In this study, researchers compared surgery, surgery plus radiotherapy, surgery plus chemotherapy, and chemotherapy for the treatment of early-stage primary gastric diffuse large cell lymphoma.
The team randomized 589 patients to the 4 treatments.
Radiotherapy was delivered at doses of 40 Gy and chemotherapy was CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) at standard doses.
The researchers used the International Prognostic Index (IPI) and modified IPI (MIPI) to determine outcome.
The team found that complete response rates were similar in the 4 arms of the study.
|Survival was better in the chemotherapy groups.|
|Annals of Surgery|
They found the event-free survival at 10 years was 28% for the surgery group, 23% for surgery plus radiotherapy, 82% for surgery plus chemotherapy, and 92% for chemotherapy alone.
Overall survival at 10 years was 54% for the surgery group, 53% for surgery plus radiotherapy, 91% in surgery plus chemotherapy, 96% for chemotherapy alone.
Late toxicity was more frequent and severe in patients who undergoing surgery.
The team found that IPI and MIPI were not useful in determining outcome; multivariate analysis failed to identify other prognostic factors.
Dr Agustin Aviles and colleagues concluded, "In patients with…diffuse large cell lymphoma in early stage, surgery plus chemotherapy achieved good results".
"Thus it appears that chemotherapy should be considered the treatment of choice in this patient setting".
"Current clinical classifications of risk are not useful in defining treatment".