R-CHOP with dose-attenuated radiation therapy could induce good prognosis in gastric diffuse large B cell lymphoma

We retrospectively analyzed 40 gastric DLBCL patients receiving chemotherapy with or without radiation in our institute. Those in stages II-IV were treated with six cycles of R-CHOP without radiation; for those in stage I, we administered three cycles of R-CHOP with radiation.The three-year overall survival (OS) and progression-free survival (PFS) rates were 95.2 and 91.8%, respectively. Those in stage I obtained 100% of OS. The radiation dose prescribed was 30.6？Gy for CR cases and 39.6 to 40？Gy for PR after chemotherapy. Although survival rates tended to correlate with staging groups or age-adjusted IPI classifications, multivariate statistical analysis did not show clear differences. All 14 patients with initial bleeding were successfully managed without surgery during treatment.R-CHOP therapy was very effective for gastric DLBCL. It may be not necessary to use more than 30.6？Gy of radiotherapy in the highly chemo-sensitive cases. Less toxic treatments should be made available to gastric DLBCL patients.Primary gastric diffuse large B cell lymphoma (DLBCL) is a relatively common disease in gastric lymphoma as well as gastric marginal zone B cell lymphoma (MALT). In many previous reports, the prognosis for gastric lymphoma was considered good; however, these reports involved MALT, indolent lymphoma, and DLBCL cases [1,2]. Treatments were varied and included surgical resection, radiotherapy, antibiotics against helicobacter pyroli, and chemotherapy [3]. Reports focusing only on primary gastric DLBCL are very few, and the treatment strategy has not been stabilized and individualized across institutions. Recently, it has been known that rituximab combined CHOP (R-CHOP) has been shown to be very effective for DLBCL, remarkably improving overall survival and progression free-survival [4]. For localized DLBCL, radiation following limited cycles of R-CHOP led to good prognosis [5-7]. In the Southwest Oncology Group Study (SWOG) 0014 study, RCHOP with radiotherapy for earl