Long‐term outcome in localized extranodal mucosa‐associated lymphoid tissue lymphomas treated with radiotherapy

Abstract

BACKGROUND: This study was conducted to evaluate the long-term outcomes in patients with stage IE and IIE mucosa-associated lymphoid tissue (MALT) lymphomas treated with involved field radiotherapy (RT). METHODS: Between 1989 and 2004, 192 patients with stage I and II MALT lymphomas were treated. The report focuses on 167 patients who received RT. The median age of patients was 58 years with a female predominance (2:1). Presenting sites were as follows: orbital adnexa in 71 patients, salivary glands in 28 patients, stomach in 25 patients, thyroid in 21 patients, and other sites in 22 patients. The median dose to nonorbital sites was 30 grays (Gy) (range, 17.5-35 Gy) and was 25 Gy for the orbit (range, 25-35 Gy). The median follow-up was 7.4 years (range, 0.67-16.20 years). RESULTS: Complete response and complete response, unconfirmed (CR/CRu) was noted in 166 (99%) patients. The 10-year recurrence-free rate (RFR) was 76%, the disease-free survival (DFS) rate was 68%, the overall survival (OS) rate was 87%, and the cause-specific survival rate was 98%. According to presenting site, the 10-year RFR was 95% for thyroid, 92% for stomach, 68% for salivary glands, and 67% for orbit. Patients with thyroid and gastric MALTs had better outcome compared with patients with MALTs diagnosed at other sites (P ¼.004). Among those patients who achieved CR, 19% developed disease recurrence (n ¼ 31), chiefly in distant sites or untreated contralateral-paired organs. At the time of disease recurrence, 7 patients (23%) had transformed to diffuse large B-cell lymphoma, 2 of whom died of lymphoma. The 5-year OS rate after treatment failure was 83%. CONCLUSIONS: Patients with localized MALT lymphomas are reported to have excellent clinical outcome after moderate-dose RT, and some are likely cured. In the current study, thyroid and gastric MALTs were found to have significantly less risk of distant recurrence. Despite disease recurrence, the overall survival remains excellent in these patients. Cancer 2010;116:3815-24.

A Prospective Analysis of Efficacy and Long-Term Outcome of Radiation Therapy for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

“…However, Vrieling et al [26] reported that there were 7 recurrent cases among 56 patients with gastric MALT lymphoma who achieved CR after RT, and that 2 of them showed recurrence in the stomach. On the other hand, Goda et al [27] reported absence of disease recurrence in 25 patients with gastric MALT lymphoma who achieved CR after RT. In our study, one of the three recurrent cases showed transformation to diffuse large-cell lymphoma, but none of the above-mentioned recurrent cases with gastric MALT lymphoma transformed to diffuse large-cell lymphoma.…”

“…In our study, one of the three recurrent cases showed transformation to diffuse large-cell lymphoma, but none of the above-mentioned recurrent cases with gastric MALT lymphoma transformed to diffuse large-cell lymphoma. However, according to the reports of Tsai et al [21] and Goda et al [27], 22.5 and 33.3%, respectively, of the recurrent cases transformed to diffuse large-cell lymphoma among the patients with MALT lymphoma originating from organs other than the stomach.…”

“…Only a few reports [6,21,25,26,27] described post-RT relapsing cases with gastric MALT lymphoma, and there are many unknown factors such as relapse frequency, relapse site, and transformation frequency to diffuse large-cell lymphoma. We could not observe any findings characteristic to the relapsing cases from the retrospectively reviewed factors except for H. pylori status and the translocation in our present study.…”

Mucosa-associated lymphoid tissue lymphoma of the urinary bladder

“…Goda et al [15] reported the long-term outcome of localized MALT lymphomas treated with radiotherapy: the CR rate was 99 %, the 10-year recurrence-free rate was 76 %, and the overall survival rate was 87 %. These findings suggest that radiotherapy is a good choice in the interest of organ preservation, while also producing the desired therapeutic effect.…”

Bilateral Conjunctival Mucosa-Associated Lymphoid Tissue Type Lymphoma in a Kidney Transplant Recipient

“…Rituximab, which is an anti-CD20 monoclonal antibody, is strongly suggested in a systemic disease (20). This case was an EBV-negative lymphoma and the disease extent was limited to the eye; therefore, we decided that a local radiotherapy would be the treatment modality because radiotherapy is one of the competent options among the treatment modalities for orbital MALT lymphoma (21)(22)(23)(24)(25). Recent studies reported that a radiotherapy dose range of 25∼35 Gy achieved ex-cellent survival rates for stage IEA orbital MALT lymphoma (26).…”