The role of radiotherapy in the treatment of gastric mucosa-associated lymphoid tissue lymphoma

Abstract

Purpose: To assess radiotherapy for patients with early stage gastric mucosa-associated lymphoid tissue (MALT) lymphoma with respect to survival, treatment response, and complications.

Materials and methods: Enrolled into this study were 48 patients diagnosed with gastric MALT lymphoma from January 2000 to September 2012. Forty-one patients had low grade and seven had mixed component with high grade. Helicobacter pylori eradication was performed in 33 patients. Thirty-four patients received radiotherapy alone. Ten patients received chemotherapy before radiotherapy, and three patients underwent surgery followed by chemotherapy and radiotherapy. One patient received surgery followed by radiotherapy. All patients received radiotherapy of median dose of 30.6 Gy.

Results: The duration of follow-up ranged from 6 to 158 months (median, 48 months). Five-year overall survival and cause-specific survival rates were 90.3% and 100%. All patients treated with radiotherapy alone achieved pathologic complete remission (pCR) in 31 of the low-grade and in three of the mixed-grade patients. All patients treated with chemotherapy and/or surgery prior to radiotherapy achieved pCR except one patient who received chemotherapy before radiotherapy. During the follow-up period, three patients developed diffuse large B-cell lymphoma in the stomach, and one developed gastric adenocarcinoma after radiotherapy. No grade 3 or higher acute or late complications developed. One patient, who initially exhibited gastroptosis, developed mild atrophy of left kidney.

Conclusion: These findings indicate that a modest dose of radiotherapy alone can achieve a high cure rate for low-grade and even mixed-grade gastric MALT lymphoma without serious toxicity. Patients should be carefully observed after radiotherapy to screen for secondary malignancies.

Keywords: Marginal zone B-cell lymphoma; Radiotherapy; Stomach.

Fig. 1

(A) Simulation images of two-dimensional plan for radiotherapy with anterior-posterior opposing two fields including stomach and regional lymphatic area. (B) Three-dimensional plan with dose distribution shown on adjacent visceral organs. (C) Patient with gastroptosis, which required the radiotherapy field to be much larger than usual, covering entire left kidney. (D) Follow-up abdomen computed tomography showing mild atrophy with normal parenchymal density of left kidney.

Fig. 2

Breakdown of treatment modality by pathologic grade. Low grade (A) and low and high grade mixed (B). H., Helicoboacter; dCRT, definitive radiotherapy; PD, persistent disease; sRT, salvage radiotherapy; CTx, chemotherapy; CR, complete remission; cRT, consolidative radiotherapy; S, surgery.