PURPOSE: To assess the clinical outcomes of radiotherapy (RT) using two-dimensional (2D) and three-dimensional conformal RT (3D-CRT) for patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma to evaluate the effectiveness of involved field RT with moderate-dose and to evaluate the benefit of 3D-CRT comparing with 2D-RT. MATERIALS AND METHODS: Between July 2003 and March 2015, 33 patients with stage IE and IIE gastric MALT lymphoma received RT were analyzed. Of 33 patients, 17 patients (51.5%) were Helicobacter pylori (HP) negative and 16 patients (48.5%) were HP positive but refractory to HP eradication (HPE). The 2D-RT (n = 14) and 3D-CRT (n = 19) were performed and total dose was 30.6 Gy/17 fractions. Of 11 patients who RT planning data were available, dose-volumetric parameters between 2D-RT and 3D-CRT plans was compared. RESULTS: All patients reached complete remission (CR) eventually and median time to CR was 3 months (range, 1 to 15 months). No local relapse occurred and one patient died with second primary malignancy. Tumor response, survival, and toxicity were not significantly different between 2D-RT and 3D-CRT (p > 0.05, each). In analysis for dose-volumetric parameters, D(max) and CI for PTV were significantly lower in 3D-CRT plans than 2D-RT plans (p < 0.05, each) and D(mean) and V₁₅ for right kidney and D(mean) for left kidney were significantly lower in 3D-CRT than 2D-RT (p < 0.05, each). CONCLUSION: Our data suggested that involved field RT with moderate-dose for gastric MALT lymphoma could be promising and 3D-CRT could be considered to improve the target coverage and reduce radiation dose to the both kidneys.
Helicobacter pylori ; Humans ; Kidney ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Radiotherapy ; Recurrence ; Stomach

PURPOSE: The purpose of this study was to evaluate the clinical features and the long-term outcomes of primary conjunctival marginal zone B-cell lymphoma (MZBCL) patients who were treated with radiation therapy (RT). MATERIALS AND METHODS: Retrospective data of 79 patients with 121 primary conjunctival MZBCL lesions were collected from January 1, 2001 till June 30, 2014. All lesions were treated by local RT (26 Gy) with patient-specific customized lens-shielding device. RESULTS: The current Korean patients' cohort showed younger median age at diagnosis (38 years), great female preponderance (78.5%) and more frequent bilateral involvement (53.2%) than the previous studies. Following 26 Gy's RT, excellent clinical outcomes were achieved: 5-year rates of overall survival, local relapse-free survival, and contralateral relapse-free survival were 100%, 98.1%, and 91.5%, respectively. Two patients (2.5%) developed local relapse and five (6.3%) developed relapse at initially uninvolved contralateral conjunctiva with median interval of 52.9 months, and late adverse events of grade 2 and 3 occurred in seven (8.8%) and two (2.5%) patients, respectively. CONCLUSION: 26 Gy's RT was highly effective and safe, with the use of lens-shielding device, in treating patients with primary conjunctival MZBCL.
Cohort Studies ; Conjunctiva ; Diagnosis ; Female ; Humans ; Lymphoma, B-Cell, Marginal Zone* ; Radiotherapy ; Recurrence ; Retrospective Studies

Approximately 90% of gastric mucosa-associated lymphoid tissue (MALT) lymphomas are associated with Helicobacter pylori infection and 10% of gastric MALT lymphomas occur independent of H. pylori infection. The gene translocation t(11;18)(q21;q21) is frequently observed in cases presenting with H. pylori-negative gastric MALT lymphomas. H. pylori-negative gastric MALT lymphomas do not differ from H. pylori-positive gastric MALT lymphomas in terms of clinical features and endoscopic findings and show similar prognosis. H. pylori eradication therapy could be considered as first-line treatment for gastric MALT lymphomas regardless of their H. pylori infection status. In cases with H. pylori-negative gastric MALT lymphomas, the rate of response to eradication therapy varies from 0 to 83%. If gastric MALT lymphoma persists for more than a year, secondary treatment with radiotherapy, chemotherapy, and/or surgery should be considered. Of note, the comparative outcome is excellent.
B-Lymphocytes ; Drug Therapy ; Helicobacter pylori ; Helicobacter* ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Prognosis ; Radiotherapy

PURPOSE: To retrospectively analyze dosimetric parameters of volumetric-modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3D-CRT) delivered to extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue in the stomach (gastric MALT lymphoma) to find out advantages of VMAT and conditions for definite benefits of VMAT. MATERIALS AND METHODS: Fifty patients with stage I-II gastric MALT lymphoma received VMAT (n = 14) or 3D-CRT (n = 36) between December 2005 and April 2018. Twenty-seven patients were categorized according to whether the planning target volume (PTV) overlaps kidney(s). Dosimetric parameters were analyzed by dose-volume histogram. RESULTS: Radiation dose to the liver was definitely lower with VMAT in terms of mean dose (p = 0.026) and V15 (p = 0.008). The V15 of the left kidney was lower with VMAT (p = 0.065). For those with PTV overlapping kidney(s), the left kidney V15 was significantly lower with VMAT. Furthermore, the closer the distance between the PTV and kidneys, the less the left kidney V15 with VMAT (p = 0.037). Delineation of kidney(s) by integrating all respiratory phases had no additional benefit. CONCLUSIONS: VMAT significantly increased monitor units, reduced treatment time and radiation dose to the liver and kidneys. The benefit of VMAT was definite in reducing the left kidney V15, especially in geometrically challenging conditions of overlap or close separation between PTV and kidney(s).
Humans ; Kidney ; Liver ; Lymphoid Tissue ; Lymphoma, B-Cell, Marginal Zone ; Organs at Risk ; Radiotherapy, Conformal ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Stomach

Primary extranodal non-Hodgkin's lymphomas comprise approximately 10% of all non-Hodgkin's lymphomas. However, primary tracheal non-Hodgkin's lymphoma is extremely rare, being mainly mucosa-associated lymphoid tissue lymphoma. A 65-year-old female has dry cough for one year. She was diagnosed as diffuse large B-cell lymphoma via bronchoscopic-guided biopsy. She was treated with four cycles of the R-CHOP regimen and adjuvant radiotherapy. After completion of the combined treatment, the treatment response was complete remission, and the disease free survival was 26 months.
Aged* ; B-Lymphocytes* ; Biopsy ; Cough ; Disease-Free Survival ; Female* ; Humans ; Lymphoma* ; Lymphoma, B-Cell* ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Non-Hodgkin ; Radiotherapy, Adjuvant

PURPOSE: To evaluate long-term outcomes after cryotherapy for conjunctival mucosa-associated lymphoid tissue (MALT) lymphomas. METHODS: We retrospectively analyzed 11 eyes of 8 patients who underwent cryotherapy with a confirmed histopathological diagnosis of conjunctival MALT lymphoma between January 2006 and December 2010 and were followed up for at least a year. RESULTS: The mean patient age was 36.8 years and the average follow-up was 4.1 years. Complete remission was achieved in 3 patients (4 eyes) and recurrence occurred in 5 patients (7 eyes) after the first cryotherapy. After the third cryotherapy, complete remission was achieved in 2 patients (2 eyes) and recurrence occurred in 3 patients (5 eyes). Therefore, 3 patients (5 eyes) underwent radiotherapy and finally achieved complete remission. After cryotherapy, significant complications were not observed except mild symblepharon in 4 patients (6 eyes). CONCLUSIONS: Cryotherapy, although having a higher recurrence rate than radiotherapy, is a simple treatment modality with fewer complications for patients. In the conjunctival MALT lymphoma patients who cannot undergo radiotherapy, cryotherapy should be considered as an alternative treatment modality.
Conjunctiva ; Cryotherapy* ; Diagnosis ; Follow-Up Studies ; Humans ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Radiotherapy ; Recurrence ; Retrospective Studies

BACKGROUND: Primary ocular adnexal extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (POML) is the most common subtype of lymphoma involving the eyes in Thailand. We sought to assess the characteristics and treatment outcomes of patients with POML in Thailand. METHODS: We retrospectively reviewed patient data and included patients diagnosed with POML between January 2004 and December 2016 at Chiang Mai University Hospital and King Chulalongkorn Memorial Hospital, Thailand. We collected and analyzed patients' clinical characteristics and treatment outcomes. RESULTS: Among 146 patients with lymphoma involving the eyes, 121 (82%) were diagnosed with POML. Sixty-four (52.9%) were women with median age 58 (range, 22–86) years. The most common presenting symptom was orbital mass (71.1%). Common sites of origin were the orbit (46.3%) and lacrimal gland (34.7%). At presentation, 22.3% of patients had bilateral eye involvement. About half of patients had stage I disease (N=59, 56.2%) and 20% had stage IV. Most patients (73.3%) had a low-risk International Prognostic Index. Radiotherapy was the main treatment for patients with limited-stage disease (66.7% in stage I and 56.5% in stage II). The overall response rate was 100% with complete response rates 80%, 77.3%, and 64.7% for stages I, II, and IV, respectively. Five-year progression-free survival (PFS) and overall survival were 66.1% and 94.0%, respectively. For patients with limited-stage disease, radiotherapy significantly improved PFS compared with treatment not involving radiotherapy (5-year PFS 89.9% vs. 37.3%, P=0.01). CONCLUSION: We revealed that POML has good response to treatment, especially radiotherapy, with excellent long-term outcome.
Disease-Free Survival ; Female ; Humans ; Lacrimal Apparatus ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Orbit ; Radiotherapy ; Retrospective Studies ; Thailand*

PURPOSE: The aim of this study was to evaluate the clinical features, histologic classification and treatment outcomes of patients with malignant lymphoma of the eye. METHODS: The participants included 22 patients with malignant lymphoma of the orbit and ocular adnexa treated at our hospital between May 1994 and September 2001. The authors retrospectively analyzed the sex, age, location of mass, histopathologic type, stage and results of the treatment. RESULTS: Of the 22 patients, 14 cases were male and 8 were female. The age ranged from 26 to 68 years (mean age 43 years). The most common presenting complaint was slowly growing mass of the eye. Histopathologic studies revealed extranodal marginal zone B-cell lymphoma, MALT type in 20 cases (91%). The stages of lymphomas were included I AE in 14 cases (63%), II AE in 3 cases (14%), III AE in 3 cases (14%) and IV A in 2 cases (9%). Patients received radiotherapy and/or chemotherapy. Twenty out of 22 cases (91%) achieved a complete remission. During the mean follow-up of 26 months, two patients died of progression of the disease; one patient had extranodal marginal zone B-cell lymphoma, MALT type of stage III AE and the other patient had diffuse large cell lymphoma of stage II AE. CONCLUSIONS: Radiotherapy can produce durable remission in the majority of the patients with localized primary orbital lymphoma. Chemotherapy should be performed for the patients with highly malignant lymphomas or lymphomas with systemic manifestations.
Classification ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Lymphoma* ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Large B-Cell, Diffuse ; Male ; Orbit* ; Radiotherapy ; Retrospective Studies

PURPOSE: Lymphoproliferative lesions of the ocular adnexa were analyzed to examine the final outcome, recurrence and extraorbital spread. METHODS: The biopsies and clinical follow up data for 55 patients (68 eyes) with ocular adnexal lymphoproliferative lesions were reviewed retrospectively and analyzed according to the WHO classification. RESULTS: The ocular-adnexal lymphoproliferative lesions were located as follows: orbit in 49 eyes, conjunctiva in 18 eyes, eyelid in 1 eye. The three main subtypes of lymphoma according to the WHO classification were extranodal marginal zone B-cell lymphoma of mucosa- associated lymphoid tissue (MALT-lymphoma) (62 eyes), diffuse large B-cell lymphoma (2 eyes), and benign lymphoid hyperplasia (4 eyes). Remission was achieved at 60eyes. Recurrence was occurred in 7eyes (orbit: 4, conjunctiva: 3) of MALT-lymphoma cases. Location of lymphoma at presentation was not a predictor for recurrence (conjunctiva 16.7%, orbit 8.2%; p>0.05), but bilaterality at presentation was predictive values for recurrence by a statistically significant difference(bilateral 23.1%, unilateral 4.8%; p=0.045). CONCLUSIONS: Most common ocular adnexal lymphoma in Korea was MALT- lymphoma (91.2%). Bilaterality has a predictive values on recurrence, and extraorbital spread was found only in orbital MALT-lymphoma. It is suggested that orbital MALT- lymphoma should be treated with excisional biopsy and subsequent low dose radiotherapy and followed up indefinity.
Biopsy ; Classification ; Conjunctiva ; Eyelids ; Follow-Up Studies ; Humans ; Hyperplasia ; Korea ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Orbit ; Prognosis* ; Radiotherapy ; Recurrence ; Retrospective Studies

<b>Objective:b> This study aimed to see how different initial treatment regimens affected the long-term prognosis of patients with extranodal marginal zone mucosa-associated lymphoid tissue lymphoma confining to the ocular adnexal (OAML) . <b>Methods:b> Between April 2008 and April 2019, 109 patients with initial mucosa-associated lymphoid tissue confining to ocular adnexal were evaluated and followed-up, and the prognosis of various initial treatment regimens were examined. <b>Results:b> A total of 36 patients underwent complete surgical resection of the lesions, and 73 patients had residual lesions after surgery, of which 37 patients chose watchful waiting, and 36 patients chose treatment. The treatment regimen included local radiotherapy and systemic treatment (chemotherapy, immunochemotherapy, the combination of radiotherapy and chemotherapy, etc.) , and no serious toxic and side effects were observed in patients receiving systemic treatment. The median follow-up time was 61 (10-142) months. The 5-year and 10-year progression-free survival (PFS) of monocular involvement patients were 78.2% and 76.0% . The 5-year and 10-year PFS rates of patients with binocular involvement were 64.4% and 23.5%. There was significant diference in PFS between patients with monocular and binocular involvement (P=0.010) . Patients who received additional treatment had higher PFS than those patients in the watchful waiting group (P=0.046) . The 5-year PFS was 71.4% and 90.1% among patients in the watchful waiting group and those who received additional treatment, whereas the 10-year PFS was 63.5% and 75.1% , respectively. Patients with OAML were still a risk of disease progression after 5 years. <b>Conclusions:b> Patients with binocular involvement OAML at the start of the disease had a poor prognosis, but treatment could reduce the risk of recurrence/progression. Systemic therapy is one of the first-line treatment options for patients with OAML, who require long-term monitoring.
Eye Neoplasms/radiotherapy* ; Humans ; Lymphoid Tissue/pathology* ; Lymphoma, B-Cell, Marginal Zone/therapy* ; Prognosis ; Retrospective Studies ; Treatment Outcome