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Gastric lymphoma of mucosa associated lymphoid tissue (MALT) type: longterm treatment results

Abstract

Objective: In recent years, a large proportion of non-Hodgkin's lymphomas of the stomach are recognized as low grade tumors of the mucosa associated lymphoid tissue (MALT) type. Since the MALT morphological subtype has only gained acceptance as a malignant lymphoma after the establishment of the Working Formulation, there is limited information about its natural history, disease pattern, and longterm treatment outcome. This study is an analysis of these parameters in patients with primary MALT lymphoma of the stomach. Materials and Methods: Consecutive patients with primary gastric MALT lymphoma who received definitive treatment at the Massachusetts General Hospital between (4(78)) and (2(95)) were included in the study. The diagnosis was pathologically verified in all cases. Clinical staging studies included chest X-ray +/- chest CT, abdomino-pelvic CT or bipedal lymphangiogram, barium swallow, and bone marrow biopsy. Treatment strategies included combinations of partial or total gastrectomy, radiation (RT) and chemotherapy (chemo). RT was given via multifield technique, with 10-25MV photons, to doses of 36-50.4 Gy (1.1-1.8 Gy per fraction, 5 days a week). Survival analyses were performed by the Kaplan-Meier actuarial method. Results: There were twenty-two patients between the ages of 45 - 93 years, with a mean follow-up of 67 months. Ten  More>>
Publication Date:
Jul 01, 1995
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 32; Journal Issue: 971; Other Information: Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 1995
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOPSY; COMPUTERIZED TOMOGRAPHY; GASTROINTESTINAL TRACT; LYMPHOCYTES; LYMPHOMAS; RADIATION DOSES; RADIOTHERAPY; STOMACH; SURGERY; SURVIVAL TIME; SYMPTOMS; X RADIATION
OSTI ID:
20420792
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US03R2035005197
Submitting Site:
INIS
Size:
page(s) 282
Announcement Date:

Citation Formats

Fung, Claire Y, Kachnic, Lisa A, Daly, William, Younger, Jerry, Harris, Nancy L, and Graeme-Cook, Fiona. Gastric lymphoma of mucosa associated lymphoid tissue (MALT) type: longterm treatment results. United States: N. p., 1995. Web. doi:10.1016/0360-3016(95)97943-U.
Fung, Claire Y, Kachnic, Lisa A, Daly, William, Younger, Jerry, Harris, Nancy L, & Graeme-Cook, Fiona. Gastric lymphoma of mucosa associated lymphoid tissue (MALT) type: longterm treatment results. United States. doi:10.1016/0360-3016(95)97943-U.
Fung, Claire Y, Kachnic, Lisa A, Daly, William, Younger, Jerry, Harris, Nancy L, and Graeme-Cook, Fiona. 1995. "Gastric lymphoma of mucosa associated lymphoid tissue (MALT) type: longterm treatment results." United States. doi:10.1016/0360-3016(95)97943-U. https://www.osti.gov/servlets/purl/10.1016/0360-3016(95)97943-U.
@misc{etde_20420792,
title = {Gastric lymphoma of mucosa associated lymphoid tissue (MALT) type: longterm treatment results}
author = {Fung, Claire Y, Kachnic, Lisa A, Daly, William, Younger, Jerry, Harris, Nancy L, and Graeme-Cook, Fiona}
abstractNote = {Objective: In recent years, a large proportion of non-Hodgkin's lymphomas of the stomach are recognized as low grade tumors of the mucosa associated lymphoid tissue (MALT) type. Since the MALT morphological subtype has only gained acceptance as a malignant lymphoma after the establishment of the Working Formulation, there is limited information about its natural history, disease pattern, and longterm treatment outcome. This study is an analysis of these parameters in patients with primary MALT lymphoma of the stomach. Materials and Methods: Consecutive patients with primary gastric MALT lymphoma who received definitive treatment at the Massachusetts General Hospital between (4(78)) and (2(95)) were included in the study. The diagnosis was pathologically verified in all cases. Clinical staging studies included chest X-ray +/- chest CT, abdomino-pelvic CT or bipedal lymphangiogram, barium swallow, and bone marrow biopsy. Treatment strategies included combinations of partial or total gastrectomy, radiation (RT) and chemotherapy (chemo). RT was given via multifield technique, with 10-25MV photons, to doses of 36-50.4 Gy (1.1-1.8 Gy per fraction, 5 days a week). Survival analyses were performed by the Kaplan-Meier actuarial method. Results: There were twenty-two patients between the ages of 45 - 93 years, with a mean follow-up of 67 months. Ten were male and 12 female. The most frequent presenting symptoms were epigastric pain (77%), dyspepsia (65%), and melena (41%). The mean duration of symptoms was 27 months. Eighteen cases were clinical stage (cs)I, two csII, one csIII, and one csIV. The treatment approaches were: 1) csI:6 gastrectomy alone, 7 gastrectomy and RT, 1 gastrectomy and chemo, 2 RT alone, 1 chemo and RT, 1 no therapy; 2) csII: 2 gastrectomy and RT; 3) csIII: 1 gastrectomy and chemo; 4) csIV: 1 chemo and RT. Among 16 gastrectomy specimens, multifocal gastric involvement was evident in 50%. The most frequently involved sites were the body (63%) and antrum (44%). Of cases with body involvement, the lesser curvature was involved in (8(10)), and the greater curvature in(3(10)) . 14 csI patients underwent partial or total gastrectomy. Ten were pathological stage I and the remaining 4 (28%) were pathologically upgraded due to perigastric nodal or porta hepatis involvement. There was 1 relapse among the 17 csI patients who received definitive treatment, yielding a relapse-free survival rate of 92% at 7 years. The 7-year disease-specific and overall survival rates were 100% and 88% respectively. The two csII patients died of relapsed lymphoma at 2.5 and 4.8 years. The csIII patient relapsed after CHOP chemo, underwent salvage autologous bone marrow transplant, and is alive without disease 3.3 years from diagnosis. The csIV patient is relapse-free 5.8 years after chemo and gastric RT. For the entire study population, the 7-year relapse-free and overall survival rates were 73% and 76% respectively. Conclusions: In this study, the diagnosis of gastric MALT lymphoma was often preceded by a long period of symptoms. The frequent symptoms of epigastric pain and dyspepsia mimicked those of gastritis. Examination of gastrectomy specimens indicated that lymphomatous involvement was often multifocal, with the body and antrum being the most commonly involved sites. In this study group, about 90% of patients had localized (csI and II) disease. Among the csI patients who underwent a gastrectomy, 72% were pathological stage I and 28% were upstaged. For stage I patients, local treatment with gastrectomy with or without adjuvant therapy and definitive RT were effective treatment modalities, yielding excellent 7-year relapse-free and disease-specific survival rates of 92% and 100% respectively. These data indicate that in contrast to many other low grade lymphomas, MALT lymphoma of the stomach predominantly presents as localized disease which may be highly curable with local therapy only, and radiation may play a significant role in its treatment. A prospective clinical trial is about to begin to investigate the role of gastric irradiation (without gastrectomy) for localized gastric MALT lymphomas and also the role of antibiotic therapy in patients with associated Helicobacter pylori infection.}
doi = {10.1016/0360-3016(95)97943-U}
journal = {International Journal of Radiation Oncology, Biology and Physics}
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}