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Strahlentherapie und Onkologie

, Volume 195, Issue 6, pp 544–557 | Cite as

Favorable radiation field decrease in gastric marginal zone lymphoma

Experience of the German Study Group on Gastrointestinal Lymphoma (DSGL)
  • Gabriele ReinartzEmail author
  • Regina P. Pyra
  • Georg Lenz
  • Rüdiger Liersch
  • Georg Stüben
  • Oliver Micke
  • Kay Willborn
  • Clemens F. Hess
  • Andreas Probst
  • Rainer Fietkau
  • Ralf Jany
  • Jürgen Schultze
  • Christian Rübe
  • Carsten Hirt
  • Wolfgang Fischbach
  • Martin Bentz
  • Severin Daum
  • Christiane Pott
  • Markus Tiemann
  • Peter Möller
  • Andreas Neubauer
  • Martin Wilhelm
  • Normann Willich
  • Wolfgang E. Berdel
  • Hans T. Eich
Original Article
  • 127 Downloads

Abstract

Purpose

Long-term impact of stage-adapted field reduction in a large cohort of gastric marginal zone lymphoma (gMZL) patients treated conservatively with curative radiation therapy (RT).

Patients and methods

Prospective analysis of paper records of 290 patients with stage IE–IIE gMZL, treated in 78 radiotherapeutic institutions in Germany from 1992–2013. Stage-adapted radiation fields decreased from extended field (EF) to involved field (IF) over the course of three consecutive prospective trials of the German Study Group on Gastrointestinal Lymphoma (DSGL). Treatment results were compared between the three cohorts.

Results

Overall collective with median age of 60 years, slight male predominance (m:f = 1.1:1) and ratio of disease stage I:stage II = 2.1:1. Median follow-up 6.4 years in total: 13.0 years in the first gastrointestinal study (GIT 1992), 8.2 years in the second (GIT 1996) and 4.7 years in the third study (DSGL 01/2003). Stage-adapted radiation field decrease together with further technological development led to reduced relative frequencies of acute/chronic adverse effects and until now was accompanied by lower disease recurrence. The third study design with smallest field size (IF in stage I, locoregional EF in stage II) achieved the best survival outcome at the 5‑year follow-up (overall survival 92.7%, event-free survival 89.5% and lymphoma-specific survival 100.0%). Disease relapse observed in 10 patients. Cumulative incidence of disease-specific death was 1.7% of the followed patients. Primary disease stage associated with lymphoma-specific survival.

Conclusion

Stage-adapted reduction towards IF in gMZL resulted in favorable adverse effects, local control and survival rates. These results support further decreases in modern RT of gMZL.

Keywords

Indolent gastric lymphoma Non-Hodgkin lymphoma Extended field Involved field Radiation therapy 

Erfolgreiche Strahlenfeldverkleinerung bei gastralem Marginalzonenlymphom

Erfahrungen der Deutschen Studiengruppe Gastrointestinale Lymphome (DSGL)

Zusammenfassung

Zielsetzung

Langzeiteffekt der stadienadaptierten Strahlenfeldverkleinerung bei kurativer Radiotherapie (RT) in einer großen Kohorte von Patienten mit gastralem Marginalzonenlymphom (gMZL).

Patienten und Methoden

Prospektive Analyse der Papierakten von 290 Patienten mit gMZL im Stadium IE–IIE, behandelt in 78 radiotherapeutischen Institutionen in Deutschland von 1992–2013. Stadienadaptierte Strahlenfeldreduktion vom „extended field“ (EF) zum „involved field“ (IF) im Verlauf der drei konsekutiven prospektiven Studien der Deutschen Studiengruppe Gastrointestinale Lymphome (DSGL). Behandlungsergebnisse wurden zwischen den drei Studienkohorten verglichen.

Ergebnisse

Gesamtkollektiv mit medianem Alter von 60 Jahren; Geschlechterverhältnis m:w = 1,1:1 und Stadienverhältnis I:II = 2,1:1. Medianes Follow-up insgesamt 6,4 Jahre: 13,0 Jahre in der ersten gastrointestinalen Studie (GIT 1992), 8,2 Jahre in der zweiten (GIT 1996) und 4,7 Jahre in der dritten Studie (DSGL 01/2003). Die stadienadaptierte Strahlenfeldverkleinerung zusammen mit der technischen Weiterentwicklung führte zu reduzierten relativen Häufigkeiten der akuten/chronischen Nebenwirkungen und ist bislang begleitet von einer niedrigeren Rezidivrate. Das Konzept der dritten Studie mit der kleinsten Feldausdehnung (IF im Stadium I, lokoregionales EF im Stadium II) erreichte die besten Überlebensraten nach einem Follow-up von 5 Jahren (Gesamtüberleben 92,7%, ereignisfreies Überleben 89,5% und lymphomspezifisches Überleben 100,0%). Lymphomrezidive wurden bei 10 Patienten beobachtet. Die kumulative Inzidenz der krankheitsspezifischen Todesrate bei den nachbeobachteten Patienten betrug 1,7%. Das primäre Krankheitsstadium war assoziiert mit dem lymphomspezifischen Überleben.

Schlussfolgerung

Die stadienadaptierte Feldverkleinerung zum IF bei gMZL resultiert in günstigen Nebenwirkungen, lokaler Kontrolle und Überlebensraten. Diese Ergebnisse bekräftigen die weitere Deeskalation der modernen RT von gMZL.

Schlüsselwörter

Indolentes Magenlymphom Non-Hodgkin-Lymphom Extended field Involved field Radiotherapie 

Notes

Acknowledgements

We thank all patients, treating physicians, investigators and participants, who provided ongoing support for these trials. This work was supported by 78 radiotherapeutic institutions in Germany, listed in the appendix. The biostatistical assistance of Dr. Rene Schmidt, Institute of Biostatistics and Clinical Research University of Münster, is gratefully acknowledged.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical guidelines

Conflict of interest

G. Reinartz, R.P. Pyra, G. Lenz, R. Liersch, G. Stüben, O. Micke, K. Willborn, C.F. Hess, A. Probst, R. Jany, J. Schultze, C. Rübe, C. Hirt, W. Fischbach, M. Bentz, S. Daum, C. Pott, M. Tiemann, P. Möller, A. Neubauer, M. Wilhelm, N. Willich, W.E. Berdel and H.T. Eich declare that they have no competing interests. R. Fietkau reports grants, personal fees and non-financial support from Merck Serono, personal fees and non-financial support from Fresenius Kabi, personal fees and non-financial support from Novocure, grants, personal fees and non-financial support from MSD, grants, personal fees and non-financial support from AstraZeneca, personal fees and non-financial support from Brainlab, personal fees and non-financial support from Sennewald GmbH, personal fees and non-financial support from Bristol-Myers Squibb, outside the submitted work.

Ethical standards

The trials were conducted in accordance with the Declaration of Helsinki on Ethical Principles for Medical Research after approval of the Ethical Board of the physicians’ chamber of Westfalia-Lippe and the Westfalian Wilhelms-University of Münster. The studies were reviewed by the local Ethical Committees (institutional review boards) of the involved trials sites.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Gabriele Reinartz
    • 1
    Email author
  • Regina P. Pyra
    • 1
  • Georg Lenz
    • 2
  • Rüdiger Liersch
    • 2
  • Georg Stüben
    • 3
  • Oliver Micke
    • 4
  • Kay Willborn
    • 5
  • Clemens F. Hess
    • 6
  • Andreas Probst
    • 7
  • Rainer Fietkau
    • 8
  • Ralf Jany
    • 9
  • Jürgen Schultze
    • 10
  • Christian Rübe
    • 11
  • Carsten Hirt
    • 12
  • Wolfgang Fischbach
    • 13
  • Martin Bentz
    • 14
  • Severin Daum
    • 15
  • Christiane Pott
    • 16
  • Markus Tiemann
    • 17
  • Peter Möller
    • 18
  • Andreas Neubauer
    • 19
  • Martin Wilhelm
    • 20
  • Normann Willich
    • 1
  • Wolfgang E. Berdel
    • 2
  • Hans T. Eich
    • 1
  1. 1.Department of Radiation OncologyUniversity Hospital of MünsterMünsterGermany
  2. 2.Department of Medicine A, Hematology, Oncology and PneumologyUniversity Hospital of MünsterMünsterGermany
  3. 3.Department of Radiation OncologyHospital AugsburgAugsburgGermany
  4. 4.Department of Radiotherapy and Radiation OncologyFranziskus Hospital BielefeldBielefeldGermany
  5. 5.Department of Radiotherapy and Radiation OncologyPius Hospital OldenburgOldenburgGermany
  6. 6.Department of Radiation OncologyUniversity Hospital of GöttingenGöttingenGermany
  7. 7.Department of GastroenterologyCentral HospitalAugsburgGermany
  8. 8.Department of Radiation OncologyUniversity of ErlangenErlangenGermany
  9. 9.Department of Radiation OncologySaint Marien HospitalHammGermany
  10. 10.Department of Radiation OncologyUniversity of Schleswig-HolsteinKielGermany
  11. 11.Department of Radiation OncologyUniversity of SaarlandHomburgGermany
  12. 12.Department of Medical OncologyUniversity of GreifswaldGreifswaldGermany
  13. 13.Department of Gastroenterology and OncologyHospital of AschaffenburgAschaffenburgGermany
  14. 14.Department of Medical OncologyMunicipal Hospital of KarlsruheKarlsruheGermany
  15. 15.Department of GastroenterologyUniversity CharitéBerlinGermany
  16. 16.Department of Medical OncologyUniversity of Schleswig-HolsteinKielGermany
  17. 17.Institute for Hematopathology HamburgHamburgGermany
  18. 18.Department of PathologyUniversity of UlmUlmGermany
  19. 19.Department of Medical OncologyUniversity of MarburgMarburgGermany
  20. 20.Department of Medical Oncology, Klinikum NürnbergParacelsus Medical UniversityNürnbergGermany

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