The Role of Surgical Resection, Radiation Dose, and Radiation Field Size in the Management of Gastric Lymphoma: Retrospective Study

AT Monroe, RW Hinerman, CG Morris, NP Mendenhall

Hong Kong J Radiol 2004;7:121-8

Objective: This retrospective review sought to determine outcomes in gastric lymphoma and analyse the effect of field size and radiation dose on patterns of recurrence and toxicity.

Patients and Methods: The study group comprised 31 patients (25 men and 6 women) whose mean age was 62 years. Fifteen patients had low-grade lymphoma, including 6 with mucosaassociated lymphoid tissue lymphoma, and 16 had intermediate- to high-grade lymphoma. Surgical resection was a component of therapy in 15 cases, whereas radiation therapy was the sole local therapy in 16 cases. Involved-field radiation therapy was delivered to 17 patients — typically with chemotherapy for intermediate- to high-grade lymphoma and alone for mucosa-associated lymphoid tissue lymphoma. Whole-abdomen radiation therapy was used in 14 patients. The median radiation dose was 30 Gy (range, 20-40 Gy). The median follow-up duration was 41 months.

Results: Five-year cause-specific survival, overall survival, and recurrence-free survival were 79%, 49%, and 84%, respectively. There was no significant difference between patients according to whether or not they underwent surgical resection. No patient experienced an infield or marginal failure after radiation. There was no significant difference between involved-field radiation therapy and whole-abdomen radiation therapy with respect to the Radiation Therapy Oncology Group acute gastrointestinal toxicity scores or disease control. Five (16%) of 31 patients developed a second malignancy a mean of 6.3 years after radiation.

Conclusions: Radiotherapy without surgical resection resulted in excellent local control in gastric lymphoma, with no observed in-field failures at a median dose of 30 Gy. Similar acute toxicities were observed with involved-field and whole-abdomen radiation therapy.