Exclusive moderate-dose radiotherapy in gastric marginal zone B-cell MALT lymphoma: Results of a prospective study with a long term follow-up

Ruskoné-Fourmestraux, A; Matysiak‐Budnik, Tamara; Fabiani, Bettina; Cervera, Pascale; Brixi, Hédia; Malicot, Karine Le; Nion–Larmurier, Isabelle; Fléjou, J F; Hennequin, Christophe; Quéro, L.

doi:10.1016/j.radonc.2015.08.029

Cited by 42 publications

(29 citation statements)

References 37 publications

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“…Radiotherapy is a promising therapy for gastric MALT lymphomas that are residual or recurrent after eradication therapy. Several reports have mentioned that the 5-year cause-specific survival rates in patients with gastric MALT lymphoma who receive radiotherapy are 80–100% [4–6, 8, 20–22]. In our study, good long-term local control was achieved over a median follow-up period of 10 years.…”

Section: Discussionsupporting

confidence: 64%

Radiotherapy for localized gastric mucosa–associated lymphoid tissue lymphoma: long-term outcomes over 10 years

Ohkubo

Saito

Ushijima

et al. 2017

Journal of Radiation Research

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This study aimed to assess the long-term outcomes of radiotherapy in patients with localized gastric mucosa–associated lymphoid tissue (MALT) lymphoma. Twenty-seven patients with Stage I gastric MALT lymphoma were treated with radiotherapy from 1999 to 2010. The median age was 65 years (range: 31–84). Fifteen patients were Helicobacter pylori–negative. Thirteen patients were treated with definitive radiotherapy alone. The other 14 patients who had refractory or residual disease following a prior treatment received salvage radiotherapy. The median dose of the radiotherapy was 30 Gy in 20 fractions (range: 30–39.5 Gy). The median follow-up period was 121 months (range: 8–176 months). The 5- and 10-year overall survival rates for all patients were 92% and 87%, respectively. No patients died from MALT lymphoma. Three patients died of other diseases at 8, 33 and 74 months after radiotherapy (myocardial infarction, pneumonia and hepatocellular carcinoma, respectively). No cases of local recurrence were observed during the follow-up period. There were no serious late gastric, liver or kidney complications during a median follow-up period of over 10 years. Two patients remain alive with distant metastases: a lung metastasis and an abdominal lymph node metastasis at 104 months and 21 months after radiotherapy, respectively. Excellent long-term local control was observed in patients with localized gastric MALT lymphoma after radiotherapy. However, lifelong follow-up should be conducted to detect cases of late recurrence, especially distant metastases.

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Section: Discussionsupporting

confidence: 64%

Radiotherapy for localized gastric mucosa–associated lymphoid tissue lymphoma: long-term outcomes over 10 years

Ohkubo

Saito

Ushijima

et al. 2017

Journal of Radiation Research

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“… 6 A total of 97.8% of patients who were resistant to antibiotic therapy responded to radiotherapy. 70 The most common side effects of radiotherapy included anorexia, nausea, and vomiting. With a dose of 30 to 35 Gy, no delayed toxicity (such as gastric ulcers or gastrointestinal hemorrhaging) has been noted, although long-term effects of radiotherapy on the functionality and integrity of the gastric mucous membrane remain ulcear.…”

Section: Treatmentmentioning

confidence: 99%

Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment

et al. 2018

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Primary gastric lymphoma (PGL) is the most common extranodal non-Hodgkin lymphoma and represents a wide spectrum of disease, ranging from indolent low-grade marginal zone lymphoma or mucosa-associated lymphoid tissue (MALT) lymphoma to aggressive diffuse large B-cell lymphoma. The PGL is a relatively rare cancer and easily misdiagnosed due to its unspecific symptoms of the digestive tract. The medical literature and ongoing clinical trials were reviewed on the clinical presentation, diagnosis, prognosis, prevention, and treatment of PGL. Primary gastric lymphoma is an event in the course of cancer with a variable clinical presentation and a wide differential diagnosis. Chronic gastritis secondary to Helicobacter pylori (H pylori) infection has been considered a major predisposing factor for MALT lymphoma. Magnetic resonance imaging and endoscopic ultrasonography have helped in staging of these cancers. The clinical course and prognosis of this disease are dependent on histopathological subtype and stage at the time of diagnosis. A global therapeutic approach to the cure of PGL has completely changed over the past 10 years, including innovative and conservative options to reduce treatment toxicity. Due to the rarity of PGL, many aspects of this neoplasm are still controversial. The incidence of this disease is increasing, making it necessary for clinicians to understand the clinical symptoms, workup, and treatment of these lymphomas.

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“…All CT images were exported to the treatment planning system (Pinnacle 3 ; Phillips Radiation Oncology Systems, Fitchburg, WI) and were registered by the hardware arrangement. The gross tumor volume (GTV) was identi ed based on the endoscopic examination ndings, and it was con rmed that the whole stomach appropriately covered the GTV.…”

Section: D-ct Imaging and Structure Generationmentioning

confidence: 99%

“…Radiotherapy of gastric mucosa-associated lymphoid tissue (MALT) lymphoma provides excellent longterm local control and survival [1][2][3][4]. The clinical target volume (CTV) for gastric MALT lymphoma is de ned as the whole stomach, and the planning target volume (PTV) margin, which accounts for variations in stomach volume, respiratory movement, and patient set-up error, is added to the CTV.…”

Section: Introductionmentioning

confidence: 99%

Impact of Four-Dimensional Cone-Beam Computed Tomography on Target Localization for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Radiotherapy: Reducing Planning Target Volume Margin

Shimohigashi

Toya

Saitô

et al. 2020

Preprint

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Background: Radiotherapy of gastric mucosa-associated lymphoid tissue (MALT) lymphoma should be delivered to the whole stomach with optimal planning target volume (PTV) margins that account for variations in stomach volume, respiratory movement, and patient set-up error. In this study, we evaluated whether the use of four-dimensional cone-beam computed tomography (4D-CBCT) reduces the PTV margin.Methods: Eight patients underwent radiotherapy with 15 fractions of gastric MALT lymphoma using 4D-CBCT. Structures with PTV margins of 5–30 mm (5 mm intervals) from the internal target volume of the stomach defined based on the 4D-CT images were generated. For the target localization, we performed matching based on skin marking (skin matching), bone anatomy (bone matching), and stomach anatomy (4D soft-tissue matching) based on registration between planning CT and 4D-CBCT images from 10 phases. For each patient, we calculated the covering ratio (CR) of the stomach with variable PTV margins, based on the 4D-CBCT images, with a total of 150 phases [CR (%) = (number of covering phases / 150 phases) × 100], for three target localization methods. We compared the CR values of the different target localization methods and defined a minimal PTV margin with an average CR of ≥ 95 % for all patients as optimal.Results: The average CR for all patients increased from 17.9 % to 100 %, 19.6 % to 99.8 %, and 33.8 % to 100 %, in the skin, bone, and 4D soft-tissue matchings, respectively, as the PTV margins increased from 5 to 30 mm. The CR obtained by 4D soft-tissue matching was superior to that obtained by skin (P = 0.013) and bone matching (P = 0.008) for a PTV margin of 15 mm. The optimal PTV margins were 20 mm (average CR: 95.2 %), 25 mm (average CR: 99.1 %), and 15 mm (average CR: 98.0 %) for the skin, bone, and 4D soft-tissue matchings, respectively.Conclusions: This study demonstrates that the use of 4D-CBCT reduces the PTV margin when applying 4D soft-tissue matching, compared to skin and bone matchings. Additionally, bone matching does not reduce the PTV margin as compared with traditional skin matching.

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Exclusive moderate-dose radiotherapy in gastric marginal zone B-cell MALT lymphoma: Results of a prospective study with a long term follow-up

Cited by 42 publications

References 37 publications

Radiotherapy for localized gastric mucosa–associated lymphoid tissue lymphoma: long-term outcomes over 10 years

Radiotherapy for localized gastric mucosa–associated lymphoid tissue lymphoma: long-term outcomes over 10 years

Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment

Impact of Four-Dimensional Cone-Beam Computed Tomography on Target Localization for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Radiotherapy: Reducing Planning Target Volume Margin

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