Annals of Oncology 15:842, 2004
© 2004 European Society for Medical Oncology
Reply to Letter to the Editor on "Surgical resection plus chemotherapy versus chemotherapy alone: comparison of two strategies to treat diffuse large B-cell gastric lymphoma", by M. Binn, A. Ruskoné-Fourmestraux, E. Lepage et al. (Ann Oncol 2003; 14: 1751–1757)
Department of Gastroenterology, Hôpital Henri Mondor, Créteil, France
*E-mail: jean-charles.delchier@hmn.ap-hop-paris.fr
I read with interest the comments by Ibrahim et al. concerning our paper [1]. They pointed out in their previously published study [2] that International Prognostic Index (IPI) was not fully adapted to predict overall survival rate in gastric large B-cell lymphoma (diffuse large B-cell lymphoma, DLBC) lymphoma. In fact, they showed that in their population, including patients with extended disease, the low-risk group according to the IPI had significantly better prognosis than the other groups (low-intermediate, intermediate, high-risk), but that there was not any significant difference between the last three groups. The results of our study, which included only localized gastric lymphomas, confirmed that the IPI was efficient in showing a better survival rate in the low risk group as compared with the others. Therefore, we stated that we observed results in agreement with those published by Ibrahim et al [2].
I also read with interest the comments by Abali and Barista. I agree that timing of LDH determination is important. It was determined before surgery in the GELD group. Therefore, differences between the level of LDH in the GELA patients and the GELD patients were related to differences in severity of the disease. I agree with the authors that starting time for overall survival and disease-free survival should be more clearly defined in the GELD group: it was the time of inclusion in the protocol. Regarding response criteria, I am surprised by the authors’ comment. The criteria of Cheson et al. [3] were defined to evaluate response in the absence of curative surgery. Pathological examination of surgical specimen after resection of a localized tumor at initial staging does appear as a well adapted mean in evaluating response.
Chemotherapy in the GELA group was not homogeneous as patients were included in two trials comparing several regimens. However, our aim was not to determine the better chemotherapy but to compare two strategies: surgery versus chemotherapy. Authors from the GELD group previously published results showing the efficiency of surgery [4, 5]. The results of the present study confirmed their findings and showed that in patients with similar inclusion criteria, chemotherapy provided comparable survival to surgery. Therefore, we concluded that gastrectomy is probably not mandatory in low-risk patients with localized gastric DLBC lymphomas.
REFERENCES
1. Binn M, Ruskone-Fourmestraux A, Lepage E et al. Surgical resection plus chemotherapy versus chemotherapy alone: comparison of two strategies to treat diffuse large B-cell gastric lymphoma. Ann Oncol 2003; 14: 1751–1757.
2. Ibrahim EM, Ezzat AA, Raja MA et al. Primary gastric non-Hodgkin’s lymphoma: clinical features, management, and prognosis of 185 patients with diffuse large B-cell lymphoma. Ann Oncol 1999; 10: 1441–1449.
3. Cheson BD, Horning SJ, Coiffier B et al. Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI Sponsored International Working Group. J Clin Oncol 1999; 17: 1244.
4. Ruskone-Fourmestraux A, Aegerter P, Delmer A et al. Primary digestive tract lymphoma: a prospective multicentric study of 91 patients. Groupe d’Etude des Lymphomes Digestifs. Gastroenterology 1993; 105: 1662–1671.[Web of Science][Medline]
5. Vaillant JC, Ruskone-Fourmestraux A, Aegerter P et al. Management and long-term results of surgery for localized gastric lymphomas. Am J Surg 2000; 179: 216–222.[CrossRef][Web of Science][Medline]
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