Yahalom Joachim, Xu Amy J, Noy Ariela, Lobaugh Stephanie, Chelius Monica, Chau Karen, Portlock Carol, Hajj Carla, Imber Brandon S, Straus David J, Moskowitz Craig H, Coleman Morton, Zelenetz Andrew D, Zhang Zhigang, Dogan Ahmet
Memorial Sloan Kettering Cancer Center, New York, NY; and.
New York-Presbyterian/Weill Cornell Medical College, New York, NY.
Blood Adv. 2021 Apr 13;5(7):1830-1836. doi: 10.1182/bloodadvances.2020003992.
Treatment options for Helicobacter pylori-independent gastric mucosa-associated lymphoid tissue (MALT) lymphoma (GML) include surgery, immunotherapy, chemotherapy, and radiation therapy (RT). The purpose of this study was to investigate the efficacy and safety of RT and routine endoscopic surveillance, hypothesizing that most patients are curable with RT alone. We queried a single institution database at a tertiary referral cancer center for patients with H pylori-independent GML treated with RT between 1991 and 2017. Response was assessed by follow-up endoscopies (EGDs) starting 10 to 12 weeks post-RT. Computed tomography scans were also part of the follow-up program, and positron emission tomography was added when clinically appropriate. We identified 178 patients (median age, 63 years; range, 25-89 years); 86% had stage I disease, 7% had stage II disease, and 7% had stage IV disease. Median RT dose was 3000 cGy over 20 fractions. Ninety-five percent of patients exhibited complete pathologic response on posttreatment EGD. Two patients experienced grade 3 toxicity, and 2 patients experienced in-field secondary malignancies. Over a median follow-up of 6.2 years, 9.6% experienced local failures, and 11.8% developed distant sites of disease. Five-year and 10-year overall survival were 94% and 79%, respectively, from last date of RT. RT is a highly effective and safe treatment for GML with excellent overall survival and very rare acute or late treatment-related toxicities. Favorable outcomes from this large retrospective sample of patients provide credible and compelling support for RT as standard of care for H pylori-independent GML.
幽门螺杆菌非依赖性胃黏膜相关淋巴组织（MALT）淋巴瘤（GML）的治疗选择包括手术、免疫疗法、化疗和放射治疗（RT）。本研究的目的是调查RT和常规内镜监测的疗效和安全性，假设大多数患者仅通过RT即可治愈。我们查询了一家三级转诊癌症中心的单一机构数据库，以获取1991年至2017年间接受RT治疗的幽门螺杆菌非依赖性GML患者。在RT后10至12周开始通过随访内镜检查（EGD）评估反应。计算机断层扫描也是随访计划的一部分，在临床适当时增加正电子发射断层扫描。我们确定了178例患者（中位年龄63岁；范围25 - 89岁）；86%为I期疾病，7%为II期疾病，7%为IV期疾病。RT的中位剂量为20次分割共3000 cGy。95%的患者在治疗后的EGD上表现出完全病理缓解。2例患者出现3级毒性，2例患者出现野内继发性恶性肿瘤。在中位随访6.2年期间，9.6%的患者出现局部复发，11.8%的患者出现远处疾病部位。从RT的最后日期起，5年和10年总生存率分别为94%和79%。RT是治疗GML的一种高效且安全的方法，总体生存率极佳，急性或晚期治疗相关毒性非常罕见。来自这一大型回顾性患者样本的良好结果为RT作为幽门螺杆菌非依赖性GML的护理标准提供了可信且有力的支持。
