Agnès Ruskoné-Fourmestraux1, Tamara Matysiak-Budnik2, Bettina Fabiani3, Pascale Cervera3, Hedia Brixi4, Karine Le Malicot5, Isabelle Nion-Larmurier6, Jean-Fançois Fléjou3, Christophe Hennequin7, Laurent Quéro7. 1. Department of Gastroenterology, St Antoine Hospital, AP-HP, Faculté de Médicine Pierre et Marie Curie, Paris, France; Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France. Electronic address: agnes.fourmestraux@sat.aphp.fr. 2. IMAD & Hepato-Gastroenterology and Digestive Oncology, CHU de Nantes, France; Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France. 3. Department of Pathology, St Antoine Hospital, AP-HP, Faculté de Médecine Pierre et Marie Curie, Paris, France. 4. Department of Gastroenterology, CHU Reims, France; Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France. 5. Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France. 6. Department of Gastroenterology, St Antoine Hospital, AP-HP, Faculté de Médicine Pierre et Marie Curie, Paris, France. 7. Department of Radiotherapy, St Louis Hospital, AP-HP, Paris, France; Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France.
Abstract
BACKGROUND: In gastric MALT lymphomas persisting after Helicobacter pylori (H. pylori) eradication, a treatment by moderate-dose radiotherapy (RT) has been proposed but its efficacy has not been confirmed in large prospective series with long term endoscopic follow-up. METHOD: Patients with localised gastric MALT lymphoma persisting after H. pylori eradication were offered moderate-dose RT (30Gy, 2Gy/fraction) and followed with annual endoscopies. All biopsies before and after RT were reviewed by a committee of pathologists. RESULTS: From 1995 to 2011, out of the 232 patients followed prospectively, 53 received RT for persistence of lymphoma after H. pylori eradication: either macroscopic ulcer (n=31), or microscopic lymphomatous infiltrate (n=22), after a mean follow-up of 12 and 31months, respectively. All lymphomas were localised (45 stage IE and 8 stage IIE) and 38 (72%) were H. pylori-positive. The mean clinical and endoscopic follow-up from diagnosis was 7.6years (2.2-19.1). No acute or late toxicity occurred. A complete remission was achieved in all patients but one (98%) with no relapse after a median follow-up of 4.9years (1.3-16.6) after completion of RT. Overall survival and 5-year disease specific survival were 94% and 100%, respectively. One patient died of gastric adenocarcinoma. CONCLUSION: Moderate-dose RT (30Gy) is effective and safe for localised gastric MALT lymphoma persisting after H. pylori eradication.
BACKGROUND: In gastric MALT lymphomas persisting after Helicobacter pylori (H. pylori) eradication, a treatment by moderate-dose radiotherapy (RT) has been proposed but its efficacy has not been confirmed in large prospective series with long term endoscopic follow-up. METHOD:Patients with localised gastric MALT lymphoma persisting after H. pylori eradication were offered moderate-dose RT (30Gy, 2Gy/fraction) and followed with annual endoscopies. All biopsies before and after RT were reviewed by a committee of pathologists. RESULTS: From 1995 to 2011, out of the 232 patients followed prospectively, 53 received RT for persistence of lymphoma after H. pylori eradication: either macroscopic ulcer (n=31), or microscopic lymphomatous infiltrate (n=22), after a mean follow-up of 12 and 31months, respectively. All lymphomas were localised (45 stage IE and 8 stage IIE) and 38 (72%) were H. pylori-positive. The mean clinical and endoscopic follow-up from diagnosis was 7.6years (2.2-19.1). No acute or late toxicity occurred. A complete remission was achieved in all patients but one (98%) with no relapse after a median follow-up of 4.9years (1.3-16.6) after completion of RT. Overall survival and 5-year disease specific survival were 94% and 100%, respectively. One patient died of gastric adenocarcinoma. CONCLUSION: Moderate-dose RT (30Gy) is effective and safe for localised gastric MALT lymphoma persisting after H. pylori eradication.
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