UPmémoires

English

Purpose/Objective(s): Mucosa-Associated Lymphoid Tissue (MALT) lymphoma of the stomach is rare. It is referred to as a distinct pathophysiologic entity. Recent advances made significant changes in therapeutic strategies including surgery, antibiotic therapy, chemotherapy and immunotherapy. We report patient outcome of localized gastric MALT lymphoma treated with low dose radiation therapy. Treatment tolerance is discussed.

Material/Methods: From 2005 to 2019, 17 patients with gastric MALT lymphoma were treated in the department of radiation oncology, University Hospital of Poitiers. Eight patients were of stage IE (47.1%), 6 stage IIE (35.3%) and 3 stage IV (17.6%). Their median age was 62 years and an average of 62.8 years. Sex ratio of 8 men for 9 women (1:1.13) with WHO performance status of 1 in 15 cases and 0 in 2. Tumor localization was as follows: fundus 11 (64.8%) and antrum 3 (17.6%), corpus 3 (17.6%). Radiation therapy was indicated in all 17 cases (100%) because of persistence of disease infiltration on biopsy after adequate antibiotic therapy. Five of these cases had persistent visible tumors on gastroscopic evaluation. The moderate radiation dose was 30.6 Gy in 1.8 Gy fractions delivered with conformal 3 dimensional techniques.

Results: Median follow was 71 months (range: 24 to 124). Overall survival and progression free survival were 100% for both at 5 years and 94% and 100% respectively at 10.33 years. Grade I acute side effects were observed including nausea, dysphagia, dyspepsia or anorexia. Grade II toxicity was observed in 3 patients including dyspepsia in 1 case, epigastric pain in another and gastroesophageal reflux in a third case.

Conclusion: Radiation therapy of localized gastric MALT lymphoma after failure of a primary medical treatment gives good results in terms of local control and long-term survival. Toxicity profiles are acceptable though new radiation techniques may improve overall results.