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J Gastroenterol Dig Dis 2017 | Volume 2, Issue 3
World Gastroenterological &
Gastroenterology and Endoscopy
October 30-31, 2017 | Toronto, Canada
World Congress on
The challenge of primary gastric lymphoma treatment
Marcelo Mester
University of São Paulo Medical School, Brazil
Statement of the Problem:
Primary gastric lymphomas (PGL)
are heterogeneous. PGL include high grade diffuse large B-cell
lymphomas (DLBCL) and the more indolent marginal zone
lymphomas (MZL). Gastric MZL areMALT (mucosa associated
lymphoid tissue) lymphomas, which may be
Helicobacter
pylory
(Hp) infection-related. Thus, many controversies
remain surrounding the optimal PGL treatment: primary
surgery (S), chemotherapy (CT), radiotherapy (RT), or their
combinations, and simple Hp-eradication for the MALTs.
Methodology & Theoretical Orientation:
Review of our
experience over a 25 yr-period, and a discussion on the
various PGL treatment strategies.
Findings:
From 1979-2008, 61 records of PGL patients with a
median follow-up time of 67.5 mo included high (77%) or low
(23%) grades, stages Ie (45.9%), IIe1 (14.8%), IIe2 (8.2%), IIIe
(18%), IVe (13.1%) (Musshoff). Rx were S (20%), S+C (34%),
C (37%), C+S (8%) (after 2004 mostly chemo). Rx-failures,
and a 8.9% mortality were all under chemo, and before
2004; there was no 30-day surgical mortality. This pattern
changed after 2008 when most PGL were treated by primary
chemo; mortality was below 3%. Most world centers also
shifted to primary chemo (Rituximab-CHOP) after 2004, with
surgery becoming salvage therapy (or of chemo-induced
complications). Hp(+)-MALTs were treated by Hp eradication;
resistant or Hp(-) MALTs were treated by surgery or radiation.
Recently a prospective randomized multicentric phase III
study with 401 patients having Hp eradication-resistant or
recurrent gastric MALTs, and other non-gastric MZL, showed
better results by chlorambucil+rituximab compared to each
drug alone, suggesting other avenues for these tumors. An
international MALT prognostic index (MALT-IPI) was also
generated.
Conclusion & Significance:
PGL survival remains associated
with stage, grade, and Rx. Organ conservation is key however
optimal chemo regimens with adequate dose-intensity as
well as Hp-control are paramount for this endeavor.
Speaker Biography
MarceloMester is a Research-Fellow in Surgical Oncology at theMassachusetts General
Hospital, Harvard Medical School. He is an Assistant-Professor of Gastrointestinal
Surgery, Hospital das Clínicas, University of São Paulo Medical School. He is a founding
Member of the International Gastric Cancer Association (IGCA, 1995) and the Brazilian
Association of Gastric Cancer (ABCG) where he is currently a Board Member. He has
studied gastrointestinal lymphomas for many years and has presented Brazilian data
on the issue. He was three times awarded best paper in international congresses, all of
them with gastric lymphoma data.
e:
mester.marcelo@gmail.com