Outcomes After Reduced-Dose Intensity Modulated Radiation Therapy for Gastric Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma

Abstract

Purpose/Objectives: In patients with gastric extranodal marginal zone lymphoma of mucosaassociated lymphoid tissue lymphoma (MALT lymphoma), the standard radiation therapy (RT) dose is ≥ 30 Gy. We report the outcome of patients treated with reduced 24 Gy compared with ≥ 30 Gy. Materials/Methods: We reviewed 32 patients diagnosed between 2007 and 2017 with gastric MALT lymphoma and treated with involved site radiation therapy (ISRT) using intensity modulated radiation therapy (IMRT). Response to therapy was based on post-RT endoscopic biopsy. Freedom from local treatment failure (FFTLF), freedom from treatment failure (FFTF), and overall survival (OS) outcomes were determined. Results: The median age of patients at diagnosis was 58 years. Antimicrobial therapy was administered to 11 patients pre-RT, with residual disease was documented in all 11patients. Rituximab (n=2) or Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP, n=1) was administered in 3 patients pre-RT; with biopsy proven persistent disease after therapy in all 3 cases. One patient received RT (36 Gy) and concurrent rituximab. Median RT dose was 30 Gy; 30-36 Gy in 66% (n=21) and 24 Gy in 34% (n=11). Post-RT biopsy documented CR in all patients. Failures occurred in the stomach, and duodenum at 3.6 and 4.5 years, respectively, *

Decreased heart dose with deep inspiration breath hold for the treatment of gastric lymphoma with IMRT

“…With this approach doses to organs at risk were low. This technique has been used at our institution and yields excellent local control rates [9]. It is important to recognize however that in the absence of extended fasting times and high-quality daily CT -IGRT, larger PTV margins are likely required.…”

“…A series of 3 -4 breath hold scans are acquired at time of simulation to ensure reproducibility and for internal target volume (ITV) gastric generation. Typically a 1 cm planning target volume (PTV) expansion on the DIBH ITV-stomach is utilized for planning when daily CT is performed for image guidance [9]. https://doi.org/10.1016/j.ctro.2020.05.013 2405-6308/Ó 2020 The Authors.…”

Radiotherapy for non-gastric intestinal versus gastric MALT lymphoma: a comparison of treatment outcomes

“…The results of this study, in which non-gastric MALT lymphoma was treated using a total dose of 30 Gy, are comparable or better than those of previous studies. As 25 Gy is frequently used for orbital MALT lymphoma [ 8 ] and the irradiation dose for gastric MALT lymphoma can be low [ 23 , 25 ], the irradiation dose to the duodenum and rectum may be reduced.…”

Making Every Single Gray Count: Involved Site Radiation Therapy Delineation Guidelines for Hematological Malignancies

“…We have found that radiation can improve outcomes for patients with early-stage follicular, 3 nodular lymphocytepredominant Hodgkin, 4 marginal zone, 5 low-risk NK Tcell nasal type, 6 and mantle cell lymphomas. 7 These patients can now be treated with definitive radiation therapy with no systemic therapy.…”