Background
Retrospective single-institution series from Memorial Sloan Kettering Cancer Center (MSKCC). 17 patients with H. pylori-negative or antibiotic-refractory gastric MALT lymphoma treated with involved-field radiotherapy. Established RT as a curative-intent local treatment for gastric MALT lymphoma not responding to or ineligible for H. pylori eradication.
Interventions and follow up
Arm A: Involved-field radiotherapy 30 Gy to stomach and perigastric nodes (n=17)
Arm B: N/A (retrospective single-arm series)
Primary endpoint: Complete response rate and event-free survival
mFollow up: Not specified (short series)
Arm B: N/A (retrospective single-arm series)
Primary endpoint: Complete response rate and event-free survival
mFollow up: Not specified (short series)
Results
CR rate: 100% (17/17)
5-yr EFS: ~100% in original series (all patients remained in CR)
5-yr EFS: ~100% in original series (all patients remained in CR)
Adverse events
Main adverse events: Grade 1–2 nausea and gastritis common during RT. No late grade ≥3 GI toxicity. No treatment-related deaths.
Conclusions
Involved-field radiotherapy achieves excellent local control and durable complete remission in H. pylori-negative or treatment-refractory gastric MALT lymphoma. RT to 30 Gy represents a curative-intent option with minimal toxicity in this small retrospective series.
Key Limitations
Key Limitations: Very small series (n=17) with limited follow-up. Single-institution retrospective design with selection bias. Pre-rituximab era (1998). Current standard RT dose for gastric MALT has been refined to 24–25.2 Gy with reduced toxicity. Long-term risk of secondary cancers from gastric RT not assessed.
Clinical Context
The MSKCC series established RT as the standard for H. pylori-negative or refractory gastric MALT lymphoma. Current NCCN and ILROG guidelines recommend 24–30 Gy ISRT for localized gastric MALT after H. pylori eradication failure. RT achieves high cure rates with ~95% local control.
References