Pattern of Relapse in Localized Gastric Lymphoma Registered within the Prospective German Multicenter Study GIT NHL 01/92

Introduction: In 2001 (Koch et al.,JCO) we published the treatment results of 185 patients (pts) with localized primary gastric lymphoma (PGL) registered within the GIT NHL 01/92 German multicenter study. After a median time of observation of 130 months we present clinical and pathological features of relapsed patients. Methods: We compared treatment results in PGL after combined surgery and conservative (S/CM) versus conservative management (CM). Radiotherapy (Rx) and chemotherapy were stratified according to histological grading, stage, and the inclusion or omission of surgery as follows: PGL pts with indolent lymphomas in stage I received an extended field (EF) Rx with total abdominal irradiation and in stage II additionally a T-field preceded by 6 cycles of COP. The dose was 30 Gy for EF followed by a boost of 10 Gy on sites of tumor. All pts with aggressive PGL were treated with four (stage I) or six (stage II) cycles of CHOP-14 followed by EF Rx (stage I) or involved field Rx (stage II), dosage of Rx corresponded to Rx for indolent NHL. Results: Between the years 1992 and 1996, a total of 185 pts were registered. Recurrence of NHL occurred in 17 cases during follow-up. Analysis revealed no specific features of relapsed pts with respect to initial symptoms, clinical features (except stage II2 - more than regional lymph nodes involved) and initial treatment. DLBCL was the most common histological subtype seen in relapsed pts (58.8%). Indolent lymphoma relapsed in 41.2% pts. Interestingly 70% of the DLBCL initially had an additional small-cell component, and 56% relapsed as marginal zone B-cell lymphoma, particularly at primary site independent of the initial treatment. Conclusion: In this non-randomized study there was no disadvantage for a stomach preserving approach in the context of tumor recurrence. Patients with distant nodal involvement (Stage II2) and DLBCL relapsed more often than pts. with localized stages (Stage I/II1) and indolent lymphomas. Interestingly, aggressive lymphomas, with an initial small-cell component, predominantly relapsed as marginal zone B-cell lymphomas at primary site, while indolent lymphomas relapsed also generalized.