Korean J Gastroenterol.  2019 Jan;73(1):19-25. 10.4166/kjg.2019.73.1.19.

Clinical Efficacy of Radiotherapy in Helicobacter pylori Negative or Unresponsive to Eradication Therapy Primary Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

• Park BS
• Lee SH

• KMID: 2432432
• DOI: http://doi.org/10.4166/kjg.2019.73.1.19

Abstract

BACKGROUND/AIMS
The eradication of Helicobacter pylori (H. pylori) is an effective treatment in gastric mucosa-associated lymphoid tissue (MALT) lymphoma associated with H. pylori infection. However, the treatment strategy in gastric MALT lymphoma patients who are H. pylori-negative or unresponsive to H. pylori eradication therapy remains controversial. In this study, we investigated the clinical efficacy of treatments other than H. pylori eradication therapy in these groups of patients.
METHODS
This was a retrospective single-center study based on the medical records of patients diagnosed with gastric MALT lymphoma at Yeungnam University Medical Center between January 2005 and December 2016. Patients were treated with H. pylori eradication therapy, chemotherapy, or radiotherapy according to their H. pylori infection status and stage of gastric MALT lymphoma.
RESULTS
Of the 68 eligible patients, 50 were enrolled in the study. Of the 42 patients with H. pylori-positive gastric MALT lymphoma, 36 (81.7%) were treated with H. pylori eradication therapy as primary treatment and 25 (69.4%) achieved a complete response (CR). Patients without a CR after H. pylori eradication therapy (n=11, 30.6%) received radiotherapy as a secondary treatment. Two patients with H. pylori-positive gastric MALT lymphoma and eight with H. pylori-negative gastric MALT lymphoma received radiotherapy as the primary treatment. CR was achieved in all 21 patients treated with radiotherapy as primary or secondary treatment. The 5-year progression-free survival rate after radiotherapy was 92.9%.
CONCLUSIONS
Radiotherapy may be a worthwhile treatment option in patients with H. pylori-negative MALT lymphoma or H. pylori-positive MALT lymphoma that is not responsive to H. pylori eradication therapy.

Keyword

Lymphoma, B-cell, marginal zone; Stomach neoplasms; Helicobacter Pylori; Radiotherapy

MeSH Terms

Academic Medical Centers
Disease-Free Survival
Drug Therapy
Helicobacter pylori*
Helicobacter*
Humans
Lymphoid Tissue
Lymphoma
Lymphoma, B-Cell, Marginal Zone*
Medical Records
Radiotherapy*
Retrospective Studies
Stomach Neoplasms
Treatment Outcome*

Figure

• 

  Fig. 1 Treatment pathway and outcomes for patients. In total 50 patients, 42 patients (84.0%) had H. pylori infection. Eleven patients with no-CR after H. pylori eradication therapy received radiotherapy as secondary treatment and all achieved CR without relapse. Eight patients with H. pylori-negative gastric MALT lymphoma were treated with radiotherapy as the primary treatment and the CR rate after radiotherapy was 100%. MALT, mucosa-associated lymphoid tissue; H. pylori, Helicobacter pylori; RTx, radiotherapy; CTx, chemotherapy; CR, complete response.

• 

  Fig. 2 Progression-free survival rates after treatment. 5-year progression-free survival rate of all patients was 91.1%. Median survival period after all treatments was 7.4 months (range, 4.3–19.3 months). 5-year progression-free survival rate after radiotherapy was 92.3%. Median survival period after radiotherapy was 34.6 months (range, 9.8–133.6 months). RTx, radiotherapy.

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