Dincer Neris, Ugurluer Gamze, Gungor Gorkem, Zoto Mustafayev Teuta, Atalar Banu, Ozyar Enis
Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, TUR.
Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR.
Cureus. 2022 Sep 11;14(9):e29035. doi: 10.7759/cureus.29035. eCollection 2022 Sep.
Lymphoid neoplasia derived from mucosa-associated lymphoid tissue (MALT; also abbreviated as MALToma) is most commonly seen in the stomach. Radiotherapy (RT) is indicated in early-stage disease as a standard of care. With the advent of RT techniques, large field irradiation was replaced by involved site and involved field approaches. Magnetic resonance imaging-guided online adaptive RT (MRgRT) has the advantage of better soft tissue visualization, adaptive planning before each fraction, and online tumor tracking during treatment; hence, it could be a safe and effective choice for gastric MALToma patients. Herein, we investigated the interfractional changes in target and the impact of MRgRT on daily dosimetry in a gastric MALToma case. A patient diagnosed with MALToma who failed to respond to antibacterial treatment was referred to our clinic for RT. He was found to be suitable for MRgRT. We treated the patient with MRgRT in 20 fractions to a total dose of 30 Gy. Reoptimized adaptive plans were generated before each fraction since the coverages of the original plan were inadequate in each fraction. The patient showed good compliance and tolerated the treatment well. To our knowledge, this is the first documented case of a gastric MALToma treated with MRgRT. MRgRT is safe and feasible for this patient group with improved target coverage using small planning target volume margins. Without online adaptive planning, the target coverages would be inadequate and we would risk surrounding tissues to get higher doses.
源自黏膜相关淋巴组织的淋巴瘤（MALT；也简称为MALT淋巴瘤）最常见于胃部。放射治疗（RT）是早期疾病的标准治疗手段。随着放疗技术的出现，大野照射已被累及部位和累及野照射方法所取代。磁共振成像引导的在线自适应放疗（MRgRT）具有软组织可视化效果更好、每次分割前进行自适应计划以及治疗期间在线肿瘤追踪等优势；因此，它可能是胃MALT淋巴瘤患者的一种安全有效的选择。在此，我们研究了胃MALT淋巴瘤病例中靶区的分次间变化以及MRgRT对每日剂量测定的影响。一名被诊断为MALT淋巴瘤且对抗菌治疗无反应的患者被转诊至我们诊所接受放疗。发现他适合进行MRgRT。我们用MRgRT对该患者进行了20次分割，总剂量为30 Gy。由于原始计划在每次分割中的覆盖范围不足，所以在每次分割前都生成了重新优化的自适应计划。患者依从性良好，对治疗耐受性良好。据我们所知，这是首例有记录的用MRgRT治疗的胃MALT淋巴瘤病例。MRgRT对该患者群体是安全可行的，使用较小的计划靶区边缘可提高靶区覆盖范围。如果没有在线自适应计划，靶区覆盖范围将不足，我们会有使周围组织接受更高剂量的风险。
