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Dincer N, Ugurluer G, Gungor G, Zoto Mustafayev T, Atalar B, Ozyar E. Magnetic Resonance Imaging-Guided Radiation Therapy for Early-Stage Gastric Mucosa-Associated Lymphoid Tissue Lymphoma. Cureus 2022; 14:e29035. [PMID: 36249646 PMCID: PMC9550217 DOI: 10.7759/cureus.29035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
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Rolf D, Reinartz G, Rehn S, Kittel C, Eich HT. Development of Organ-Preserving Radiation Therapy in Gastric Marginal Zone Lymphoma. Cancers (Basel) 2022; 14:cancers14040873. [PMID: 35205623 PMCID: PMC8869852 DOI: 10.3390/cancers14040873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Gastric marginal zone lymphoma of the stomach is a rare cancer type primarily treated with oral proton pump inhibitors. If the disease does not respond to this, radiation is the treatment of choice. This review presents the development of radiation therapy over the last decades. Earlier, the stomach was surgically removed and irradiation was performed using large-field techniques and high doses of radiation. Currently, the standard treatment is the use of small-volume radiation therapy (with few side effects) with the preservation of the stomach, which provides excellent outcomes. In addition, this paper provides an outlook on current studies and possible future developments. Abstract Gastric marginal zone lymphoma (gMZL) of mucosa-associated lymphoid tissue (MALT) may persist even after H. pylori eradication, or it can be primarily Helicobacter pylori (H. pylori) independent. For patients without the successful eradication of lymphoma, or with progressive disease, treatment options have historically included partial or total gastrectomy. Presently, in these instances, curative radiation therapy (RT) is the current standard of care. This review emphasizes the historically changing role of radiation therapy in gMZL, progressing from large-volume RT without surgery, to localized RT, on its own, as a curative organ-preserving treatment. This overview shows the substantial progress in radiation therapy during the recent two to three decades, from high-dose, large-field techniques to low-dose, localized target volumes based on advanced imaging, three-dimensional treatment planning, and advanced treatment delivery techniques. RT has evolved from very large extended field techniques (EF) with prophylactic treatment of the whole abdomen and the supradiaphragmatic lymph nodes, applying doses between 30 and 50 Gy, to involved-field RT (IF), to the current internationally recommended involved site radiation therapy (ISRT) with a radiation dose of 24–30 Gy in gMZL. Stage-adapted RT is a highly effective and safe treatment with excellent overall survival rates and very rare acute or late treatment-related toxicities, as shown not only in retrospective studies, but also in large prospective multicenter studies, such as those conducted by the German Study Group on Gastrointestinal Lymphoma (DSGL). Further de-escalation of the radiation treatments with low-dose 20 Gy, as well as ultra-low-dose 4 Gy radiation therapy, is under investigation within ongoing prospective clinical trials of the International Lymphoma Radiation Oncology Group (ILROG) and of the German Lymphoma Alliance (GLA).
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Lim HW, Kim TH, Choi IJ, Kim CG, Lee JY, Cho SJ, Eom HS, Moon SH, Kim DY. Radiation therapy for gastric mucosa-associated lymphoid tissue lymphoma: dose-volumetric analysis and its clinical implications. Radiat Oncol J 2016; 34:193-201. [PMID: 27730803 PMCID: PMC5066445 DOI: 10.3857/roj.2016.01865] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 12/29/2022] Open
Abstract
Purpose To assess the clinical outcomes of radiotherapy (RT) using two-dimensional (2D) and three-dimensional conformal RT (3D-CRT) for patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma to evaluate the effectiveness of involved field RT with moderate-dose and to evaluate the benefit of 3D-CRT comparing with 2D-RT. Materials and Methods Between July 2003 and March 2015, 33 patients with stage IE and IIE gastric MALT lymphoma received RT were analyzed. Of 33 patients, 17 patients (51.5%) were Helicobacter pylori (HP) negative and 16 patients (48.5%) were HP positive but refractory to HP eradication (HPE). The 2D-RT (n = 14) and 3D-CRT (n = 19) were performed and total dose was 30.6 Gy/17 fractions. Of 11 patients who RT planning data were available, dose-volumetric parameters between 2D-RT and 3D-CRT plans was compared. Results All patients reached complete remission (CR) eventually and median time to CR was 3 months (range, 1 to 15 months). No local relapse occurred and one patient died with second primary malignancy. Tumor response, survival, and toxicity were not significantly different between 2D-RT and 3D-CRT (p > 0.05, each). In analysis for dose-volumetric parameters, Dmax and CI for PTV were significantly lower in 3D-CRT plans than 2D-RT plans (p < 0.05, each) and Dmean and V15 for right kidney and Dmean for left kidney were significantly lower in 3D-CRT than 2D-RT (p < 0.05, each). Conclusion Our data suggested that involved field RT with moderate-dose for gastric MALT lymphoma could be promising and 3D-CRT could be considered to improve the target coverage and reduce radiation dose to the both kidneys.
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Affiliation(s)
- Hyeon Woo Lim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Tae Hyun Kim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Soo Jeong Cho
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyeon Seok Eom
- Center for Specific Organs Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Ho Moon
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae Yong Kim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Thein AW, Myint AA, Khaing SH, Shinde SV, Maw M. Chemotherapy versus surgery with or without adjuvant chemotherapy and radiotherapy for localised primary gastric diffuse large B-cell lymphoma. Hippokratia 2016. [DOI: 10.1002/14651858.cd009914.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Aung Win Thein
- Melaka-Manipal Medical College; Department of Surgery; Jalan Batu Hampar, Bukit Baru Melaka Melaka Malaysia 75150
| | - Aye Aye Myint
- Monash University; Department of Medicine; Johor Bahru Johor Malaysia 80100
| | - Saw Hla Khaing
- Melaka-Manipal Medical College; Department of Surgery; Jalan Batu Hampar, Bukit Baru Melaka Melaka Malaysia 75150
| | - Shyamkant Vithal Shinde
- Melaka-Manipal Medical College; Department of Paediatrics; Jalan Batu Hampar Bukit Baru Melaka Melaka Malaysia 75150
| | - Myat Maw
- Melaka-Manipal Medical College; Department of Surgery; Jalan Batu Hampar, Bukit Baru Melaka Melaka Malaysia 75150
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Exclusive moderate-dose radiotherapy in gastric marginal zone B-cell MALT lymphoma: Results of a prospective study with a long term follow-up. Radiother Oncol 2015; 117:178-82. [DOI: 10.1016/j.radonc.2015.08.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/28/2015] [Accepted: 08/29/2015] [Indexed: 12/14/2022]
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Abbott S, Nikolousis E, Badger I. Intestinal lymphoma--a review of the management of emergency presentations to the general surgeon. Int J Colorectal Dis 2015; 30:151-7. [PMID: 25374417 DOI: 10.1007/s00384-014-2061-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2014] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Intestinal non-Hodgkin's lymphoma (NHL) is uncommon but not rare. This paper aims to review the recent evidence for the management of perforated NHL of the intestine, consider when chemotherapy should be commenced and examine the likely outcomes and prognosis for patients presenting as surgical emergencies with this condition. METHODS MEDLINE and Cochrane databases were searched using intestinal lymphoma, clinical presentation, perforation, management and prognosis. The full text of relevant articles was retrieved and reference lists checked for additional articles. FINDINGS Emergency surgery was required at disease presentation for between 11 and 64% of intestinal NHL cases. Perforation occurs in 1-25% of cases, and also occurs whilst on chemotherapy for NHL. Intestinal bleeding occurs in 2-22% of cases. Obstruction occurs more commonly in small bowel (5-39%) than large bowel NHL and intussusceptions occur in up to 46%. Prognosis is generally poor, especially for T cell lymphomas. CONCLUSIONS There is a lack of quality evidence for the elective and emergency treatment of NHL involving the small and large intestine. There is a lack of information regarding the impact an emergency presentation has on the timing of postoperative chemotherapy and overall prognosis. It is proposed that in order to develop evidence-based treatment protocols, there should be an intestinal NHL registry.
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Affiliation(s)
- S Abbott
- Department of Colorectal Surgery, New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK,
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7
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Clinicopathological study of primary gastric lymphomas in the central region of Tunisia, with survival analysis. Eur J Gastroenterol Hepatol 2013; 25:1060-7. [PMID: 23778310 DOI: 10.1097/meg.0b013e3283636233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Primary gastric lymphomas (PGL) are rare and represent only 5% of gastric malignancies, but are apparently increasing in incidence worldwide. Optimal treatment of PGL remains controversial. The aim of this study was to evaluate clinicopathological characteristics, prognostic factors, survival rates, and treatment modalities in Tunisian patients with PGL. METHODS We retrospectively analyzed data from patients treated for PGL in our hospital over an 18-year period (1994-2011). RESULTS Data from 128 patients with PGL were retrospectively analyzed. Eighty-four were males and the median age was 57 years (range 5-89 years). The mean BMI was 22.9 (15-39). A total of 40 patients (31.2%) had a poor performance status (PS). The antrum was the most commonly involved site (52 cases, 40.6%). The most frequent pathological subtypes were diffuse large-cell lymphomas (46.4%) and mucosa-associated lymphoid tissues (32%). Disease was localized (stages IE and IIE) in 97 patients (75.8%). Ninety-six patients were evaluable. Chemotherapy alone was used in 73 (76%) patients, with 76.7% achieving complete remission. During chemotherapy, there were no severe complications requiring urgent surgery. Actuarial five-year overall and event-free survival were 60.2 and 54.3% respectively. We found no statistically significant difference in survival between patients treated with surgery and those treated by a conservative strategy. In the multivariate study, age greater than 60 years, poor PS, and BMI less than 20 were significant prognostic factors for overall survival (P=0.04, 0.009, and <0.001, respectively). CONCLUSION Surgery provides no advantage for survival over conservative treatment. Age, PS, and BMI were effective prognostic factors.
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Kohisa J, Kamimura K, Iwanaga A, Shioji K, Kawai H, Suda T, Suzuki K, Sakurada J, Naito M, Aoyagi Y. Efficient palliative involved-field radiotherapy on highly progressive diffuse large B-cell primary gastric lymphoma with liver cirrhosis. Clin J Gastroenterol 2012; 5:164-169. [PMID: 26182162 DOI: 10.1007/s12328-012-0292-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 02/20/2012] [Indexed: 02/07/2023]
Abstract
We report the case of a 73-year-old woman having diffuse large B-cell primary gastric lymphoma with a cirrhotic liver caused by hepatitis C virus infection. She visited our hospital with symptoms of nausea and vomiting, which appeared to be caused by stenosis due to the tumor. Metastatic tumors were seen in the gastric and jugular lymph nodes. The clinical stage was IVB with a high risk of poor prognosis according to the international index. Because of poor hepatic reserve function, standard chemotherapy could not be administered. To maintain her quality of life, palliative involved-field radiotherapy was performed. The symptoms and tumor markers significantly improved, and computed tomography and endoscopy indicated the disappearance of the primary gastric tumor. Two months after radiotherapy and her return home, she died of pneumonia. Autopsy showed neither lymphoma cells nor stenosis of gastric lesion. The significant anti-tumor effect on primary tumor in our case suggests that the involved-field radiotherapy, although palliative, can be a therapeutic option for primary gastric lymphoma patients with various complications.
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Affiliation(s)
- Junji Kohisa
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan.
| | - Akito Iwanaga
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Kazuhiko Shioji
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Hirokazu Kawai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Takeshi Suda
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Kenji Suzuki
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Junko Sakurada
- Division of Cellular and Molecular Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Makoto Naito
- Division of Cellular and Molecular Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Yutaka Aoyagi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
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Ben Salah H, Ghorbel L, Krichen MS, Bellaaj H, Elloumi M, Frikha M, Daoud J. [The value of radiotherapy in the treatment of aggressive and localised gastric lymphomas]. Cancer Radiother 2008; 13:11-6. [PMID: 19091618 DOI: 10.1016/j.canrad.2008.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Revised: 11/03/2008] [Accepted: 11/04/2008] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the treatment results of localised aggressive gastric lymphomas with favourable prognosis using chemotherapy and radiotherapy. PATIENTS AND METHODS Between February 1993 and December 2004, nine patients with primary gastric high-grade lymphoma have been treated by the Lymphoma Committee of Sfax (Tunisia). The sex ratio was 1.5. The mean age was 44.9 years. Histological type was the large cell B lymphoma in 100% of the cases. Disease was stage I in eight cases and stage II in one case (Ann Arbor Classification). The treatment consisted in primary chemotherapy followed by radiotherapy of the stomach with or without regional nodes (40 Gy). RESULTS After treatment, all patients had complete remission. With a mean follow-up of 55.7 months, one patient was lost to follow-up; the other patients were alive with complete remission. No major acute toxicities or late effects were found. Overall survival was 100% at five years. CONCLUSION Chemotherapy associated with radiotherapy can be proposed to patients having localised and aggressive primary gastric lymphoma with favourable prognosis, since this treatment is well tolerated and provides satisfactory control of the disease.
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Affiliation(s)
- H Ben Salah
- Service de radiothérapie carcinologique, CHU Habib-Bourguiba, rue Majida-Bouleïla, 3029 Sfax, Tunisie.
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10
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Jezersek Novaković B, Vovk M, Juznic Setina T. A single-center study of treatment outcomes and survival in patients with primary gastric lymphomas between 1990 and 2003. Ann Hematol 2006; 85:849-56. [PMID: 16944146 DOI: 10.1007/s00277-006-0172-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 07/03/2006] [Indexed: 12/23/2022]
Abstract
Primary gastric lymphomas are the most common extranodal non-Hodgkin's lymphomas and are divided into indolent (low grade) and aggressive (high grade) types. They are mainly the disease of middle age, with a male predominance reported by most of the studies. For several years, surgery played a central role in diagnosis, staging, and treatment of this entity, yet recently there has been a move away from a surgical approach to conservative treatment. To determine the role of surgery as the initial treatment modality, we performed this retrospective single-center research on 245 patients with primary gastric lymphoma who were treated according to our protocol between 1990 and 2003. The patients' characteristics, distribution of histological types, treatment results, and disease-specific survival were followed. According to the histology, 59.2% had diffuse large B-cell lymphoma (DLCL), 26.1% MALT lymphoma, 9.8% mixed lymphoma (indolent and aggressive at the same time), while other types were infrequent. In total, 161 patients (65.7%) were treated with surgical resection as the initial treatment, which was then followed or not by additional therapy (chemotherapy, chemotherapy and radiotherapy, radiotherapy) depending on the histological type of lymphoma and the extent of residual disease after surgery. In 84 patients (34.3%), the treatment approach was conservative. The selection of treatment (chemotherapy, chemotherapy and radiotherapy, radiotherapy or Helicobacter pylori eradication only) was based on the histological type of lymphoma, considering also the patients' physical condition. The disease-specific survival in the group of patients who underwent surgery was statistically significantly better than in patients who were treated conservatively (p=0.049). At 5 years, it was 96.9% for the group treated with surgery and 89.8% in patients treated conservatively. However, the results were biased, as the patients who were treated conservatively were either in a worse performance status or presented with a more extensive disease. Similarly, in the DLCL type the disease-specific survival was better in the surgically treated group (97.2%) than in the conservatively treated patients (89.2%). The difference was barely significant (p=0.046) and again the results have to be considered with caution due to the selection of patients in a worse performance status or with a more extensive disease for conservative treatment. In the MALT lymphoma and mixed lymphoma types, there were no differences in the disease-specific survival between both treatment groups. Regarding the statement that for conservative treatment patients were selected who were unsuitable for the resection on account of concomitant diseases or due to the fact that the process was inoperable, we believe that the conservative approach gives comparable outcomes to the approach including initial surgery. The existing evidence thus no longer justifies surgery as the standard initial treatment and preference should be given to conservative treatment approaches.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Female
- Helicobacter Infections/epidemiology
- Helicobacter pylori/pathogenicity
- Humans
- Lymphoma/mortality
- Lymphoma/pathology
- Lymphoma/surgery
- Lymphoma, B-Cell, Marginal Zone/mortality
- Lymphoma, B-Cell, Marginal Zone/surgery
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/surgery
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/surgery
- Male
- Middle Aged
- Retrospective Studies
- Stomach Neoplasms/mortality
- Stomach Neoplasms/pathology
- Stomach Neoplasms/surgery
- Survival Analysis
- Treatment Outcome
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Hamaloglu E, Topaloglu S, Ozdemir A, Ozenc A. Synchronous and metachronous occurrence of gastric adenocarcinoma and gastric lymphoma: A review of the literature. World J Gastroenterol 2006; 12:3564-74. [PMID: 16773713 PMCID: PMC4087572 DOI: 10.3748/wjg.v12.i22.3564] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The occurrence of both primary gastric lymphoma and gastric adenocarcinoma in the same patient is a rare entity. The possible causative factors of synchronous or metachronous occurrence of both malignancies and varieties in the treatment modalities are reviewed according to published cases in English language medical literature.
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Affiliation(s)
- Erhan Hamaloglu
- Department of Surgery, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
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12
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Chaudhary N, Ozer H, Huard D, Lightfoot S, Mesiya S. Successful treatment of Helicobacter pylori-negative gastric MALT lymphoma with rituximab. Dig Dis Sci 2006; 51:775-8. [PMID: 16615002 DOI: 10.1007/s10620-006-3205-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 05/03/2005] [Indexed: 01/27/2023]
Abstract
Helicobacter pylori infection is strongly associated with low-grade gastric lymphoma, commonly known as mucosa-associated lymphoid tissue (MALT) lymphoma. H. pylori eradication leads to complete remission in 80% of early stage MALT lymphomas. The treatment for early stage H. pylori-negative gastric MALT lymphoma is evolving. Rituximab, a chimeric anti-CD20 antibody, has shown response rates of approximately 50% with minimal toxicity in patients with B-cell non-Hodgkin lymphoma. We describe herein the clinical, endoscopic, and histologic features of a patient with H. pylori-negative gastric MALT lymphoma treated successfully with rituximab.
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MESH Headings
- Aged
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/administration & dosage
- Biopsy, Needle
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Follow-Up Studies
- Gastroscopy/methods
- Helicobacter Infections/diagnosis
- Helicobacter pylori/isolation & purification
- Humans
- Immunohistochemistry
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Male
- Neoplasm Staging
- Rituximab
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/pathology
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Nadeem Chaudhary
- University of Oklahoma Health Sciences Center, Division of Gastroenterology, Department of Medicine, Oklahoma City, Oklahoma, USA
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Al-Shemmari SH, Sajnani KP, Ameen RM, Ragheb AM. Primary gastrointestinal non-Hodgkin's lymphoma: treatment outcome. ACTA ACUST UNITED AC 2004; 4:99-103. [PMID: 14556681 DOI: 10.3816/clm.2003.n.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Primary gastrointestinal lymphoma is the most common extranodal presentation of non-Hodgkin's lymphoma. In this retrospective study, all cases of primary gastrointestinal lymphoma registered at Kuwait Cancer Control Center between January 1992 and December 2001 were reviewed. Patients were diagnosed through an endoscopic biopsy or exploratory laparotomy. Staging procedures included computed axial tomography scan, bone marrow biopsy, barium and follow-through study, as well as routine chemistry (including lactate dehydrogenase) and hemography. There were 46 patients (30 men and 16 women); ages ranged from 16 to 82 years (median age, 43.6 years). The most common site of involvement was the stomach (70%), and the most common histology was large B cell. At least 50% of cases underwent primary radical surgery, and the majority of patients received subsequent chemotherapy and/or local radiation therapy. Chemotherapy consisted of the CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) regimen for large B-cell histology and CVP (cyclophosphamide/vincristine/prednisone) or oral alkylating agents for low-grade histology. Of this cohort, only 12 cases (26%) have had local or distant relapse. Disease-free survival rates for low-grade and high-grade non-Hodgkin's lymphoma were 64% and 81%, respectively. Primary gastrointestinal lymphoma is a potentially curable malignancy.
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Abstract
AIM: The purpose of this review is to describe the various aspects of primary gastric lymphoma and the treatment options currently available.
METHODS: After a systematic search of Pubmed, Medscape and MDconsult, we reviewed and retrieved literature regarding gastric lymphoma.
RESULTS: Primary gastric lymphoma is rare however, the incidence of this malignancy is increasing. Chronic gastritis secondary to Helicobacter pylori (H pylori) infection has been considered a major predisposing factor for MALT lymphoma. Immune histochemical marker studies and molecular biology utilizing polymerase chain reaction have facilitated appropriate diagnosis and abolished the need for diagnostic surgical resection. Advances in imaging techniques including Magnetic Resonance Imaging (MRI) and Endoscopic Ultrasonography (EUS) have helped evaluation of tumor extension and invasion. The clinical course and prognosis of this disease is dependent on histopathological sub-type and stage at the time of diagnosis. Controversy remains regarding the best treatment for early stages of this disease. Chemotherapy, surgery and combination have been studied and shared almost comparable results with survival rate of 70%-90%. However, chemotherapy possesses the advantage of preserving gastric anatomy. Radiotherapy alone has been tried and showed good results. Stage IIIE, IVE disease treatment is solely by chemotherapy and surgical resection has been a remote consideration.
CONCLUSION: We conclude that methods of diagnosis and staging of the primary gastric lymphoma have dramatically improved. The modalities of treatment are many and probably chemotherapy is superior because of high success rate, preservation of stomach and tolerable complications.
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Affiliation(s)
- Ahmad M Al-Akwaa
- Gastroenterology Division, Neelam Siddiqui Oncology Division, Department of Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
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15
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Abstract
The connection between Helicobacter pylori and gastric mucosa-associated lymphoid tissue (MALT) lymphoma is well established. H. pylori infection causes an immunological response, leading to chronic gastritis with formation of lymphoid follicles within the stomach. These lymphoid follicles resemble nodal tissues found throughout the body and are composed of reactive T cells and activated plasmal cells and B cells. The B cells are responsible for initiating a clonal expansion of centrocyte-like cells that form the basic histology of MALT lymphoma. Early diagnosis of MALT lymphoma is difficult but essential for adequate treatment. Clinical symptoms are vague and varied, with abdominal pain being a common presenting complaint. The endoscopic appearance of this tumor is varied and can be infiltrative, exophytic, or ulcerative. In addition, the tumor can have a multifocal distribution, and therefore aggressive tissue sampling is crucial for diagnosis. Endoscopic ultrasound is essential to document the extent of disease and is more accurate than CT scan in detection of spread to perigastric lymph nodes. Lesions that are confined to the mucosa or submucosa of the gastric wall are believed to be dependent on H. pylori stimulation and therefore can be successfully treated with H. pylori eradication. Those MALT lymphomas that present at more advanced stages require more aggressive management and can be treated with surgical resection, radiation, or chemotherapy. Follow-up is critical in all patients who have been treated with H. pylori eradication and consists of multiple endoscopic biopsies for histological and molecular studies as well as endoscopic ultrasound at 3, 6, and 12 months after treatment. The reappearance of MALT lymphomas has been seen years after treatment, and therefore follow-up of these patients should be indefinite.
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Affiliation(s)
- Asyia Ahmad
- Division of Gastroenterology and Hepatology, Drexel University, Philadelphia, Pennsylvania 19107, USA
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Cortelazzo S, Rossi A, Oldani E, Motta T, Giardini R, Zinzani PL, Zucca E, Gomez H, Ferreri AJM, Pinotti G, Chini C, Devizzi L, Gianni AM, Cavalli F, Barbui T. The modified International Prognostic Index can predict the outcome of localized primary intestinal lymphoma of both extranodal marginal zone B-cell and diffuse large B-cell histologies. Br J Haematol 2002; 118:218-28. [PMID: 12100151 DOI: 10.1046/j.1365-2141.2002.03613.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We have previously reported on the efficacy of a modified International Prognostic Index (MIPI) in predicting the outcome of patients with primary gastric lymphoma. This prompted the retrospective analysis of a large series of patients with primary intestinal lymphoma (PIL) of both diffuse large B-cell (DLCL) and low-grade (extranodal marginal zone B-cell lymphoma, MZL) histology. Clinical records of 122 patients with localized primary intestinal lymphoma of MZL (n=35) and DLCL (n=87) histology, confirmed by an ad hoc expert panel of pathologists, were reviewed. Forty-nine patients were treated with single therapy, while 72 received combined-modality treatment, which included surgery followed by a short-term chemotherapy. MIPI was included in a multivariate prognostic analysis for overall survival (OS) and event-free survival (EFS). Sixty-five patients (75%) with DLCL and 22 with MZL(65%) achieved complete remission. After a median follow-up of 42 months (range 6-163 months), 5-year estimates of OS and EFS were 68% and 50% for DLCL and 65% and 26% for MZL. OS varied according to MIPI, from, respectively, 86% and 87% for DLCL and MZL patients with 0-1 risk factor to 50% and 32% for patients with > 1 risk factor (P=0.01 and P=0.02). Similar results were obtained for EFS. Cox regression analysis showed an unfavourable MIPI to be the only independent predictor of shorter EFS. This retrospective study shows that stage-MIPI can be a reliable prognostic indicator for PIL of both low-grade MZL and diffuse large B-cell histology, enabling the early identification of patients at higher risk of failure.
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Affiliation(s)
- Sergio Cortelazzo
- Divisione di Ematologia e Servizio di Anatomia Patologica e Citologia, Ospedali Riuniti di Bergamo, Bergamo, Italy.
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Salman H, Bergman M, Bessler H, Fenig E, Weiss J, Beilin B, Djaldetti M. Decreased phagocytic capacity of rat peritoneal macrophages following photon abdominal irradiation. Cancer Lett 1999; 147:175-9. [PMID: 10660103 DOI: 10.1016/s0304-3835(99)00290-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Photon irradiation of the abdomen may be accompanied by complications due to a decrease in the immune defense of the recipient. Since peritoneal macrophages are an important component of the immune system, we examined the phagocytic activity and oxygen superoxide anion generation by peritoneal macrophages from rats 2 and 4 weeks after abdominal irradiation with 6 MV photons applying a single dose of 2 Gy. Two and 4 weeks after irradiation, peritoneal macrophages were harvested and their capacity to engulf latex particles and to produce oxygen superoxide anions was determined. Non-irradiated rats, treated identically otherwise, served as controls. Two weeks after irradiation the phagocytic capacity and oxygen superoxide anion generation decreased by 61 and 70%, respectively, compared with controls. This tendency persisted after 4 weeks post irradiation, the decrease in both functions being 50 and 74%, respectively. It is suggested that the altered function of peritoneal macrophages following irradiation may further compromise the immune defense in patients receiving abdominal radiotherapy.
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Affiliation(s)
- H Salman
- Department of Medicine C, Rabin Medical Center, Golda Campus, Petah Tiqva, Israel
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Cortelazzo S, Rossi A, Roggero F, Oldani E, Zucca E, Tondini C, Ambrosetti A, Pasini F, Pinotti G, Bertini M, Vitolo U, Busetto M, Gianni L, Cavalli F, Barbui T. Stage-modified international prognostic index effectively predicts clinical outcome of localized primary gastric diffuse large B-cell lymphoma. International Extranodal Lymphoma Study Group (IELSG). Ann Oncol 1999; 10:1433-40. [PMID: 10643533 DOI: 10.1023/a:1008351427601] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The definition of prognostic parameters in early stages of gastric lymphoma is still controversial. The aim of this retrospective analysis was to assess the value of the stage-modified international prognostic index (IPI) in predicting the outcome of a large, consecutive series of patients with PGL of diffuse large B-cell histology (DLCL). PATIENTS AND METHODS Three hundred twelve consecutive, newly-diagnosed, patients with localized PGL (stages I-IIE according to the 'Lugano staging system for GI lymphomas') referred from April 1972 to December 1997 to eight Italian and one Swiss centers were reviewed and their outcomes updated to June 1998. One hundred three patients were treated with single-modality therapy, while two hundred four received combined-modality treatment, most of which included surgery and short-term chemotherapy. RESULTS After a median follow-up of 66 months (range 0.6-300 months), 195 (64%) were alive in first continuous complete remission (CCR). The five-year estimates of overall survival (OS) and event-free survival (EFS) were 75% and 67%, respectively. OS and EFS varied according to IPI, from, respectively, 90% and 82% for patients with 0-1 risk factors, to 40% and 35% for patients with > or = 3 risk factors (P = 0.00001). Cox regression analysis showed that IPI was the strongest predictor of survival. CONCLUSIONS This study shows that stage-modified IPI is an effective predictive model in patients with primary DLCL of the stomach, enabling identification of patients with significantly different outcomes.
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Affiliation(s)
- S Cortelazzo
- Divisione di Ematologia, Ospedali Riuniti di Bergamo, Italy.
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Editorial. Eur Surg 1998. [DOI: 10.1007/bf02620104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rolle der Strahlentherapie im Behandlungskonzept der gastrointestinalen Lymphome. Eur Surg 1998. [DOI: 10.1007/bf02620111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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