A Prospective Trial of Radiation Therapy Efficacy and Toxicity for Localized Mucosa-associated Lymphoid Tissue (MALT) Lymphoma
| Autor: | Ranjit Nair, Chelsea C. Pinnix, Bouthaina S. Dabaja, Loretta J. Nastoupil, Jillian R. Gunther, Sattva S. Neelapu, Paolo Strati, Wenli Dong, Sairah Ahmed, Nathan Fowler, Chul S. Ha, Jason R. Westin, Raphael E Steiner, Ethan P. Damron, Penny Fang |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Skin Neoplasms Time Factors medicine.medical_treatment Kaplan-Meier Estimate Gastroenterology Helicobacter Infections 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Recurrence Stomach Neoplasms Internal medicine Biopsy Clinical endpoint Humans Medicine Radiology Nuclear Medicine and imaging Prospective Studies Radiation Injuries Prospective cohort study Aged Aged 80 and over Radiation Helicobacter pylori biology medicine.diagnostic_test business.industry Radiotherapy Dosage MALT lymphoma Lymphoma B-Cell Marginal Zone Middle Aged medicine.disease biology.organism_classification Progression-Free Survival Lymphoma Radiation therapy Treatment Outcome Oncology Head and Neck Neoplasms 030220 oncology & carcinogenesis Orbital Neoplasms Female business Mucosa-associated lymphoid tissue |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 109:1414-1420 |
| ISSN: | 0360-3016 |
| Popis: | Purpose We report the long-term results of a prospective trial conducted to determine the efficacy and safety of radiation therapy (RT) alone in treating localized mucosa-associated lymphoid tissue (MALT) lymphoma. Methods and Materials Patients with localized MALT lymphoma were eligible and treated with involved field RT to doses of 24 to 39.6 Gy. Relapse-free survival (RFS) was the primary endpoint. Kaplan-Meier analysis was used to estimate RFS, progression-free survival (PFS), and overall survival (OS) defined from time of study entry. Preplanned subgroup analyses were performed based on site of involvement. Results From 2000 to 2012, 75 patients were accrued; 73 received protocol-specified RT. Median follow-up was 9.8 years. Thirty-four patients had gastric MALT, 17 orbital, 13 head and neck nonorbit, 4 skin, and 5 disease of other sites. Thirteen of 34 patients with gastric MALT were Helicobacter pylori positive at the time of initial diagnosis and underwent 1 to 3 courses of triple antibiotic therapy. All gastric MALT patients had documented persistent MALT without H. pylori on endoscopy before enrollment in the study. All patients achieved a complete response with a median time of 3 months. Eleven patients (15%) had disease relapse, 9 of which were at sites outside the RT field with median time to progression of 38.3 months. Median PFS was 17.5 years, and median RFS and OS were not reached. The 10-year relapse-free rate was 83% (95% confidence interval [CI], 74%-93%). The 10-year PFS rate was 71% (95% CI, 60%-84%). The 10-year OS rate was 86% (95% CI, 77%-96%). RFS, PFS, and OS did not differ by disease site (P = .17, .43, and .50, respectively). All relapses were successfully salvaged. One patient developed metastatic gastric adenocarcinoma and was found to also have recurrent MALT on biopsy. Otherwise, all relapsed patients were alive without evidence of disease at last follow-up, and no patient died of MALT lymphoma. Sixty-seven patients (92%) experienced acute toxicity during radiation, all of which were grade 1 and 2, with only 1 grade 3 toxicity. Twenty-two patients (30%) experienced late toxicity, with only 1 grade 3 toxicity. Conclusions This prospective study confirms that RT for MALT lymphoma provides excellent long-term RFS with acceptable rates of toxicity. Current efforts are focused on RT de-escalation in an effort to further avoid treatment-related morbidity. Clinicaltrials.gov NCT04465162 . |
| Databáze: | OpenAIRE |
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