Clinical Profile of Patients with Primary Gastric Lymphoma: A Single Centre Experience.

BACKGROUND/AIMS: There are many controversies regarding the treatment for primary gastric non-Hodgkin’s lymphoma (PGL). We hypothesized that chemotherapy and local radiotherapy would improve patient survival in the treatment of with PGL.

METHODOLOGY: Between January 2003 and July 2007, retrospectively evaluated 15 patients with stage IE and IIE PGL. All patients clinical, biochemical, radiological and endoscopic features were evaluated. The histological diagnosis was established by endoscopic biopsies in all cases. All patients were treated with CHOP,RCHOP with or without radiotherapy. Patients with MALT as histopathology received H.pylori treatment. Upon the completion of chemotherapy, IFRT was given in the doses of 40.0 Gy. None of the patients underwent surgery. The response rates of chemotherapy and radiotherapy were analyzed.

RESULTS: We have treated 300 patients of non hodgkins lymphomas, extranodal NHLs were 80, GI lymphomas were 50,15 patients had PGL. The age rage was 39–71 years. Nine patients were males and 6 were females. The most common symptom was abdominal pain in 46.66% followed by abdominal mass in 33.33%,dyspepsia in 13.33% and weakess in 6.66% of patients. Duration of symptoms varied from 15 days to 6 months. Histological subtypes were diffuse large B-cell in 80% and marginal zone B-cell NHL of the mucosa-associated lymphoid tissue (MALT)-type in 20% of patients. Helicobacter pylori infection (HPI) was seen in all MALT type NHLs. Six patients(40%) received RCHOP with RT followed by RCHOP in 4(26.66%), CHOP in 3(20%) and R-CHOP with RT in 2 (13.33%) patients. Response was evaluated by repeat endoscopy after completion of 3 and 6 cycles. Fourteen (93.33%) patients showed complete response only after 3 cycles of chemotherapy. Only one (6.66%) relapsed who received CHOP alone. All patients are alive with a median follow-up of 30 months (range 2 to 54 months).

CONCLUSIONS: Primary chemotherapy with or without radiotherapy may produce complete remission in Stage IE-IIE PGL. The gastric function was well preserved with negligible stomach-related symptoms in all the patients. This organ-preserving combined treatment is highly effective and well tolerated for the patients with localized gastric DLBCL.