IMMUNOCHEMORADIOTHERAPY OR IMMUNOCHEMOTHERAPY ONLY IN PATIENTS WITH EXTRANONAL DIFFUSE LARGE B‐CELL LYMPHOMA OF STOMACH

Abstract

Introduction: Radiation therapy (RT) is an effective method for treating indolent lymphomas of the stomach (Yahalom, 2006), but the results proving its role in patients with extranodal diffuse large B-cell lymphoma with predominant lesions of the stomach during chemoradiation treatment are few and conflictive (Metijharissi et al., 2017, Mehmood, 2017). The purpose of the study: is to evaluate the effectiveness of immunochemoradiotherapy (ICT + RT) compared with only ICT in patients with extranodal diffuse large B-cell lymphoma of the stomach. Methods: The study included 66 primary patients aged 25-90 years (mean age - 59 years), who received and completed in the period 2006-2017. ICT + RT (26 patients) or ICT only (40 patients). Of these, men - 32; women - 34; Stage I - 6, II - 30; III - 3; IV - 27. The average observation period of the group - 45 months. 63 patients received 4-8 cycles of ICT R-CHOP-21, 3 patients - DA-EPOCH-R. RT was performed after ICT at doses of 30-40 Gy for the entire volume of the stomach and in perigastric lymph nodes. In 10 patients before treatment, 3 weeks after ICT (20 patients) and 4 weeks after RT (15 patients), a full body PET scan with 18F-FDG was performed. The groups were comparable in terms of the main prognostic factors for the IPI criteria. Patients, who received surgical treatment were not included into the study. Five patients from the ICT group with a lack of efficacy of R-CHOP-21 were treated with 2 therapy lines, 1 - the third line of therapy. Results: A complete response after R-CHOP-21 was established in 48 of 66 (73%) patients. After subsequent RT in all 26 patients of the group of ICT + RT, complete remission was achieved in terms from 7 to 93 months. (average - 50 months.). In the group of ICT only, 5 patients died (4 of them in stage IV), including 4 from the underlying disease advance, 1 - from relapse in the central nervous system. The average follow-up period for this group was 42 months, the deceased patients — 10 months. The overall 5-year survival rate of the combined treatment group is 100%, ICT is 72%. In patients with PET positive results after PCT after irradiation, the metabolic activity of the tumour was not detected. Conclusion: ICT+RT is the optimal method of treating patients with extranodal aggressive lymphoma with gastric lesions. Keywords: diffuse large B-cell lymphoma (DLBCL); extranodal lymphomas.