Abstract
BackgroundEarly-stage primary gastrointestinal (GI) low-grade B-cell lymphoma shows good therapeutic response to primary radiotherapy. However, there is no clear guideline for the evaluation of response to radiation therapy currently. The aim of this study was to analyze the relationship between the best response time and the clinical course after radiotherapy.MethodsPatients who underwent radiotherapy for treatment of primary GI low-grade B-cell lymphoma from September 2007 to December 2018 at Seoul St. Mary’s Hospital were included. Early responders were defined by best response within 6 months after radiotherapy, and delayed responders after 6 months. Clinical and pathological factors associated with delayed response and survival analyses were performed to investigate the recurrence and survival during follow-up.ResultsA total of 43 patients were evaluated and the number of gastric mucosa-associated lymphoid tissue and duodenal follicular lymphoma was 36 and 7, respectively. All of 43 patients showed complete remission to radiotherapy and the best response time after radiotherapy was a median of 3 months. There were 8 delayed responders with a median duration of 8.9 months. Early and delayed responders were characterized by a significant difference in depth of invasion beyond the mucosal layer.ConclusionsDelayed responders did not show differences in oncological outcomes compared with early responders. They were allowed to watch and wait for an additional 6 to 12 months without further treatment.
Highlights
Early-stage primary gastrointestinal (GI) low-grade B-cell lymphoma shows good therapeutic response to primary radiotherapy
In the case of gastric lymphoma infected with H.pylori, H.pylori eradication (HPE) consisted of proton pump inhibitors, amoxicillin, and clarithromycin is the primary treatment resulting in an efficacy of over 80% [5, 6]
Early-stage GI follicular lymphoma has been monitored without any treatments in the past; radiotherapy has been administered to patients with GI follicular lymphoma because of the relatively better overall survival rate [10]
Summary
Early-stage primary gastrointestinal (GI) low-grade B-cell lymphoma shows good therapeutic response to primary radiotherapy. Gastric lymphoma tends to be a multifocal disease, so the entire stomach should be irradiated according to the International Lymphoma Radiation Oncology Group (ILROG) guidelines [9]. Early-stage GI follicular lymphoma has been monitored without any treatments in the past; radiotherapy has been administered to patients with GI follicular lymphoma because of the relatively better overall survival rate [10]. ILROG recommend ≥24 Gy as radiation dose of early stage GI low-grade follicular lymphoma, and the entire duodenum should be included as radiotherapy field [9, 11]. As a rare disease, there is no standardized guideline for the duration and frequency of follow-up in patients receiving radiotherapy
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