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Helicobacter Pylori-Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy Alone

Received: 19 November 2022    Accepted: 6 December 2022    Published: 15 December 2022
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Abstract

This is a case of a 60-year-old Filipino gentleman with a six-month-history of nonspecific gastric symptoms which would be ascribed to gastroesophageal reflux disease. Each time, the patient would be prescribed proton pump inhibitors, but with only temporary and minimal relief. Eventually, further investigation would reveal that the patient actually had gastric mucosa-associated lymphoid tissue lymphoma (MALToma). Peculiar, however, is that the patient’s gastric MALToma is Helicobacter pylori-negative. The patient subsequently underwent involved-site radiation therapy to the entire stomach. A total of 3000 cGy in 20 fractions (150 cGy per fraction) was prescribed to the planning target volume, delivered using 6-megavoltage photons via volumetric modulated arc therapy (VMAT) modality in a Varian Halcyon linear accelerator. All the target criteria and organs-at-risk dose constraints were successfully met. Treatment was delivered daily, Mondays to Fridays. For every session, the patient was likewise asked to be nil per os 4 hours prior, similar to when he was simulated. Cone beam CT (CBCT) image verification was performed in every treatment session. The patient was prescribed Ondansetron 8 mg/tablet, 1 tablet orally, 1-2 hours prior to every radiation session, as prophylaxis against nausea and vomiting. The entire course of radiation therapy was well-tolerated. There were no treatment interruptions. The patient did not report any subjective complaints during and even after the course of treatment. Post-radiation therapy, there was complete clinical and endoscopic response.

Published in International Journal of Clinical Oncology and Cancer Research (Volume 7, Issue 4)
DOI 10.11648/j.ijcocr.20220704.13
Page(s) 93-98
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Gastric MALToma, Lymphoma, Radiation Therapy, Case Report

References
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[2] Zullo, A., Hassan, C., Ridola, L., Repici, A., Manta, R., and Andriani, A. (2020). Gastric MALT lymphoma: Old and new insights. Annals of Gastroenterology, 7.
[3] Violeta, F. (2018). MALT lymphoma: Epidemiology, clinical diagnosis and treatment. Journal of Medicine and Life, 11 (3), 187–193. https://doi.org/10.25122/jml-2018-0035
[4] Press, O. W., and Lichtman, M. A. (2017). General Considerations of Lymphomas: Epidemiology, Etiology, Heterogeneity, and Primary Extranodal Disease. In O. W. Press, M. A. Lichtman, & J. P. Leonard (Eds.), Williams Hematology Malignant Lymphoid Diseases (Vol. 1–Book, Section). McGraw-Hill Education. hemonc.mhmedical.com/content.aspx?aid=1148368200
[5] Lim, H. W., Kim, T. H., Choi, I. J., Kim, C. G., Lee, J. Y., Cho, S. J., Eom, H. S., Moon, S. H., & Kim, D. Y. (2016). Radiation therapy for gastric mucosa-associated lymphoid tissue lymphoma: Dose-volumetric analysis and its clinical implications. Radiation Oncology Journal, 34 (3), 193–201. https://doi.org/10.3857/roj.2016.01865
[6] Fischbach, W. (2014). Gastric MALT lymphoma—Update on diagnosis and treatment. Best Practice & Research. Clinical Gastroenterology, 28 (6), 1069–1077. https://doi.org/10.1016/j.bpg.2014.09.006
[7] Nam, T.-K., Ahn, J.-S., Choi, Y.-D., Jeong, J.-U., Kim, Y.-H., Yoon, M. S., Song, J.-Y., Ahn, S.-J., & Chung, W.-K. (2014). The Role of Radiotherapy in the Treatment of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma. Cancer Research and Treatment : Official Journal of Korean Cancer Association, 46 (1), 33–40. https://doi.org/10.4143/crt.2014.46.1.33
[8] Kim, S. W., Lim, D. H., Ahn, Y. C., Kim, W. S., Kim, S. J., Ko, Y. H., & Kim, K.-M. (2013). Clinical outcomes of radiation therapy for early-stage gastric mucosa-associated lymphoid tissue lymphoma. World Journal of Gastroenterology : WJG, 19 (36), 6062–6068. https://doi.org/10.3748/wjg.v19.i36.6062
[9] Ohkubo, Y., Saito, Y., Ushijima, H., Onishi, M., Kazumoto, T., Saitoh, J., Kubota, N., Kobayashi, H., Maseki, N., Nishimura, Y., & Kurosumi, M. (2017). Radiotherapy for localized gastric mucosa–associated lymphoid tissue lymphoma: Long-term outcomes over 10 years. Journal of Radiation Research, 58 (4), 537–542. https://doi.org/10.1093/jrr/rrw044
[10] Yahalom, J., Xu, A., Noy, A., Lobaugh, S., Chelius, M., and K. Chau et al. (2021). Involved-site radiotherapy for Helicobacter pylori-independent gastric MALT lymphoma: 26 years of experience with 178 patients. Blood Advances, 5 (7), 1830-6. https://doi.org/10.1182/bloodadvances.2020003992
[11] Olszewski, A. and J. Castillo. (2013). Comparative outcomes of oncologic therapy in gastric extranodal marginal zone (MALT) lymphoma: analysis of the SEER-Medicare database. Annals of Oncology, 24 (5): 1352-59. https://doi.org/10.1093/annonc/mds644
[12] Tsang, R. W., Gospodarowicz, M. K., Pintille, M., Bezjak, A., Wells, W., Hodgson, D., and M. Crump. (2001). Stage I and II malt lymphoma: results of treatment with radiotherapy. International Journal of Radiation Oncology, Biology, Physics, 50 (5): 1258-64. https://doi.org/10.1016/S0360-3016(01)01549-8
[13] Lee, S. K., Lee, Y. C., Chung, J. B., Chon, C. Y., Moon, Y. M., and J. K. Kang et al. (2004). Low grade gastric MALTOMA: Treatment strategies based on 10 year follow-up. World Journal of Gastroenterology, 10 (2): 223-6. doi: 10.3748/wjg.v10.i2.223
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Cite This Article
  • APA Style

    Jose Ma. Hermoso Zaldarriaga, Don Peter Santiago Dator, Kenneth Cortez Sy. (2022). Helicobacter Pylori-Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy Alone. International Journal of Clinical Oncology and Cancer Research, 7(4), 93-98. https://doi.org/10.11648/j.ijcocr.20220704.13

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    ACS Style

    Jose Ma. Hermoso Zaldarriaga; Don Peter Santiago Dator; Kenneth Cortez Sy. Helicobacter Pylori-Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy Alone. Int. J. Clin. Oncol. Cancer Res. 2022, 7(4), 93-98. doi: 10.11648/j.ijcocr.20220704.13

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    AMA Style

    Jose Ma. Hermoso Zaldarriaga, Don Peter Santiago Dator, Kenneth Cortez Sy. Helicobacter Pylori-Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy Alone. Int J Clin Oncol Cancer Res. 2022;7(4):93-98. doi: 10.11648/j.ijcocr.20220704.13

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  • @article{10.11648/j.ijcocr.20220704.13,
      author = {Jose Ma. Hermoso Zaldarriaga and Don Peter Santiago Dator and Kenneth Cortez Sy},
      title = {Helicobacter Pylori-Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy Alone},
      journal = {International Journal of Clinical Oncology and Cancer Research},
      volume = {7},
      number = {4},
      pages = {93-98},
      doi = {10.11648/j.ijcocr.20220704.13},
      url = {https://doi.org/10.11648/j.ijcocr.20220704.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcocr.20220704.13},
      abstract = {This is a case of a 60-year-old Filipino gentleman with a six-month-history of nonspecific gastric symptoms which would be ascribed to gastroesophageal reflux disease. Each time, the patient would be prescribed proton pump inhibitors, but with only temporary and minimal relief. Eventually, further investigation would reveal that the patient actually had gastric mucosa-associated lymphoid tissue lymphoma (MALToma). Peculiar, however, is that the patient’s gastric MALToma is Helicobacter pylori-negative. The patient subsequently underwent involved-site radiation therapy to the entire stomach. A total of 3000 cGy in 20 fractions (150 cGy per fraction) was prescribed to the planning target volume, delivered using 6-megavoltage photons via volumetric modulated arc therapy (VMAT) modality in a Varian Halcyon linear accelerator. All the target criteria and organs-at-risk dose constraints were successfully met. Treatment was delivered daily, Mondays to Fridays. For every session, the patient was likewise asked to be nil per os 4 hours prior, similar to when he was simulated. Cone beam CT (CBCT) image verification was performed in every treatment session. The patient was prescribed Ondansetron 8 mg/tablet, 1 tablet orally, 1-2 hours prior to every radiation session, as prophylaxis against nausea and vomiting. The entire course of radiation therapy was well-tolerated. There were no treatment interruptions. The patient did not report any subjective complaints during and even after the course of treatment. Post-radiation therapy, there was complete clinical and endoscopic response.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Helicobacter Pylori-Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy Alone
    AU  - Jose Ma. Hermoso Zaldarriaga
    AU  - Don Peter Santiago Dator
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    JF  - International Journal of Clinical Oncology and Cancer Research
    JO  - International Journal of Clinical Oncology and Cancer Research
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    PB  - Science Publishing Group
    SN  - 2578-9511
    UR  - https://doi.org/10.11648/j.ijcocr.20220704.13
    AB  - This is a case of a 60-year-old Filipino gentleman with a six-month-history of nonspecific gastric symptoms which would be ascribed to gastroesophageal reflux disease. Each time, the patient would be prescribed proton pump inhibitors, but with only temporary and minimal relief. Eventually, further investigation would reveal that the patient actually had gastric mucosa-associated lymphoid tissue lymphoma (MALToma). Peculiar, however, is that the patient’s gastric MALToma is Helicobacter pylori-negative. The patient subsequently underwent involved-site radiation therapy to the entire stomach. A total of 3000 cGy in 20 fractions (150 cGy per fraction) was prescribed to the planning target volume, delivered using 6-megavoltage photons via volumetric modulated arc therapy (VMAT) modality in a Varian Halcyon linear accelerator. All the target criteria and organs-at-risk dose constraints were successfully met. Treatment was delivered daily, Mondays to Fridays. For every session, the patient was likewise asked to be nil per os 4 hours prior, similar to when he was simulated. Cone beam CT (CBCT) image verification was performed in every treatment session. The patient was prescribed Ondansetron 8 mg/tablet, 1 tablet orally, 1-2 hours prior to every radiation session, as prophylaxis against nausea and vomiting. The entire course of radiation therapy was well-tolerated. There were no treatment interruptions. The patient did not report any subjective complaints during and even after the course of treatment. Post-radiation therapy, there was complete clinical and endoscopic response.
    VL  - 7
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Author Information
  • Department of Radiation Oncology, St. Luke’s Medical Center, Quezon City, Republic of the Philippines

  • Department of Radiation Oncology, St. Luke’s Medical Center, Quezon City, Republic of the Philippines

  • Department of Radiation Oncology, St. Luke’s Medical Center, Quezon City, Republic of the Philippines

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