Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Radiation therapy for gastric mucosa-associated lymphoid tissue lymphoma: dose-volumetric analysis and its clinical implications

  • Lim, Hyeon Woo (Proton Therapy Center, Research Institute and Hospital, National Cancer Center) ;
  • Kim, Tae Hyun (Proton Therapy Center, Research Institute and Hospital, National Cancer Center) ;
  • Choi, Il Ju (Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Kim, Chan Gyoo (Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Lee, Jong Yeul (Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Cho, Soo Jeong (Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Eom, Hyeon Seok (Center for Specific Organs Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Moon, Sung Ho (Proton Therapy Center, Research Institute and Hospital, National Cancer Center) ;
  • Kim, Dae Yong (Proton Therapy Center, Research Institute and Hospital, National Cancer Center)
  • Received : 2016.07.10
  • Accepted : 2016.08.04
  • Published : 2016.09.30
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Abstract

Purpose: To assess the clinical outcomes of radiotherapy (RT) using two-dimensional (2D) and three-dimensional conformal RT (3D-CRT) for patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma to evaluate the effectiveness of involved field RT with moderate-dose and to evaluate the benefit of 3D-CRT comparing with 2D-RT. Materials and Methods: Between July 2003 and March 2015, 33 patients with stage IE and IIE gastric MALT lymphoma received RT were analyzed. Of 33 patients, 17 patients (51.5%) were Helicobacter pylori (HP) negative and 16 patients (48.5%) were HP positive but refractory to HP eradication (HPE). The 2D-RT (n = 14) and 3D-CRT (n = 19) were performed and total dose was 30.6 Gy/17 fractions. Of 11 patients who RT planning data were available, dose-volumetric parameters between 2D-RT and 3D-CRT plans was compared. Results: All patients reached complete remission (CR) eventually and median time to CR was 3 months (range, 1 to 15 months). No local relapse occurred and one patient died with second primary malignancy. Tumor response, survival, and toxicity were not significantly different between 2D-RT and 3D-CRT (p > 0.05, each). In analysis for dose-volumetric parameters, $D_{max}$ and CI for PTV were significantly lower in 3D-CRT plans than 2D-RT plans (p < 0.05, each) and $D_{mean}$ and V15 for right kidney and $D_{mean}$ for left kidney were significantly lower in 3D-CRT than 2D-RT (p < 0.05, each). Conclusion: Our data suggested that involved field RT with moderate-dose for gastric MALT lymphoma could be promising and 3D-CRT could be considered to improve the target coverage and reduce radiation dose to the both kidneys.

Keywords

References

  1. Marshall BJ, Windsor HM. The relation of Helicobacter pylori to gastric adenocarcinoma and lymphoma: pathophysiology, epidemiology, screening, clinical presentation, treatment, and prevention. Med Clin North Am 2005;89:313-44. https://doi.org/10.1016/j.mcna.2004.09.001
  2. Nakamura S, Sugiyama T, Matsumoto T, et al. Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori: a multicentre cohort follow-up study of 420 patients in Japan. Gut 2012;61:507-13. https://doi.org/10.1136/gutjnl-2011-300495
  3. Ahmad A, Govil Y, Frank BB. Gastric mucosa-associated lymphoid tissue lymphoma. Am J Gastroenterol 2003;98:975-86. https://doi.org/10.1111/j.1572-0241.2003.07424.x
  4. Stolte M, Bayerdorffer E, Morgner A, et al. Helicobacter and gastric MALT lymphoma. Gut 2002;50 Suppl 3:III19-24. https://doi.org/10.1136/gut.50.1.19
  5. Zullo A, Hassan C, Cristofari F, et al. Effects of Helicobacter pylori eradication on early stage gastric mucosa-associated lymphoid tissue lymphoma. Clin Gastroenterol Hepatol 2010;8:105-10. https://doi.org/10.1016/j.cgh.2009.07.017
  6. Zinzani PL. Thoughts on the eradication of Helicobacter pylori infection in localized gastric mucosa-associated lymphoid tissue lymphoma. Leuk Lymphoma 2006;47:2013-4. https://doi.org/10.1080/10428190600774873
  7. Koch P, del Valle F, Berdel WE, et al. Primary gastrointestinal non-Hodgkin's lymphoma: II. combined surgical and conservative or conservative management only in localized gastric lymphoma: results of the prospective German Multicenter Study GIT NHL 01/92. J Clin Oncol 2001;19:3874-83. https://doi.org/10.1200/JCO.2001.19.18.3874
  8. Willich NA, Reinartz G, Horst EJ, et al. Operative and conservative management of primary gastric lymphoma: interim results of a German multicenter study. Int J Radiat Oncol Biol Phys 2000;46:895-901. https://doi.org/10.1016/S0360-3016(99)00475-7
  9. Burgers JM, Taal BG, van Heerde P, Somers R, den Hartog Jager FC, Hart AA. Treatment results of primary stage I and II non-Hodgkin's lymphoma of the stomach. Radiother Oncol 1988;11:319-26. https://doi.org/10.1016/0167-8140(88)90203-4
  10. Kocher M, Muller RP, Ross D, Hoederath A, Sack H. Radiotherapy for treatment of localized gastrointestinal non-Hodgkin's lymphoma. Radiother Oncol 1997;42:37-41. https://doi.org/10.1016/S0167-8140(96)01832-4
  11. Vrieling C, de Jong D, Boot H, de Boer JP, Wegman F, Aleman BM. Long-term results of stomach-conserving therapy in gastric MALT lymphoma. Radiother Oncol 2008;87:405-11. https://doi.org/10.1016/j.radonc.2008.02.012
  12. Schechter NR, Portlock CS, Yahalom J. Treatment of mucosaassociated lymphoid tissue lymphoma of the stomach with radiation alone. J Clin Oncol 1998;16:1916-21. https://doi.org/10.1200/JCO.1998.16.5.1916
  13. Tsang RW, Gospodarowicz MK, Pintilie M, et al. Localized mucosa-associated lymphoid tissue lymphoma treated with radiation therapy has excellent clinical outcome. J Clin Oncol 2003;21:4157-64. https://doi.org/10.1200/JCO.2003.06.085
  14. Tomita N, Kodaira T, Tachibana H, Nakamura T, Mizoguchi N, Takada A. Favorable outcomes of radiotherapy for early-stage mucosa-associated lymphoid tissue lymphoma. Radiother Oncol 2009;90:231-5. https://doi.org/10.1016/j.radonc.2008.12.004
  15. Ruskone-Fourmestraux A, Fischbach W, Aleman BM, et al. EGILS consensus report: gastric extranodal marginal zone B-cell lymphoma of MALT. Gut 2011;60:747-58. https://doi.org/10.1136/gut.2010.224949
  16. Nam TK, Ahn JS, Choi YD, et al. The role of radiotherapy in the treatment of gastric mucosa-associated lymphoid tissue lymphoma. Cancer Res Treat 2014;46:33-40. https://doi.org/10.4143/crt.2014.46.1.33
  17. Park HC, Park W, Hahn JS, et al. Low grade MALT lymphoma of the stomach: treatment outcome with radiotherapy alone. Yonsei Med J 2002;43:601-6. https://doi.org/10.3349/ymj.2002.43.5.601
  18. Park HS, Kim YJ, Yang WI, Suh CO, Lee YC. Treatment outcome of localized Helicobacter pylori-negative low-grade gastric MALT lymphoma. World J Gastroenterol 2010;16:2158-62. https://doi.org/10.3748/wjg.v16.i17.2158
  19. Teckie S, Qi S, Lovie S, et al. Long-term outcomes and patterns of relapse of early-stage extranodal marginal zone lymphoma treated with radiation therapy with curative intent. Int J Radiat Oncol Biol Phys 2015;92:130-7. https://doi.org/10.1016/j.ijrobp.2015.01.040
  20. Della Biancia C, Hunt M, Furhang E, Wu E, Yahalom J. Radiation treatment planning techniques for lymphoma of the stomach. Int J Radiat Oncol Biol Phys 2005;62:745-51. https://doi.org/10.1016/j.ijrobp.2004.10.025
  21. Musshoff K. Clinical staging classification of non-Hodgkin's lymphomas (author's transl). Strahlentherapie 1977;153:218-21.
  22. Thieblemont C, Bastion Y, Berger F, et al. Mucosa-associated lymphoid tissue gastrointestinal and nongastrointestinal lymphoma behavior: analysis of 108 patients. J Clin Oncol 1997;15:1624-30. https://doi.org/10.1200/JCO.1997.15.4.1624
  23. Kataria T, Sharma K, Subramani V, Karrthick KP, Bisht SS. Homogeneity Index: an objective tool for assessment of conformal radiation treatments. J Med Phys 2012;37:207-13. https://doi.org/10.4103/0971-6203.103606
  24. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 1981;47:207-14. https://doi.org/10.1002/1097-0142(19810101)47:1<207::AID-CNCR2820470134>3.0.CO;2-6
  25. Wirth A, Gospodarowicz M, Aleman BM, et al. Long-term outcome for gastric marginal zone lymphoma treated with radiotherapy: a retrospective, multi-centre, International Extranodal Lymphoma Study Group study. Ann Oncol 2013;24:1344-51. https://doi.org/10.1093/annonc/mds623
  26. Park W, Chang SK, Yang WI, et al. Rationale for radiotherapy as a treatment modality in gastric mucosa-associated lymphoid tissue lymphoma. Int J Radiat Oncol Biol Phys 2004;58:1480-6. https://doi.org/10.1016/j.ijrobp.2003.09.002
  27. Isaacson PG. Gastric MALT lymphoma: from concept to cure. Ann Oncol 1999;10:637-45. https://doi.org/10.1023/A:1008396618983
  28. Kim SW, Lim DH, Ahn YC, et al. Clinical outcomes of radiation therapy for early-stage gastric mucosa-associated lymphoid tissue lymphoma. World J Gastroenterol 2013;19:6062-8. https://doi.org/10.3748/wjg.v19.i36.6062
  29. Gobbi PG, Corbella F, Valentino F, et al. Complete long-term response to radiotherapy of gastric early-stage marginal zone lymphoma resistant to both anti-Helicobacter pylori antibiotics and chemotherapy. Ann Oncol 2009;20:465-8.
  30. Ono S, Kato M, Takagi K, et al. Long-term treatment of localized gastric marginal zone B-cell mucosa associated lymphoid tissue lymphoma including incidence of metachronous gastric cancer. J Gastroenterol Hepatol 2010;25:804-9. https://doi.org/10.1111/j.1440-1746.2009.06204.x
  31. Capelle LG, de Vries AC, Looman CW, et al. Gastric MALT lymphoma: epidemiology and high adenocarcinoma risk in a nation-wide study. Eur J Cancer 2008;44:2470-6. https://doi.org/10.1016/j.ejca.2008.07.005
  32. Talamonti MS, Dawes LG, Joehl RJ, Nahrwold DL. Gastrointestinal lymphoma: a case for primary surgical resection. Arch Surg 1990;125:972-6. https://doi.org/10.1001/archsurg.1990.01410200030003
  33. Mittal B, Wasserman TH, Griffith RC. Non-Hodgkin's lymphoma of the stomach. Am J Gastroenterol 1983;78:780-7.
  34. Eng T, Ha CS. Image-guided radiation therapy in lymphoma management. Radiat Oncol J 2015;33:161-71. https://doi.org/10.3857/roj.2015.33.3.161

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