone B-cell lymphoma (MZBCL) of MALT and diffuse large B-cell lymphoma (DLBCL), respectively, with respect to long-term outcome and quality of life. Methods: 49 patients [21 male and 28 female; age 65 (35 – 75) years] with newly diagnosed MZBCL of MALT (n = 19) and DLBCL (n = 30) of stage I and II were recruited. Outcome was evaluated after a follow-up of 74 (7 – 102) months and quality of life was measured using the SF-36 health survey and the gastrointestinal life quality index (GLQI). Results: Complete remission rates in MZBCL of MALT were 88 % and 89 % in patients treated by surgery or radiotherapy, respectively. The corresponding rates for patients with DLBCL were 93 % following surgery plus chemotherapy and 92 % after chemotherapy alone, respectively. The results in the different treatment groups did not differ significantly. Posttherapeutic quality of life was generally high with a significant advantage for patients treated conservatively compared to those who underwent surgery. Conclusion: Long-term outcome of patients with gastric lymphoma is excellent irrespective of the lymphoma type and the treatment approach. Considering quality of life a conservative therapeutic strategy should be favoured.

References

• 1 Parlier Y, Najman A, Lecomte D et al. Results of a cooperative prospective study of treatment of primary digestive localisation of non-Hodgkin’s lymphoma.  Gastroenterol Clin Biol. 1985;  9 922-928
  Google Scholar
• 2 Sheridan W P, Medley G, Brodie G N. Non-Hodgkin’s lymphoma of the stomach. A prospective pilot study of surgery plus chemotherapy in early and advanced disease.  J Clin Oncol. 1985;  3 495-500
  Google Scholar
• 3 Steward W P, Harris M, Wagstaff J et al. A prospective study of the treatment of high-grade histology non-Hodgkin’s lymphoma involving the gastrointestinal tract.  Eur J Clin Oncol. 1985;  21 1195-1200
  Google Scholar
• 4 Rackner V L, Thirlby R C, Ryan J A. Role of surgery in multimodality therapy for gastrointestinal lymphoma.  Am J Surg. 1991;  161 570-575
  Google Scholar
• 5 Fung C Y, Grossbard M L, Linggood R M et al. Mucosa-associated lymphoid tissue lymphoma of the stomach: long term outcome after local treatment.  Cancer. 1999;  85 9-17
  Google Scholar
• 6 Kodera Y, Yamamura Y, Nakamura S et al. The role of radical gastrectomy with systematic lymphadenactomy for the diagnosis and treatment of primary gastric lymphoma.  Ann Surg. 1998;  227 454-450
  Google Scholar
• 7 Ruskone-Fourmestraux A, Aegerter P, Delmer A et al. Primary digestive tract lymphoma: a prospective multicentric study of 91 patients.  Gastroenterology. 1993;  105 1662-1671
  Google Scholar
• 8 Fischbach W, Dragosics B, Koelve-Goebeler M E et al. Primary gastric B-cell Lymphoma: Results of a Prospective Multicenter Study.  Gastroenterology. 2000;  119 1191-1202
  Google Scholar
• 9 Maor M H, Velasquez W S, Fuller L M et al. Stomach conservation in stages IE and IIE gastric non-Hodgkin’s lymphoma.  J Clin Oncol. 1990;  8 255-271
  Google Scholar
• 10 Solidoro A, Payet C, Sanchez Lihon J et al. Gastric lymphomas: chemotherapy as a primary treatment.  Semin Surg Oncol. 1990;  6 218-225
  Google Scholar
• 11 Haim N, Leviov M, Ben-Arieh Y et al. Intermediate and high-grade gastric non-Hodgkin’s lymphoma: a prospective study of non-surgical treatment with primary chemotherapy, with and without radiotherapy.  Leuk Lymph. 1995;  17 321-326
  Google Scholar
• 12 Hammel P, Haioun C, Chaumette M T et al. Efficacy of single-agent chemotherapy in low-grade B-cell mucosa- associated lymphoid tissue lymphoma with prominent gastric expression.  J Clin Oncol. 1995;  13 2524-2529
  Google Scholar
• 13 Schechter N R, Portlock C S, Yahalom J. Treatment of mucosa-associated lymphoid tissue lymphoma of the stomach with radiation alone.  J Clin Oncol. 1998;  16 916-921
  Google Scholar
• 14 Tsang R W, Gospodarowicz M K, Pintilie M. Localized mucosa-associated lymphoid tissue lymphoma treated with radiation therapy has excellent clinical outcome.  J Clin Oncol. 2003;  21 4157-4164
  Google Scholar
• 15 Koch P, Probst A, Berdel W E et al. Treatment results in localized primary gastric lymphoma: data of patients registered within the German multicenter study (GIT NHL 02 / 96).  J Clin Oncol. 2005;  23 7050-7059
  Google Scholar
• 16 Swerdlow S H, ed WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC; 2008: 229-232
  Google Scholar
• 17 Eypasch E, Wood-Dauphinee S, Williams J I et al. Der Gastrointestinale Lebensqualitätsindex (GLQI). Ein klinimetrischer Index zur Befindlichkeitsmessung in der gastroenterologischen Chirurgie.  Chirurg. 1993;  64 264-274
  Google Scholar
• 18 Fischbach W, Malfertheiner P, Hoffmann J C et al. S3-Leitlinie „Helicobacter pylori und gastroduo-denale Ulkuskrankheit” der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) in Zusammenarbeit mit der Deutschen Gesellschaft für Hygiene und Mikrobiologie, Gesellschaft für Pädiatrische Gastroenterologie und Ernährung e. V. und der Deutschen Gesellschaft für Rheumatologie – AWMF-Register-Nr. 021 / 001.  Z Gastroenterol. 2009;  47 68-102
  Google Scholar
• 19 Brands F, Monig S P, Raab M. Treatment and prognosis of gastric lymphoma.  Eur J Surg. 1997;  163 803-813
  Google Scholar
• 20 Aviles A, Nambo M J, Neri N et al. The role of surgery in primary gastric lymphoma: results of a controlled clinical trial.  Ann Surg. 2004;  240 44-50
  Google Scholar
• 21 Koch P, Probst A, Berdel W E et al. Treatment results in localized primary gastric lymphoma: data of patients registered within the German multicenter study (GIT NHL 02 / 96).  J Clin Oncol. 2005;  23 7050-7059
  Google Scholar
• 22 Cogliatti S B, Schmid U, Schumacher U et al. Primary B-cell gastric lymphoma: a clinicopathological study of 145 patients.  Gastroenterology. 1991;  101 1159-1170
  Google Scholar
• 23 Zinzani P L, Frezza G, Bendandi M et al. Primary gastric lymphoma: a clinical and therapeutic evaluation of 82 patients.  Leuk Lymphoma. 1995;  19 461-466
  Google Scholar
• 24 Vaillant J C, Ruskone-Fourmestraux A, Aegerter P et al. Management and long-term results of surgery for localized gastric lymphomas.  Am J Surg. 2000;  179 216-222
  Google Scholar
• 25 Sano T. Treatment of primary gastric lymphoma: experience in the National Cancer Center Hospital, Tokyo [In Process Citation].  Recent Results Cancer Res. 2000;  156 104-107
  Google Scholar
• 26 Koch P, del Valle F, Berdel W E et al. 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.  J Clin Oncol. 2001;  19 3874-83
  Google Scholar
• 27 Kodera Y, Yamamura Y, Nakamura S et al. The role of radical gastrectomy with systematic lymphadenectomy for the diagnosis and treatment of primary gastric lymphoma.  Ann Surg. 1998;  227 45-50
  Google Scholar
• 28 Kuo S H, Chen L T, Wu M S et al. Long-term follow-up of gastrectomized patients with mucosa-associated lymphoid tissue lymphoma : need for a revisit of surgical treatment.  Ann Surg. 2008;  247 265-269
  Google Scholar
• 29 Wotherspoon A C, Doglioni C, Diss T C et al. Regression of primary low-grade B-cell gastric lymphoma of mucosa- associated lymphoid tissue type after eradication of Helicobacter pylori.  Lancet. 1993;  342 575-577
  Google Scholar
• 30 Steinbach G, Ford R, Glober G et al. Antibiotic treatment of gastric lymphoma of mucosa-associated lymphoid tissue. An uncontrolled trial.  Ann Intern Med. 1999;  131 88-95
  Google Scholar
• 31 Ruskone-Fourmestraux A, Lavergne A, Aegerter P H et al. Predictive factors for regression of gastric MALT lymphoma after anti-Helicobacter pylori treatment.  Gut. 2001;  48 297-303
  Google Scholar
• 32 Bayerdorffer E, Neubauer A, Rudolph B et al. Regression of primary gastric lymphoma of mucosa-associated lymphoid tissue type after cure of Helicobacter pylori infection. MALT Lymphoma Study Group.  Lancet. 1995;  345 1591-1594
  Google Scholar
• 33 Montalban C, Santon A, Boixeda D et al. Treatment of low grade gastric mucosa-associated lymphoid tissue lymphoma in stage I with Helicobacter pylori eradication. Long-term results after sequential histologic and molecular follow-up.  Haematologica. 2001;  86 609-617
  Google Scholar
• 34 Roggero E, Zucca E, Pinotti G et al. Eradication of Helicobacter pylori infection in primary low-grade gastric lymphoma of mucosa-associated lymphoid tissue.  Ann Intern Med. 1995;  122 767-769
  Google Scholar
• 35 Neubauer A, Thiede C, Morgner A et al. Cure of Helicobacter pylori infection and duration of remission of low- grade gastric mucosa-associated lymphoid tissue lymphoma.  J Natl Cancer Inst. 1997;  89 1350-1355
  Google Scholar
• 36 Nakamura S, Matsumoto T, Suekane H et al. Long-term clinical outcome of Helicobacter pylori eradication for gastric mucosa-associated lymphoid tissue lymphoma with a reference to second-line treatment.  Cancer. 2005;  104 532-540
  Google Scholar
• 37 Fischbach W, Goebeler-Kolve M E, Dragosics B et al. Long term outcome of patients with gastric marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT) following exclusive Helicobacter pylori eradication therapy: experience from a large prospective series.  Gut. 2004;  53 34-37
  Google Scholar
• 38 Wundisch T, Thiede C, Morgner A et al. Long-term follow-up of gastric MALT lymphoma after Helicobacter pylori eradication.  J Clin Oncol. 2005;  23 8018-8024
  Google Scholar
• 39 Burgers J M, Taal B G, Heerde van P et al. Treatment results of primary stage I and II non-Hodgkin’s lymphoma of the stomach.  Radiother Oncol. 1988;  11 319-326
  Google Scholar
• 40 Kocher M, Muller R P, Ross D et al. Radiotherapy for treatment of localized gastrointestinal non-Hodgkin’s lymphoma.  Radiother Oncol. 1997;  42 37-41
  Google Scholar
• 41 Schechter N R, Portlock C S, Yahalom J. Treatment of mucosa-associated lymphoid tissue lymphoma of the stomach with radiation alone.  J Clin Oncol. 1998;  16 1916-1921
  Google Scholar
• 42 Thieblemont C, Dumontet C, Bouafia F et al. Outcome in relation to treatment modalities in 48 patients with localized gastric MALT lymphoma: a retrospective study of patients treated during 1976 – 2001.  Leuk Lymphoma. 2003;  44 257-262
  Google Scholar
• 43 Tsang R W, Gospodarowicz M K, Pintilie M et al. Stage I and II MALT lymphoma: results of treatment with radiotherapy.  Int J Radiat Oncol Biol Phys. 2001;  50 1258-1264
  Google Scholar
• 44 Vrieling C, Jong de D, Boot H et al. Long-term results of stomach-conserving therapy in gastric MALT lymphoma.  Radiother Oncol. 2008;  87 405-411
  Google Scholar
• 45 Tomita N, Kodaira T, Tachibana H et al. Favorable outcomes of radiotherapy for early-stage mucosa-associated lymphoid tissue lymphoma.  Radiother Oncol. 2009;  90 231-235
  Google Scholar

Prof. Dr. Wolfgang Fischbach

Medizinische Klinik II und Klinik für Palliativmedizin, Klinikum Aschaffenburg, Akademisches Lehrkrankenhaus der Universität Würzburg

Am Hasenkopf

63739 Aschaffenburg

Germany

Phone: ++ 49/60 21/32 30 10

Fax: ++ 49/60 21/32 30 31

Email: med2-aschaffenburg@t-online.de