Abstract
The treatment of primary gastric lymphoma is evolving in post-rituximab era. The role of Helicobacter pyroli eradication alone can cure not only Mucosa-Associated Lymphoepithelial Tumor (MALT) but also some of diffuse large B cell lymphoma with or without MALT component. The efficacy of rituximab containing chemotherapy is so effective that the role of surgery is overshadowed. There are many studies, although most of them were retrospective trials, however it highlights the current mainstay of immune-chemotherapy provided an outstanding long term survival more than 80-90%.H pylori In real world there are substantial patients may receive surgery first, yet still needs post-operative adjuvant chemotherapy for some of them has a risk of relapse of lymphoma. And recent studies showed there’s no statistical difference between the two modalities. The main reason for patients proceeded to surgery as primary treatment is the gastroenterologist preference and showed no difference in terms of progression free survival and overall survival. The rituximab was introduced to lymphoma treatment since 1999, and demonstrated a superior long term survival in diffuse large B cell lymphoma for R-CHOP relatively to CHOP regimen. The highly effective treatment made PGL being easily curable disease; furthermore there are new insights of why and how the antibiotic therapy as exclusive treatment for limited disease will be a mainstay in treating this malignancy. We make a proposal how to treat the primary gastric lymphoma and MALT, and highlight the changing treatment modalities with regards to the integration of Helicobacter pyroli eradication to conventional chemotherapy as well as the complimentary role of surgery and radiotherapy.
Citation
Chang MC and Kuo SH. Primary Gastric Lymphoma. J Gastroenterol. 2017; 3(1): 1006.