Role of Follow Up Endoscopic Examinations in Response Assessment of Patients with Gastric Diffuse Large B Cell Lymphoma

Abstract

Listen

Translate article

ABSTRACT Aim: According to the guidelines of lymphoma, gastric diffuse large B cell lymphoma (DLBCL) patients are supposed to perform CT and/or PET CT regularly for response assessment after treatment such as chemotherapy and radiation therapy. However, endoscopic examinations and biopsies are not indicated for follow up guidelines. The aim of this study was to investigate the necessity and efficacy of endoscopic examinations when following up during and after treatment of tumor. Methods: This was a retrospective study of 44 consecutive patients who were diagnosed with gastric diffuse large B cell lymphoma, treated and underwent serial follow up endoscopies and biopsies from July 2009 to April 2014 in Seoul St. Mary's hospital. Endoscopic examinations and biopsies were performed at the time of diagnosis and after treatment. Disappearance of mucosal lesion except atrophy, discoloration, and neovascularization was defined as endoscopic remission. We followed the terms of NCCN guidelines (complete remission, partial response, stable disease, progressive disease) to determine clinical response with CT and/or PET CT. Results: A total of 161 endoscopic examinations were performed (median 3.7; range 2-7). Within a median follow up period of 27 months (range 4-57), 39 (89%) patients achieved complete remission in clinical response, while endoscopic remission was found in 34 (77%) patients. Only 32 (73%) patients achieved both forms of remission. 2 of 5 patients who achieved complete remission in clinical response but had remnant lesion at endoscopic examinations have recurred after several months. Patient demographics N = 44 Age 57.8 ± 12.07 (23-76) Male 22 (50%) Number of total f/u endoscopy (mean) 161 (3.7, 2-7) Duration of f/u period per patient (months) 27 (4-57) Clinical response Complete remission 39 (88.7%) Partial response 4 (9.1%) Progressive disease 1 (2.3%) Endoscopic response Complete remission 34 (77.3%) Partial response 7 (15.9%) Progressive disease 1 (2.3%) Conclusions: In gastric DLBCL patients, endoscopic response not always correlates with clinical response, and it also predicts the recurrence of disease as well. Therefore, we suggest that follow up endoscopic examinations and biopsies should be performed in addition to radiologic examinations such as CT and PET CT. Disclosure: All authors have declared no conflicts of interest.