Sequential H. pylori eradication and radiation therapy with reduced dose compared to standard dose for gastric MALT lymphoma stages IE &amp; II1E: a prospective randomized trial

Schmelz, Renate; Miehlke, Stephan; Thiede, Christian; Brueckner, Stefan; Dawel, M.; Kühn, Matthias; Ruskoné-Formestraux, A; Stolte, Manfred; Jentsch, Christina; Hampe, Jochen; Morgner, Andrea

doi:10.1007/s00535-018-1517-4

Cited by 25 publications

(21 citation statements)

References 27 publications

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“…The largest cohort, reported by Yahalom et al, comprised 178 H. pylori -independent gastric MALT lymphoma patients, 95% of whom exhibited a complete pathological response to RT (median dose 30 Gy), with rare acute or late toxicity [ 91 ]. Schmelz et al revealed that a reduced RT dose of 25.2 Gy was as effective as the standard RT of 36 Gy in localized gastric MALT lymphoma [ 92 ]. The German Study Group on Gastrointestinal Lymphoma (DSGL) reported that stage-adopted reduction from extended field RT (EFRT) to involved field RT (IFRT) led to a better outcome and reduction of adverse effects in gastric MALT lymphoma [ 93 ].…”

Section: Treatment and Clinical Responsementioning

confidence: 99%

Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma in the Gastrointestinal Tract in the Modern Era

Ishikawa

Nakamura

Satou

et al. 2022

Cancers

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Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) typically arises from sites such as the stomach, where there is no organized lymphoid tissue. Close associations between Helicobacter pylori and gastric MALT lymphoma or Campylobacter jejuni and immunoproliferative small intestinal disease (IPSID) have been established. A subset of tumors is associated with chromosomal rearrangement and/or genetic alterations. This disease often presents as localized disease, requiring diverse treatment approaches, from antibiotic therapy to radiotherapy and immunochemotherapy. Eradication therapy for H. pylori effectively cures gastric MALT lymphoma in most patients. However, treatment strategies for H. pylori-negative gastric MALT lymphoma are still challenging. In addition, the effectiveness of antibiotic therapy has been controversial in intestinal MALT lymphoma, except for IPSID. Endoscopic treatment has been noted to usually achieve complete remission in endoscopically resectable colorectal MALT lymphoma with localized disease. MALT lymphoma has been excluded from post-transplant lymphoproliferative disorders with the exception of Epstein–Barr virus (EBV)-positive marginal zone lymphoma (MZL). We also describe the expanding spectrum of EBV-negative MZL and a close association of the disease with the gastrointestinal tract.

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Section: Treatment and Clinical Responsementioning

confidence: 99%

Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma in the Gastrointestinal Tract in the Modern Era

Ishikawa

Nakamura

Satou

et al. 2022

Cancers

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“…A recently reported randomized trial (HELYX II) evaluated the efficacy of salvage RT for patients that harbored persistent lymphoma after H. pylori eradication or for those who presented with H. pylori negative disease (25). Twenty nine patients with low grade gMALT lymphoma stages IE and II1E were randomized to receive RT to the stomach to a dose of 25.2 or 36 Gy (both in 1.8 Gy fractions).…”

Section: Doses Of 30-45mentioning

confidence: 99%

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

Pinnix

Gunther

Milgrom

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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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, *

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“…Moreover, the CR at a median time of 1.85 months was 100%. 26 Similarly, Pinnix et al recently reported similar outcomes between gMALT lymphoma patients treated with 24 Gy (n = 11) and 30 Gy. 21 The 2-years FFTF and OS were 100% and 97%, respectively, and the CR at a median time of 3.5 months was 94%.…”

Section: Discussionmentioning

confidence: 66%

Comparable Efficacy of Reduced Dose Radiation Therapy for the Treatment of Early Stage Gastric Extranodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue

Saifi

Lester

Rule

et al. 2021

Advances in Radiation Oncology

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This study compares reduced (<27 Gy) to standard dose (≥30 Gy) radiation therapy (RT) in the treatment of gastric extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (gMALT lymphoma). Methods and Materials: Forty-two patients with stage I or II disease were retrospectively reviewed. Response to RT was assessed with endoscopy after RT. Complete response rate (CR), freedom from treatment failure, and overall survival (OS) were calculated. Results: All patients were stage I (n = 40) or II (n = 2). All patients had residual biopsy proven gMALT lymphoma before RT. Twenty-six patients (61.9%) were treated with standard dose RT, 30 to 36 Gy, and 16 (38.1%) with the reduced dose RT, 23.5 to 27 Gy. The median follow-up was 29.5 months (range, 6-85). Thirty-six patients (86%) achieved complete response (CR), and 6 patients (14%) achieved partial response (PR). The complete response rate (CR) at the first endoscopic assessment, median time of 3 months, was 81% (95% confidence interval, 0.61%-0.93%) for standard RT, and 94% (confidence interval, 0.69%-0.99%) for reduced RT. Among CR patients, one patient had locally relapsed disease at 50 months. The 1-year overall survival (OS) was 100% in both groups. The 1-year freedom from treatment failure (FFTF) was 100% in the reduced RT group and 92% in the standard RT group. The 2-year FFTF and OS of the whole cohort were 92% and 96%, respectively. There was no significant difference in the OS, FFTF, and CR between the 2 treatment groups (P = .38, P = .18, and P = .267, respectively). For toxicity, the mean liver dose and the mean V20 heart dose were significantly lower in the reduced RT group (P <.001 and P = .001, respectively). However, incidence and severity of reported toxicities were similar between the 2 groups.

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Sequential H. pylori eradication and radiation therapy with reduced dose compared to standard dose for gastric MALT lymphoma stages IE & II1E: a prospective randomized trial

Cited by 25 publications

References 27 publications

Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma in the Gastrointestinal Tract in the Modern Era

Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma in the Gastrointestinal Tract in the Modern Era

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

Comparable Efficacy of Reduced Dose Radiation Therapy for the Treatment of Early Stage Gastric Extranodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue

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