Long-term follow-up of gastric lymphoma after stomach conserving treatment.

The therapeutic strategy in gastric lymphoma has completely changed over the last two decades. This change is mainly characterised by the abandonment of surgery in favour of conservative therapies and the introduction of Helicobacter pylori eradication therapy. It became evident that conservative treatment with radiation and/or chemotherapy is at least as effective as surgical resection and additionally offers the advantage of stomach preservation and better quality of life. The therapeutic goal is undoubtedly complete remission of the lymphoma as a necessary basis for cure of the disease. Both radiotherapy and chemotherapy have a high curative potential in gastric MALT lymphoma and diffuse large B-cell lymphoma (DLBCL), respectively. An open question is the additional benefit of radiation following Rituximab-CHOP chemotherapy in DLBCL. In patients with gastric MALT lymphoma of stage I H. pylori eradication offers complete remission rates of up to 80% with excellent long-term prognosis and a real chance of cure. Patients with MALT lymphoma of stage II and those with DLBCL of stage I may also respond to eradication therapy in the individual case. It also emerged recently that there is no need for any oncological therapy in patients revealing minimal histological residuals after successful H. pylori eradication. A watch-and-wait strategy is the adequate management of this condition. In summary, therapy of gastric lymphoma is nowadays individualised with lymphoma type, stage, and H. pylori status as the determinants of the choice of treatment. Efficacy and quality of life are strong arguments for a definite conservative approach encompassing H. pylori eradication, radiation and chemotherapy.

[Gastric MALT-type lymphoma. Pathology, pathogenesis, diagnostics and therapy]. / Magenlymphome vom MALT-Typ. Pathologie, Pathogenese, Diagnostik und Therapie.

Helicobacter pylori infection plays a central role in the development of gastric MALT-type (mucosa-associated lymphoid tissue) lymphoma. Infection results in chronic H. pylori gastritis and stimulates together with antigens or autoantigens proliferation of B-lymphocytes which is the basis for the neoplastic transformation. Histology of MALT-type lymphoma is architecturally similar to the physiological MALT. Invasion and destruction of the gastric epithelium with development of so-called lympho-epithelial lesions is the most important diagnostic criterion. Cytologically MALT-lymphoma resembles centrocytes and monocytes. For definitive lymphoma diagnosis and for the differential diagnosis from other small cell lymphomas in the stomach immunohistochemistry can be helpful. The phenotype of MALT-type lymphoma is identical to non-neoplastic B-lymphocytes of the marginal zone (CD20+, CD5-, CD10- and CD23-). Individual therapy is strongly dependent from histological type and lymphoma stadium. Therapy modalities are H. pylori eradication, radiochemotherapy, surgery or a combination of these. Aim of the therapy is the complete lymphoma regression and cure of the disease.

[Interdisciplinary clinical pathway for colorectal cancer]. / Interdisziplinärer Behandlungspfad bei kolorektalem Karzinom.

Limited financial resources in public health care have led to the introduction of clinical pathways as a means to a better effectivity and efficacy. Colorectal cancer met the requirements for establishing such a pathway in a distinguished way: high patient volume, high costs, interdisciplinary multi-modal treatment concepts in a relevant frequency, and existing evidence based guidelines. This article gives an example of a clinical pathway for colorectal cancer as established in our hospital. The potential of such pathways to save costs as well as their implications on treatment results and patients' satisfaction will have to be critically analyzed in the future before their value can be definitely estimated.

[Palliative treatment for colorectal cancer]. / Kolorektales Karzinom.

Over 50,000 new cases of colorectal cancer are diagnosed in Germany every year. About half of these patients will be cured by surgery. The other reoccur or present primarily with advanced disease. Recently, the survival of patients with metastasized disease has been prolonged from about 6 months with best supportive care alone to more than 20 months with combination chemotherapy. Therefore, adequate palliation is reasonable. Irresectable liver metastasis can be treated by locally ablative procedures such as radiofrequency ablation (RFA) or laserinduced thermotherapy (LITT). In the individual case resection of lung or brain metastasis should be discussed. Practitioners have to deal with plenty of supportive opportunities e.g. analgesics, bisphosphonates, central acting drugs, nutrition but also with drug side effects. In centers different endoscopic or interventional radiologic procedures are offered. Considering the variety of therapeutic options, it is prudent to discuss individual treatment plans in an interdisciplinary "tumor board" and involve the practitioners in the decision making.

Primary gastric lymphoma of MALT: considerations of pathogenesis, diagnosis and therapy.

Primary gastric lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct entity with its own histological classification. Epidemiological, histomorphological, molecular biological and experimental data clearly underline that infection of the gastric mucosa by Helicobacter pylori plays an important role in both the development and progression of MALT lymphoma. Considering the histological grade of malignancy and dissemination (stage) of the disease as decisive prognostic factors, and therapeutic determinants, endoscopic bioptical diagnosis and endoscopic ultrasound are of particular importance. In cases of localized (stage 1), low grade lymphoma, eradication of H pylori offers a promising and fascinating therapeutic option. Surgical resection, radiotherapy or chemotherapy, and their combination, have proven to be effective treatment modalities. There is a need to clarify whether operative or conservative therapeutic strategies should be favoured in the future.

[Current aspects of pathogenesis, diagnosis and therapy of primary MALT stomach lymphomas]. / Aktuelle Aspekte zu Pathogenese, Diagnostik und Therapie primärer Magenlymphome des MALT.

Primary gastrointestinal lymphoma of MALT occupy a special position which is documented in their own histological classification. Our knowledge about pathogenesis, biological and therapeutical behaviour of this lymphoma entity has increased substantially during recent years. Considering epidemiological, histomorphological and experimental data Helicobacter pylori infection undoubtless plays an important role in the development and progression of gastric MALT-lymphoma. In view of histological malignancy (low or high grade) and dissemination of the disease (stage) as decisive prognostic factors and therapeutical determinants endoscopic-bioptical diagnosis as well as endoscopic ultrasound are of major importance. In case of localized low-grade lymphoma eradication of Helicobacter pylori offers a promising therapeutic option. Surgical resection and radiochemotherapy have proven to be effective treatment modalities. There is a need for randomized trials to clarify if operative or conservative therapeutic strategies have to be favored in the future.

[MALT-lymphoma--conservative therapy]. / MALT-Lymphome--konservative Therapie.

Primary gastrointestinal lymphoma of the MALT (mucosa-associated lymphoid tissue) are nowadays regarded as a distinct entity with specific morphological, biological and clinical characteristics. Therapeutic strategies are based on their histological grade (low or high malignancy) and stage of the disease. They include surgical resection and/or radiotherapy for the local tumor control as well as chemotherapy in the case of disseminated disease or high malignancy. Currently, eradication of Helicobacter pylori offers another promising therapeutic option in low malignant gastric lymphoma of stage EI.

[Primary gastric lymphoma of the MALT type. The current knowledge on its etiology, therapy and prognosis]. / Primäre Magenlymphome vom MALT-Typ. Gegenwärtiger Wissensstand zu Atiologie, Therapie und Prognose.

Primary gastric lymphoma are nowadays considered as a distinct lymphoma entity. They are mostly classified as low or high grade malignant B-cell-lymphoma of the MALT (mucosa-associated lymphoid tissue). Within the gastrointestinal tract, the stomach is most frequently involved. In the pathogenesis of gastric lymphoma, Helicobacter pylori-associated gastritis plays an important conditioning role. Histological grading, stage and resectability of lymphoma are considered as major prognostic factors. Options in the therapy of gastric lymphoma are based on their histological grade and stage of the disease. They include surgical resection and/or radiotherapy for local tumor control as well as chemotherapy in the case of disseminated disease or high malignancy. Currently, special interest focuses on the effect of Helicobacter pylori eradication.