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Favorable radiation field decrease in gastric marginal zone lymphoma : Experience of the German Study Group on

Gabriele Reinartz1, Regina P Pyra2, Georg Lenz3

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Strahlentherapie Und Onkologie : Organ Der Deutschen Rontgengesellschaft ... [Et Al]
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Summary

Reducing radiation fields in gastric marginal zone lymphoma (gMZL) treatment improved outcomes. Stage-adapted field reduction led to fewer side effects and better survival rates in gMZL patients.

Keywords:
Extended fieldIndolent gastric lymphomaInvolved fieldNon-Hodgkin lymphomaRadiation therapy

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Gastrointestinal Oncology

Background:

  • Gastric marginal zone lymphoma (gMZL) is a distinct subtype of non-Hodgkin lymphoma.
  • Conservative treatment with curative radiation therapy (RT) has been a standard approach for gMZL.
  • Optimizing RT techniques is crucial for improving patient outcomes and minimizing toxicity.

Purpose of the Study:

  • To evaluate the long-term impact of stage-adapted radiation field reduction in a large cohort of gMZL patients.
  • To assess the influence of decreasing radiation field sizes on treatment outcomes, including survival and adverse events.
  • To compare treatment results across different prospective trials employing stage-adapted field reduction strategies.

Main Methods:

  • A prospective analysis of 290 patients with stage IE-IIE gMZL treated between 1992-2013 across 78 German radiotherapeutic institutions.
  • Patients were treated within three consecutive prospective trials of the German Study Group on Gastrointestinal Lymphoma (DSGL), with radiation fields progressively reduced from extended field (EF) to involved field (IF).
  • Treatment outcomes, including survival rates and adverse effects, were compared between the three study cohorts.

Main Results:

  • The study included 290 patients with a median age of 60 years and a median follow-up of 6.4 years.
  • Stage-adapted radiation field reduction, coupled with technological advancements, resulted in decreased acute and chronic adverse effects and lower disease recurrence rates.
  • The third study cohort, utilizing the smallest field sizes (IF in stage I, locoregional EF in stage II), demonstrated the best 5-year survival outcomes: 92.7% overall survival, 89.5% event-free survival, and 100.0% lymphoma-specific survival.

Conclusions:

  • Stage-adapted reduction of radiation fields towards involved field (IF) in gMZL treatment yields favorable outcomes regarding adverse effects, local control, and survival rates.
  • These findings support the continued exploration of reduced radiation fields in modern RT for gMZL.
  • Primary disease stage is a significant factor associated with lymphoma-specific survival in gMZL patients treated with RT.