# Radiation Oncology/NHL/MALT

* Front Page: Radiation Oncology | RTOG Trials | Randomized Trials
* Non-Hodgkin lymphoma: Main Page | Randomized
* Overview: Overview |
* Follicular |
* Diffuse large B-cell |
* MALT |
* Nodal marginal zone |
* Mantle cell |
* CLL/SLL |
* Lymphoblastic |
* Burkitt |
* NK/T cell |
* Anaplastic large cell |
* Primary CNS Lymphoma
* Treatment:
* Aggressive |
* Specific sites |
* Radioimmunotherapy

## Overview

* MALT is classified as an extra-nodal marginal zone lymphoma.
* Extra-nodal marginal zone lymphomas tend to home to a certain tissue and remain localized. Therefore, MALT lymphomas are often stage I and highly curable.
* Pathologically, see lymphoepithelial lesions as the malignant lymphoma cells invade and destroy normal epithelium (such as glands).

## Work-Up

* Tel Aviv, 2007 (Israel) PMID 17662066 -- "Diagnostic accuracy of PET/CT in patients with extranodal marginal zone MALT lymphoma." (Perry C, Eur J Haematol. 2007 Sept 79(3), 205-209)
** Prospective. 33 patients with bx-proven MALT lymphoma, evaluated with PET/CT. Sites: gastric 55%, lung 15%, orbit 12%, parotid 9%
** PET/CT: Active disease at diagnosis 55%. Sensitivity gastric 39% vs. non-gastric 75%. Advanced disease 100% vs. early stage (I-II) 42%
** Conclusion: PET/CT useful tool; sensitivity depends on stage and location

## Reviews

* See also reviews at Nodal marginal zone lymphoma

## Treatment

* See also Follicular lymphoma treatment page
* JAROG; 2007 (Japan)(2002-2004) PMID 17601683 -- "A Multicenter Phase II Study of Local Radiation Therapy for Stage IEA Mucosa-Associated Lymphoid Tissue Lymphomas: A Preliminary Report From the Japan Radiation Oncology Group (JAROG)." (Isobe K, Int J Radiat Oncol Biol Phys. 2007 Nov 15;69(4):1181-6. Epub 2007 Jul 2.)
** Phase II. 37 patients with MALT (orbit n=24, thyroid n=4, salivary n=4, others n=5). RT dose: if orbital or minimal residual disease 30.6 Gy, if residual tumor <6cm 36 Gy, if >6 cm 39.6 Gy. Median F/U 3.1 years
** Outcome: 3-year OS 100%, PFS 92%, LC 97%
** Toxicity: Late Grade 3 (cataract) 3 patients
** Conclusion: Moderate RT dose highly effective

## Gastric MALT
### Helicobacter pylori eradication

* Germany, 2005 - PMID 16204012 — "Long-Term Follow-Up of Gastric MALT Lymphoma After Helicobacter Pylori Eradication." Wündisch T et al. J Clin Oncol. 2005 Nov 1;23(31):8018-24.
** 120 pts. Stage IE. Median f/u 75 mo.
** 5-yr OS 90%. 80% achieved CR by biopsy. 80% of CR pts remained in CR; 17% showed histologic residual dz during follow-entered a second CR; 3% of those with CR had a relapse.

### Radiation

* International Extranodal Lymphoma Study Group (IELSG); 2013 - PMID 23293112 -- "Long-term outcome for gastric marginal zone lymphoma treated with radiotherapy: a retrospective, multi-centre, International Extranodal Lymphoma Study Group study." (Wirth A, Ann Oncol. 2013 May;24(5):1344-51.)
** Retrospective. Multicenter. 102 pts (58 de novo, 44 with relapse) treated with RT. Of the 44 relapsed pts: 35 previously treated with antibiotics, 9 with chemo, 8 with surgery. 61 pts treated with RT to the stomach/nodes only and 41 to whole abdomen. Median RT dose 40 Gy in 22 fractions.
** Median f/u 7.9 yr. 10- and 15-year FFTF was 88%. 10-yr OS 70%.
** Worse outcome: large-cell component (13%) and an exophytic growth pattern (12%).
** Conclusion: "Radiotherapy achieves cure for the majority of patients with low-grade GMZL, including patients who have had prior therapy"
* Princess Margaret Hospital; 2001 (1989-98) - PMID 11483337 -- "Stage I and II MALT lymphoma: results of treatment with radiotherapy." (Tsang RW, Int J Radiat Oncol Biol Phys. 2001 Aug 1;50(5):1258-64.)
** Retrospective. 15 pts with gastric MALT, Stage I-IIE (paper includes a total of 70 pts with MALT lymphoma of various sites). 11 pts (gastric MALT) treated with RT. 1 pt treated with surgical excision only; 2 pts antibiotics only; 1 refused tx. RT dose 20-30 Gy.
** No relapses were observed in patients with stomach and thyroid lymphoma. The 5-year DFS for these patients was 93%, in contrast to 69% for patients presenting in other sites.
** Conclusion: "Localized MALT lymphomas have excellent prognosis following moderate-dose RT"
* Memorial Sloan Kettering; 1998 - PMID 9586910 — "Treatment of mucosa-associated lymphoid tissue lymphoma of the stomach with radiation alone." (Schechter N, J Clin Oncol. 1998 May;16(5):1916-21.)
** Retrospective. 17 patients with stage 1-2 low-grade MALT of the stomach. RT alone to median 30 Gy (range, 28.5 to 43.5 Gy) in 1.5 Gy fractions within 4 weeks to stomach and adjacent lymph nodes. Median F/U 27 mo.
** Outcome: 100% biopsy-confirmed CR. 100% EFS at last F/U
** Toxicity: No significant side effects
** Conclusion: Low-dose RT alone is feasible and safe

## Ocular MALT
### Chlamydophila Psittaci eradication

* Extrandoal Lymphoma Study Group; 2012 PMID 22802315 -- "Chlamydophila Psittaci Eradication With Doxycycline As First-Line Targeted Therapy for Ocular Adnexae Lymphoma: Final Results of an International Phase II Trial." (Ferreri AJ, J Clin Oncol. 2012 Aug 20;30(24):2988-94. Epub 2012 Jul 16.)
** Phase II. 47 patients with ocular adnexal marginal zone lymphoma (OAMZL). Assessment of Chlamydophila psittaci (Cp), followed by treatment with doxycyline. Median F/U 3.1 years
** Outcome: Cp DNA detected in 89% of biopsies. Lymphoma regression in 65%. 5-year PFS 55%. Cp eradication associated with improved response (SS) and PFS (NS)
** Conclusion: Upfront doxycycline is a rational and active treatment for patients with Stage I Cp-positive OAMZL