Follow-up Therapy for Large Cell Lymphoma of the Stomach?

December 30, 2002

Question

I have a 60-year-old woman with large cell lymphoma of the stomach who was started on chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). CT scans of the chest, abdomen, and pelvis did not show any lymphadenopathy, and bone marrow was normal. Is there any role for surgery and/or radiation therapy?

Response from

The patient described here has a large cell lymphoma of the stomach and has been treated with CHOP chemotherapy. She has no evidence of extra-abdominal disease and apparently has responded well to CHOP. In addition, bone marrow examinations are negative for evidence of lymphoma.

Assuming that this was a large B-cell lymphoma that was CD-20-positive, the treatment with CHOP chemotherapy is very appropriate. Some clinicians might consider the addition of rituximab to the CHOP if the patient had a CD-20-positive tumor.[1] However, if the patient has already undergone a full course of CHOP, I do not feel that there is a need to add rituximab at this point.

The question remains whether radiation would be valuable in such a patient. There are data supporting the use of regional radiation after the completion of CHOP chemotherapy in patients with locally advanced non-Hodgkin's lymphoma. If the patient were doing well post chemotherapy, one might consider the addition of radiation to the stomach and the gastric lymph node-bearing areas. However, the data of Miller and colleagues[2] suggest that incremental benefit of radiation, even though statistically significant, is relatively small for stage I and II intermediate and high-grade lymphoma.

Comments

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