Lymphoma Malt

MALT Non-Gastric Extra-Nodal

Clinical

  • Involves: GI, Salivary glands, breast, thyroid, orbit, conjunctiva, skin, lung and other sites.

Treatment

  • 30 Gy RT almost always control sites of disease.

Outcome

  • Local control 97-100%
  • 5-PFS: 75%
  • 5-OS: 95%

== Orbital MALT ==

MALT Gastric

General

  • 50% have disease within the mucosa and submucosa.
  • H. pylori association present
  • t(11;18) in gastric MALT is not associated with H. Pylori
  • thus t(11:18) gastric MALT is insensitivity to antibiotic treatment

Nodal Failure Risk[1]

MALT.jpg
  • location of nodal failure in low-grade MALT (Japanese Research Society for Gastric Cancer)
MALT.jpg
  • location of nodal failure in high-grade MALT

Treatment

H. Pylori Positive

  • Triple drug: PPI, Clarithromycin, and amoxicillin
  • Restage at 3 month with endoscopy and biopsy or earlier if symptomatic
  • IFRT for residual lymphoma after anti-biotic treatment if symptomatic or progressive
  • Otherwise treat with anti-biotic until H. pylori is negative and then observe
  • Complete response to antibiotic therapy can take as long as 18 months eventhough

H. Pylori Negative or stage II

  • IFRT

IFRT Dose and Technique

  • 30 Gy in 15 fractions Radiation to involved field, if resistant to antibiotic therapy.
    • limited our target volume to the stomach and the perigastric nodes[1]
Bibliography
1. Park W, Chang SK, Yang WI, et al. Rationale for radiotherapy as a treatment modality in gastric mucosa-associated lymphoid tissue lymphoma. Int J Radiat Oncol Biol Phys 2004;58:1480–6.
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