Gastrointestinale Lymphome: Ausblick und zukünftige Therapiestrategien

Considering the histological grade of malignancy and dissemination (stage) of disease as decisive prognostic factors and therapeutic determinants, a subtle endoscopic bioptical diagnosis (gastric mapping) is of particular importance. Push enteroscopy and capsule endoscopy can be expected to diagnose an intestinal lymphoma without surgical intervention more often than previously. They also offer an opportunity to establish the frequency of a multiorganic manifestation of gastrointestinal lymphoma. Conventional endoscopic ultrasound represents an obligatory investigation when staging the patients. The use of high-resolution mini-echoendoscopes and endosonographically guided puncture will probably improve the diagnostic accuracy. Future therapeutic strategies comprise Helicobacter pylori eradication therapy in higher stages (>1) of low-grade lymphoma and in patients with localized high-grade lymphoma under strict study conditions as well as a watch-and-wait strategy in those with minimal residuals of lymphoma revealed by histology after successful treatment of Helicobacter pylori. The clinical value of anti-CD20 antibody therapy is currently unclear. With respect to the classical oncological treatment modalities, future activities will focus on the reduction of treatment-related toxicities and of long-term complications while offering a high therapeutic efficacy.