The Role of Radiotherapy in the Treatment of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma
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PurposeTo assess radiotherapy for patients with early stage gastric mucosa-associatedlymphoid tissue (MALT) lymphoma with respect to survival, treatment response, andcomplications. Materials and MethodsEnrolled into this study were 48 patients diagnosed with gastric MALT lymphoma fromJanuary 2000 to September 2012. Forty-one patients had low grade and seven hadmixed component with high grade. Helicobacter pylori eradication was performed in33 patients. Thirty-four patients received radiotherapy alone. Ten patients receivedchemotherapy before radiotherapy, and three patients underwent surgery followedby chemotherapy and radiotherapy. One patient received surgery followed by radiotherapy. All patients received radiotherapy of median dose of 30.6 Gy. ResultsThe duration of follow-up ranged from 6 to 158 months (median, 48 months). Five-year overall survival and cause-specific survival rates were 90.3% and 100%. Allpatients treated with radiotherapy alone achieved pathologic complete remission(pCR) in 31 of the low-grade and in three of the mixed-grade patients. All patientstreated with chemotherapy and/or surgery prior to radiotherapy achieved pCR exceptone patient who received chemotherapy before radiotherapy. During the follow-upperiod, three patients developed diffuse large B-cell lymphoma in the stomach, andone developed gastric adenocarcinoma after radiotherapy. No grade 3 or higher acuteor late complications developed. One patient, who initially exhibited gastroptosis,developed mild atrophy of left kidney. ConclusionThese findings indicate that a modest dose of radiotherapy alone can achieve a highcure rate for low-grade and even mixed-grade gastric MALT lymphoma without serioustoxicity. Patients should be carefully observed after radiotherapy to screen forsecondary malignancies.
Abstract
PurposeTo assess radiotherapy for patients with early stage gastric mucosa-associatedlymphoid tissue (MALT) lymphoma with respect to survival, treatment response, andcomplications. Materials and MethodsEnrolled into this study were 48 patients diagnosed with gastric MALT lymphoma fromJanuary 2000 to September 2012. Forty-one patients had low grade and seven hadmixed component with high grade. Helicobacter pylori eradication was performed in33 patients. Thirty-four patients received radiotherapy alone. Ten patients receivedchemotherapy before radiotherapy, and three patients underwent surgery followedby chemotherapy and radiotherapy. One patient received surgery followed by radiotherapy. All patients received radiotherapy of median dose of 30.6 Gy. ResultsThe duration of follow-up ranged from 6 to 158 months (median, 48 months). Five-year overall survival and cause-specific survival rates were 90.3% and 100%. Allpatients treated with radiotherapy alone achieved pathologic complete remission(pCR) in 31 of the low-grade and in three of the mixed-grade patients. All patientstreated with chemotherapy and/or surgery prior to radiotherapy achieved pCR exceptone patient who received chemotherapy before radiotherapy. During the follow-upperiod, three patients developed diffuse large B-cell lymphoma in the stomach, andone developed gastric adenocarcinoma after radiotherapy. No grade 3 or higher acuteor late complications developed. One patient, who initially exhibited gastroptosis,developed mild atrophy of left kidney. ConclusionThese findings indicate that a modest dose of radiotherapy alone can achieve a highcure rate for low-grade and even mixed-grade gastric MALT lymphoma without serioustoxicity. Patients should be carefully observed after radiotherapy to screen forsecondary malignancies.
참고문헌 (25)
- Hyeon Jin Park, "Statistics of hematologic malignancies in Korea: incidence, prevalence and survival rates from 1999 to 2008", Blood Research, 47(1), pp.28~38 (2012), 대한혈액학회
- 김진만, "WHO Classification of Malignant Lymphomas in Korea: Report of the Third Nationwide Study", Journal of Pathology and Translational Medicine, 45(3), pp.254~260 (2011), 대한병리학회
- JeeSookHahn, "Eleven-Year Experience of Low Grade Lymphoma in Korea (Based on REAL Classification)", Yonsei Medical Journal, 44(5), pp.757~770 (2003), 연세대학교의과대학
- Marshall BJ, "The relation of Helicobacter pylori to gastric adenocarcinoma and lymphoma: pathophysiology, epidemiology, screening, clinical presentation, treatment, and prevention", Med Clin North Am, 89, pp.313~344 (2005)
- Nakamura S, "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, 61, pp.507~513 (2012)
- Ahmad A, "Gastric mucosa-associated lymphoid tissue lymphoma", Am J Gastroenterol, 98, pp.975~986 (2003)
- Zullo A, "Effects of Helicobacter pylori eradication on early stage gastric mucosa-associated lymphoid tissue lymphoma", Clin Gastroenterol Hepatol, 8, pp.105~110 (2010)
- HeeChulPark, "Low Grade MALT Lymphoma of the Stomach: Treatment Outcome with Radiotherapy Alone", Yonsei Medical Journal, 43(5), pp.601~606 (2002), 연세대학교의과대학
- Schechter NR, "Treatment of mucosaassociated lymphoid tissue lymphoma of the stomach with radiation alone", J Clin Oncol, 16, pp.1916~1921 (1998)
- Vrieling C, "Long-term results of stomach-conserving therapy in gastric MALT lymphoma", Radiother Oncol, 87, pp.405~411 (2008)
- Okada H, "A prospective analysis of efficacy and longterm outcome of radiation therapy for gastric mucosa-associated lymphoid tissue lymphoma", Digestion, 86, pp.179~186 (2012)
- Yoshino T, "Gastric low-grade mucosa-associated lymphoid tissue lymphomas : their histogenesis and high-grade transformation", Pathol Int, 48, pp.323~331 (1998)
- Du M, "The accumulation of p53 abnormalities is associated with progression of mucosaassociated lymphoid tissue lymphoma", Blood, 86, pp.4587~4593 (1995)
- Omonishi K, "bcl-6 protein is identified in high-grade but not low-grade mucosa-associated lymphoid tissue lymphomas of the stomach", Mod Pathol, 11, pp.181~185 (1998)
- Sagaert X, "Forkhead box protein P1 expression in mucosa-associated lymphoid tissue lymphomas predicts poor prognosis and transformation to diffuse large B-cell lymphoma", J Clin Oncol, 24, pp.2490~2497 (2006)
- Nguyen LT, "Helicobacter pylori virulence and the diversity of gastric cancer in Asia", J Med Microbiol, 57(Pt 12), pp.1445~1453 (2008)
- "An international association between Helicobacter pylori infection and gastric cancer", Lancet, 341, pp.1359~1362 (1993), The EUROGAST Study Group
- Hasegawa N, "Early-stage gastric adenocarcinoma : revealed after anti-Helicobacter pylori therapy of MALT lymphoma", Gastrointest Endosc, 53, pp.495~ (2001)
- 서동범, "위 점막연관림프조직 림프종 관해 후 발생한 조기 위암 1예", 대한소화기학회지, 49(4), pp.245~250 (2007), 대한소화기학회
- Zucca E, "High incidence of other neoplasms in patients with low-grade gastric MALT lymphoma", Ann Oncol, 6, pp.726~728 (1995)
- Montalban C, "Other cancers in patients with gastric MALT lymphoma", Leuk Lymphoma, 33, pp.161~168 (1999)
- Armitage JO, "Treatment-related myelodysplasia and acute leukemia in non-Hodgkin's lymphoma patients", J Clin Oncol, 21, pp.897~906 (2003)
- Harris NL, "The World Health Organization classification of hematological malignancies report of the Clinical Advisory Committee Meeting, Airlie House, Virginia, November 1997", Mod Pathol, 13, pp.193~207 (2000)
- Chen LT, "Long-term results of anti-Helicobacter pylori therapy in earlystage gastric high-grade transformed MALT lymphoma", J Natl Cancer Inst, 97, pp.1345~1353 (2005)
- "NCCN clinical practice guidelines on oncology: Non-Hodgkin's Lymphomas, version 3" (2012)[URL]