Jeon Seung Hyuck, Chang Ji Hyun, Kim Il Han, Yoon Hong In, Eom Keun-Yong
Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Int J Radiat Oncol Biol Phys. 2025 Mar 15;121(4):1000-1005. doi: 10.1016/j.ijrobp.2024.10.020. Epub 2024 Oct 23.
Definitive radiation therapy (RT) of 30 Gy or higher is commonly recommended to treat Helicobacter pylori-independent gastric mucosa-associated lymphoid tissue (MALT) lymphoma with an excellent disease control rate. However, the efficacy of reduced-dose RT has not yet been evaluated in a prospective cohort study. This multi-institutional study aimed to determine the role of reduced-dose RT in the treatment of stage IE gastric MALT lymphoma.
Between March 2017 and June 2022, 62 patients with histologically confirmed stage IE gastric MALT lymphoma without evidence of H pylori infection were enrolled. The patients were treated with reduced-dose RT at a total dose of 24 to 25.5 Gy to the entire stomach. The response to therapy was evaluated by endoscopy with a biopsy of suspicious lesions if necessary. The primary endpoints were 6-month complete remission (CR) and local failure-free survival.
Among 62 patients, 32 (51.6%) were previously treated for H pylori eradication. Radiation therapy was delivered using 3D-conformal (n = 20, 32.3%) or intensity modulated radiation therapy (n = 42, 67.7%). The median follow-up duration was 34.5 months (range, 9.6-68.8 months). The 6-month CR rate was 96.7%. The 5-year local failure-free survival and progression-free survival rates were 92.0% and 90.4%, respectively. None of the patients experienced grade 3 or worse acute toxicities, and grade 2 acute toxicities were reported in 17 patients (27.4%).
Reduced-dose RT exhibited excellent response rates in stage IE gastric MALT lymphoma, comparable to historical controls of standard-dose (≥30 Gy) radiation therapy, with a minimal toxicity profile. Current prospective evidence strongly supports the use of definitive radiation therapy (24-25.5 Gy) for the treatment of H pylori-independent stage IE gastric MALT lymphoma.
通常推荐采用30 Gy或更高剂量的根治性放射治疗（RT）来治疗幽门螺杆菌非依赖性胃黏膜相关淋巴组织（MALT）淋巴瘤，其疾病控制率良好。然而，前瞻性队列研究尚未评估低剂量RT的疗效。这项多机构研究旨在确定低剂量RT在治疗ⅠE期胃MALT淋巴瘤中的作用。
2017年3月至2022年6月期间，纳入62例经组织学确诊为ⅠE期胃MALT淋巴瘤且无幽门螺杆菌感染证据的患者。患者接受全胃24至25.5 Gy的低剂量RT治疗。必要时通过内镜检查及对可疑病变进行活检来评估治疗反应。主要终点为6个月完全缓解（CR）和局部无失败生存。
62例患者中，32例（51.6%）曾接受过幽门螺杆菌根除治疗。采用三维适形放疗（n = 20，32.3%）或调强放疗（n = 42,67.7%）进行放射治疗。中位随访时间为34.5个月（范围9.6 - 68.8个月）。6个月CR率为96.7%。5年局部无失败生存率和无进展生存率分别为92.0%和90.4%。没有患者出现3级或更严重的急性毒性反应，17例患者（27.4%）报告有2级急性毒性反应。
低剂量RT在ⅠE期胃MALT淋巴瘤中显示出优异的反应率与标准剂量（≥30 Gy）放射治疗的历史对照相当，且毒性极小。当前的前瞻性证据有力地支持采用根治性放射治疗（24 - 25.5 Gy）来治疗幽门螺杆菌非依赖性ⅠE期胃MALT淋巴瘤。
