MALT lymphoma
Long-term results of stomach-conserving therapy in gastric MALT lymphoma

https://doi.org/10.1016/j.radonc.2008.02.012Get rights and content

Abstract

Purpose

To evaluate long-term results of stomach-conserving therapy and to assess the value of histological probable minimal residual disease (pMRD) in predicting outcome in patients with gastric MALT lymphoma.

Materials and methods

We studied 115 patients with stage I–II2 gastric MALT lymphoma treated between 1975 and 2002. Initially, first-line treatment consisted of radiotherapy only. Since 1994 most patients were primarily treated with Helicobacter pylori eradication; radiotherapy was used in case of eradication failure. To assess the value of pMRD, first follow-up biopsy samples classified as compete remission (CR) according to classical clinico-pathological criteria and biopsy samples 1 year after assessment of histological CR were reviewed; results were related to outcome.

Results

Following radiotherapy only (n = 56) 96% achieved a clinical CR; 10-year cancer-specific survival rate was 94%. Following H. pylori eradication only (n = 35) CR-rate was 43% and after additional treatment 89%; 5-year cause-specific survival was 93%. There was no difference in relapse rate following initial histological CR or pMRD.

Conclusions

Patients with early stage gastric MALT lymphoma have a favorable long-term outcome following conservative treatment. Outcome after H. pylori eradication followed by delayed radiotherapy on indication was excellent. In our series pMRD was not associated with increased risk of recurrence.

Section snippets

Materials and methods

Between 1975 and 2002 115 patients with gastric MALT lymphoma stage I and II were treated in the Netherlands Cancer Institute.

Patients were staged according to the Ann Arbor classification system, modified by Musshoff [22] and according to the Paris staging system for primary gastrointestinal lymphomas [23] in 33 patients. Staging procedures included patients’ history and physical examination (including inspection of Waldeyer’s ring), complete blood count, erythrocyte sedimentation rate, serum

Clinical characteristics of overall population

The majority of patients presented with stage I, H. pylori positive disease. Detailed information on the clinical characteristics of all patients is given in Table 1.

Treatment and response

Fig. 1 summarizes the treatment of all evaluated patients (n = 115). In order to analyze the effects of radio- and/or chemotherapy without influence of H. pylori eradication, patients who have received H. pylori eradication at any moment in time were described separately. Before the introduction of H. pylori eradication, patients

Discussion

This paper describes a large single institution series of patients with primary gastric MALT lymphoma treated with stomach-conserving therapy. It reflects the changes in therapeutic approach over the last decades. From the 1970s to the early 1990s the majority of patients with stage I gastric MALT lymphoma were treated with radiotherapy alone. This resulted in a CR-rate of 96%, a low recurrence rate and an excellent long-term (cancer-specific) survival. From 1994 onwards, most of these patients

References (33)

  • W. Park et al.

    Rationale for radiotherapy as a treatment modality in gastric mucosa-associated lymphoid tissue lymphoma

    Int J Radiat Oncol Biol Phys

    (2004)
  • M. Verheij et al.

    Evidence for a renovascular component in hypertensive patients with late radiation nephropathy

    Int J Radiat Oncol Biol Phys

    (1994)
  • E.P. Jansen et al.

    Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer

    Int J Radiat Oncol Biol Phys

    (2007)
  • W. Fischbach et al.

    Minimal residual low-grade gastric MALT-type lymphoma after eradication of Helicobacter pylori

    Lancet

    (2002)
  • N.L. Harris et al.

    World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting – Airlie House, Virginia, November 1997

    J. Clin. Oncol.

    (1999)
  • B.G. Taal et al.

    Primary non-Hodgkin lymphoma of the stomach: endoscopic pattern and prognosis in low versus high grade malignancy in relation to the MALT concept

    Gut

    (1996)
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