Radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma

Table 1 Paris staging system

	Tumour extension
T1m N0 M0	Mucosa
T1sm N0 M0	Submucosa
T2 N0 M0	Muscularis propria
T3 N0 M0	Serosa
T1–3 N1 M0	Perigastric lymph nodes
T1–3 N2 M0	More distant regional nodes
T4 N0–2 M0	Invasion of adjacent structures with or without abdominal lymph nodes
T1–4 N3 M0	Extra-abdominal lymph nodes
T1–4 N0–3 M1	Distant (non-contiguous) GI sites involvement
T1–4 N0–3 M2	Non-GI sites involvement

T: Tumor; N: Nodes; M: Metastasis; GI: Gastrointestinal

Table 2 Lugano staging system

Stage
Stage I	Confined to the GI tract (single primary or multiple, non-contiguous)
Stage II	Extension into abdomen
II1	Local nodal involvement
II2	Distant nodal involvement
Stage IIE	Penetration of serosa to involve adjacent organs or tissues
Stage IV	Disseminated extranodal involvement or concomitant supra-diaphragmatic nodal involvement

GI: Gastrointestinal.

Table 3 Studies of radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma

Ref.	Country	Patients, n (%)	Stage	Failure of H. pylori eradication or H. pylori	H. pylori	Median [Total RT dose]	Median F/U (mo)	Survival	Relapse (Local/distant)	Toxicity G3+
Schechter et al[31], 1998	NY, United States	17	IE = 71%; II1 = 24%, II2 = 5%	17/17	12/17	30 Gy [28.5–43.5]	27 [11–68]	NR	0/0	0
Park et al[32], 2002	Korea	6	IE = 100%	4/6	1/6	30.6 Gy [30–39]	12	100%	0/0	0
Tsang et al[33], 2003	Canada	13/93 (gastric and RT subgroup)	IA = 88%; IIA = 10%, IIB = 2%	13/13	7/15	26.2 [20–35]	61	98% at 5 yr for the entire cohort	0/0	0
Koch et al[24], 2005	Germany	144/332 (indolent subgroup with conservative management)	I = 66%; II1 = 17%; II2 = 17%	NR	NR	40 Gy	42 [0.07–97.4]	93% at 3.5 yr	6	9
Avilés et al[34], 2005	Mexcio	78/241 (RT group)	IE = 73%; IIE = 27%	NR	NR	40 Gy	90 [58–139]	75% at 10 yr	0/30	0
Sugimoto et al[35], 2006	Japan	3	I = 3	3/3	0	39 Gy [36–40]	42 [24–72]	100%	0/0	0
Tsai et al[36], 2007	MA, United Sttaes	18/77 gastric and RT subgroup	IE = 100%	6/18	NR	30 Gy [18–40]	61 [2–177]	91% at 5 yr for the entire cohort	0 over 11 patients treated by RT	NR
Yamashita et al[37], 2008	Japan	11/41 gastric subgroup	IE = 90%; IIE = 10% (whole cohort)	6/11	5/11	30 Gy	32 [2–162]	100%	0/0	0
Vrieling et al[38], 2008	The Netherlands	68/115 (RT subgroup)	I = 79%; II1 = 12%, II2 = 9%	85/115	13/115	40 Gy [31–44]	150 [7–301] (radiotherapy only cohort)	78% at 5 yr (entire cohort)	3/4	NR
Gobbi et al[39], 2009	Italia	5	IE = 4; IIE = 1	5/5	0/5	30 Gy	48 [21–70]	80%	0	0
Tomita et al[40], 2009	Japan	20/50 (gastric subgroup)	IE = 96%; IIE = 4% (entire cohort)	20/20	7/20	32 Gy [25.6–50]	92	97% at 5 yr (entire cohort)	0	2% for all cohort
Goda et al[41], 2010	Canada	25/167 (gastric subgroup)	IA = 90%; IIA = 9%; IIB = 1%	19/19	5/19	30 Gy [20-35]	89 [8–194]	95% at 5-yr (entire cohort)	0	NR
Okada et al[42], 2012	Japan	22	IE = 19; IIE = 3	22/22	14/22	30 Gy	74 [27–159]	91% at 5-yr	0/3	0
Kim et al[43]; 2013	Korea	64	IE = 53 (83%); IIE = 11 (17%)	56/60	33/64	36 Gy	39 [9–131]	94% at 5-yr	5	0
Wirth et al[16], 2013	International (IELSG)	102	IE = 84%; IIE = 16%	80/102	45/90	40 Gy [26–46]	95 [4–528]	70% at 10 yr	7/5	NR
Nam et al[44], 2014	Korea	41 (MALT subgroup)	IE = 77%; IIE = 23%	29/41	29.6%(whole cohort)	30.6 Gy [30.6-43.2]	48 [6– 158]	90% at 5-yr (entire cohort)	1/0	0
Abe et al[45], 2013	Japan	34	IE = 34 (100%)	34/34	17/34	30 Gy	90 (14–156)	100% at 5-yr	1 (emergency gastrectomy during RT at 15 Gy for acute bleeding)/0	1
Ruskoné-Fourmestraux et al[18], 2015	France	53	IE = 45 (85%); IIE = 8 (15%)	53/53	15/53	30 Gy	59 (4–199)	94% at 5-yr	0/0	0
Lim et al[46], 2016	Korea	33	IE = 30 (91%); IIE = 3 (9%)	33/33	17/33	30.6 Gy	50 (12–145)	97% at 5-yr	0	0
Ohkubo et al[47], 2017	Japan	27	IE = 27 (100%)	24/27	15/27	30 Gy [30–39.5]	121 (8–176)	92% at 5-yr; 87% at 10-yr	0/2	2/27 (White blood cell count decreases)
Teckie et al[48], 2017	NY, United States	122/225 (gastric and RT subgroup)	IE = 225 (92%); IIE = 19 (8%)	115/122	78/122	30 Gy	62 [2–256]	92% at 5-yr; 79% at 10-yr for all the subgroups	7 (gastric subgroup)	NR
Pinnix et al[17], 2019	TX, United States	32	IE = 25(78%); IIE = 5 (16%); IV = 2 (6%)	32/32	25/32	36 Gy (2; 6%); 30 Gy (n = 19; 59%); 24 Gy (n = 11; 34%)	55 [32–78]	97% at 2-yr	1/1	NR
Schmelz et al[49], 2019	Germany	22	IE = 20; IIE = 2	22/22	0/22	25.2 Gy/36 Gy	79 [36.4 –143.8]	100% at 56.6 yr	0	NR
Watanabe et al[50], 2020	Japan	30/34 (gastric subgroup)	IE = 100%	26/30	16/30	30 Gy [30–40]	61 [9–136]	94.7% at 5 yr	0/2	0

RT: Radiotherapy; NR: Not reported; H. pylori: Helicobacter pylori.