Radiation Therapy Outcome and Clinical Features of Duodenal-Type Follicular Lymphoma

Lee, Hansang; Oh, Dongryul; Yang, Kyung Mi; Ko, Young Hyeh; Ahn, Yong Chan; Kim, Won Seog; Kim, Seok Jin

doi:10.4143/crt.2018.190

“…A recent retrospective study analyzed the efficacy of the radiotherapy field reduction in low-grade follicular and MALT lymphoma, and reported that there was no difference in local control and survival between the existing IFRT and involved-site radiotherapy [18]. Further research is underway to reduce radiation fields and doses in low-grade B-cell lymphoma [19,20]. However, the clinical factors that affect the response time and oncologic outcome of delayed response to radiation therapy have not yet been evaluated in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…In the UK, a 3-phase multicenter prospective study was conducted comparing the local control rates of 40 Gy and 24 Gy in indolent lymphoma, and the local control rates were 93% and 92%, respectively, which did not differ between the two groups [19]. In addition, Lee et al reported 95% complete remission of the duodenal follicular lymphoma after 24 Gy irradiation [20]. Therefore, 24 Gy for duodenal follicular lymphoma and 30.6 Gy for gastric MALT lymphoma were prescribed in our instution, and there was no difference in local control between 24 Gy and 30.6 Gy in this study.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the response time to involved-field radiotherapy in primary gastrointestinal low-grade B-cell lymphoma

Choi

¹

,

Lee

²

,

Jung

³

et al. 2020

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Background: Early-stage primary gastrointestinal (GI) low-grade B-cell lymphoma shows good therapeutic response to primary radiotherapy. However, there is no clear guideline for the evaluation of response to radiation therapy currently. The aim of this study was to analyze the relationship between the best response time and the clinical course after radiotherapy. Methods: Patients who underwent radiotherapy for treatment of primary GI low-grade B-cell lymphoma from September 2007 to December 2018 at Seoul St. Mary's Hospital were included. Early responders were defined by best response within 6 months after radiotherapy, and delayed responders after 6 months. Clinical and pathological factors associated with delayed response and survival analyses were performed to investigate the recurrence and survival during follow-up. Results: A total of 43 patients were evaluated and the number of gastric mucosa-associated lymphoid tissue and duodenal follicular lymphoma was 36 and 7, respectively. All of 43 patients showed complete remission to radiotherapy and the best response time after radiotherapy was a median of 3 months. There were 8 delayed responders with a median duration of 8.9 months. Early and delayed responders were characterized by a significant difference in depth of invasion beyond the mucosal layer. Conclusions: Delayed responders did not show differences in oncological outcomes compared with early responders. They were allowed to watch and wait for an additional 6 to 12 months without further treatment. Background Gastrointestinal (GI) lymphoma is the most common extranodal lymphomas and primary GI lymphoma is usually diagnosed in the stomach, duodenum, esophagus and rectum [1, 2]. More than 90% of all GI lymphomas are of B-cell lineage and treatment modalities differ according to the pathological subtype [3]. Systemic involvement of Bcell lymphomas in early stage with low-grade pathology such as mucosa-associated lymphoid tissue (MALT) or follicular lymphoma is rare and it can be cured by local radiotherapy or observed without treatment. Factors known to cause primary GI lymphoma include bacterial infections such as H.pylori and C.jejuni, preexisting intestinal diseases, and immunosuppression [4]. In the case of gastric lymphoma infected with H.pylori, H.pylori eradication (HPE) consisted of proton pump inhibitors, amoxicillin, and clarithromycin is the primary treatment resulting in an efficacy of over 80% [5, 6]. Involved-field radiotherapy (IFRT) is indicated for patients with H.pylori-positive lymphoma refractory to

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“…A recent retrospective study analyzed the e cacy of the radiotherapy eld reduction in low-grade follicular and MALT lymphoma, and reported that there was no difference in local control and survival between the existing IFRT and involvedsite radiotherapy [18]. Further research is underway to reduce radiation elds and doses in low-grade Bcell lymphoma [19,20]. However, the clinical factors that affect the response time and oncologic outcome of delayed response to radiation therapy have not yet been evaluated in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…In the UK, a 3-phase multicenter prospective study was conducted comparing the local control rates of 40 Gy and 24 Gy in indolent lymphoma, and the local control rates were 93% and 92%, which did not differ between the two groups [19]. In addition, Lee et al reported 95% complete remission of the duodenal follicular lymphoma after 24 Gy irradiation [20]. Therefore, 24 Gy for duodenal follicular lymphoma and 30.6 Gy for gastric MALT lymphoma were prescribed in our instution, and there was no difference in local control between 24 Gy and 30.6 Gy in this study.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Response Time to Involved-Field Radiotherapy in Primary Gastrointestinal Low-Grade B-Cell Lymphoma

Choi¹,

Lee

²

,

Jung

³

et al. 2020

Preprint

0

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Background: Early-stage primary gastrointestinal (GI) low-grade B-cell lymphoma shows good therapeutic response to primary radiotherapy. However, there is no clear guideline for the evaluation of response to radiation therapy currently. The aim of this study was to analyze the relationship between the best response time and the clinical course after radiotherapy.Methods: Patients who underwent radiotherapy for treatment of primary GI low-grade B-cell lymphoma from September 2007 to December 2018 at Seoul St. Mary's Hospital were included. Early responders were defined by best response within 6 months after radiotherapy, and delayed responders after 6 months. Clinical and pathological factors associated with delayed response and survival analyses were performed to investigate the recurrence and survival during follow-up.Results: A total of 43 patients were evaluated and the number of gastric mucosa-associated lymphoid tissue and duodenal follicular lymphoma was 36 and 7, respectively. All of 43 patients showed complete remission to radiotherapy and the best response time after radiotherapy was a median of 3 months. There were 8 delayed responders with a median duration of 8.9 months. Early and delayed responders were characterized by a significant difference in depth of invasion beyond the mucosal layer.Conclusions: Delayed responders did not show differences in oncological outcomes compared with early responders. They were allowed to watch and wait for an additional 6 to 12 months without further treatment.

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“…In another report, using only radiotherapy as treatment, Lee et al () retrospectively studied 20 patients between 2008 and 2017. Almost all were stage 1 and had low‐grade disease.…”

Section: Treatmentmentioning

confidence: 99%

What do we know about duodenal‐type follicular lymphoma? From pathological definition to treatment options

Duffles

¹

,

Collins

²

,

Rocha

³

2019

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Summary Duodenal‐type follicular lymphoma (DFL) is a newly recognised variant of follicular lymphoma (FL), although little is known about its biology and clinical evolution. In general, patients tend to have mild symptoms and do not require therapy, comparable with other forms of low‐tumour burden asymptomatic FL. Specific pathological features, such as a dendritic cell meshwork, low expression of CD10 and upregulation of activation‐induced cytidine deaminase can help the diagnosis. The molecular landscape of DFL is similar to the classical nodal presentation of FL, although studies using gene expression profiling demonstrate a close relation with MALT lymphomas. Markers associated with inflammation have suggested that the microenvironment plays a likely role in the pathogenesis of DFL and its low progression rate. Clinical series published vary between 20–63 patients with an estimated overall survival between 92–100% and a median follow‐up ranging between 20 and 107 months. Treatment options include a watch and wait strategy, rituximab monotherapy and radiotherapy. In this review, we summarise current pathological data and treatment studies in DFL.

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Radiation Therapy Outcome and Clinical Features of Duodenal-Type Follicular Lymphoma

Abstract: Taken together, radiation therapy alone could be effective in controlling duodenal lesion. A further study with longer follow-up duration is warranted to confirm our findings.

Cited by 14 publications

References 18 publications

Analysis of the response time to involved-field radiotherapy in primary gastrointestinal low-grade B-cell lymphoma

Analysis of the response time to involved-field radiotherapy in primary gastrointestinal low-grade B-cell lymphoma

Analysis of the Response Time to Involved-Field Radiotherapy in Primary Gastrointestinal Low-Grade B-Cell Lymphoma

What do we know about duodenal‐type follicular lymphoma? From pathological definition to treatment options

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