Gastric lymphoma and other malignancies

Data on the treatment of primary gastric lymphoma are typically retrospective and uncontrolled, making comparisons difficult. The most exciting new development is in understanding the pathogenesis of the disease. Specifically, the identification of MALT and so-called MALT lymphomas, their relationship to H. pylori infection, and the complete regression of early low-grade B-cell lymphomas with eradication of H. pylori have potential to change the incidence and treatment of gastric lymphoma. Currently, a trial of eradication of H. pylori for all confirmed superficial MALT lymphomas seems reasonable before resorting to surgery. Subtotal gastrectomy is the surgical treatment of choice for all other resectable primary gastric lymphomas, whatever their stage. For true pathologic Stage IE lesions, adjuvant therapy may not further improve the already-good prognosis, but patients with IE lesions of 5 cm or greater diameter would probably benefit from it. A histologically positive margin requires adjuvant therapy after surgery. Stage IIE and later lesions should all receive adjuvant therapy, always after surgical resection if possible, to reduce the risks of perforation and bleeding related to treatment. It has not yet been elucidated whether adjuvant therapy should consist of radiation alone, chemotherapy alone, or both. Some IE and IIE lymphomas can certainly be cured with radiation or chemotherapy, alone or in combination, as primary therapy without surgery; but the treatment-related morbidity and mortality rates are significant and at this time the authors feel that this approach cannot be recommended as standard therapy. The incidence of primary gastric lymphoma is increasing in the United States, making the need for prospective controlled trials of different therapies all the greater.