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Journal of Gastroenterology

, Volume 54, Issue 5, pp 388–395 | Cite as

Sequential H. pylori eradication and radiation therapy with reduced dose compared to standard dose for gastric MALT lymphoma stages IE & II1E: a prospective randomized trial

  • Renate SchmelzEmail author
  • Stephan Miehlke
  • Christian Thiede
  • Stefan Brueckner
  • Monic Dawel
  • Matthias Kuhn
  • Agnes Ruskoné-Formestraux
  • Manfred Stolte
  • Christina Jentsch
  • Jochen Hampe
  • Andrea Morgner
Original Article—Alimentary Tract

Abstract

Background

In Helicobacter pylori (H. pylori) positive stage I gastric low-grade MALT lymphoma, eradication is the accepted first-line therapy. The role of eradication therapy in lymphoma > stage IE is still unclear. However, about 20% of patients show persistent lymphoma following successful eradication or primary H. pylori-negative lymphoma. A prospective study for salvage radiation therapy with standard 36 Gy in comparison to a reduced dose of 25.2 Gy is still missing.

Methods

A prospective, multicentre study investigated the efficacy of eradication in H. pylori-positive gastric low-grade MALT lymphoma stages IE and II1E (HELYX I). Refractory lymphoma or H. pylori-negative patients were treated in a prospective, randomised, multicentre, phase II study to receive either 25.2 Gy or 36 Gy radiotherapy (HELYX II).

Results

102 patients (3 drop outs) were included in HELYX I: 75/99 (75.8%) showed complete remission after a median of 2.8 months. 18 (18.2%) had partial remission (PR) and 6 (6.0%) no change (NC). 29 patients (7 drop outs) were randomized in HELYX II (7 primarily H. pylori-negative, 15 patients from HELYX I with refractory disease after eradication). All patients achieved stable CR irrespective of radiation dose. Both presence of the t(11,18) translocation (OR 9.0, p = 0.01) and monoclonality of the tumour cells (OR 6.3, p = 0.006) were predictors for persistant lymphoma after eradication therapy.

Conclusions

Most H. pylori-positive low grade gastric MALT lymphoma stage IE and II1E respond with stable CR after eradication therapy. In patients with refractory disease or H. pylori negative low grade gastric MALT lymphoma a dosage-reduced radiation therapy with 25.2 Gy is an effective standard dose in stage IE and II1E.

Trial registration

ClinicalTrials.gov: NCT00154440.

Keywords

Gastric low-grade MALT lymphoma Eradication Radiotherapy Translocation (11;18) 

Notes

Acknowledgements

This paper is dedicated to Professor Brigitte Dragosics and her enthusiasm for gastric lymphomas.

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Renate Schmelz
    • 1
    Email author
  • Stephan Miehlke
    • 2
  • Christian Thiede
    • 1
  • Stefan Brueckner
    • 1
  • Monic Dawel
    • 3
  • Matthias Kuhn
    • 4
  • Agnes Ruskoné-Formestraux
    • 5
  • Manfred Stolte
    • 6
  • Christina Jentsch
    • 3
  • Jochen Hampe
    • 1
  • Andrea Morgner
    • 7
  1. 1.Medical Departement 1University Hospital Carl Gustav Carus, Technical UniversityDresdenGermany
  2. 2.Center for Digestive Diseases, Cooperation of Internal MedicineHamburgGermany
  3. 3.Department of Radiation Oncology, Faculty of MedicineUniversity Hospital Carl Gustav Carus, Technische UniversitätDresdenGermany
  4. 4.Institute for Medical Informatics and BiometryTechnical UniversityDresdenGermany
  5. 5.Service de GastroentérologieSt Antoine HospitalParisFrance
  6. 6.Institute for Pathology, Hospital KulmbachKulmbachGermany
  7. 7.University Hospital Hamburg-Eppendorf, Center for Oncology and University Cancer Center Hamburg (UCCH)HamburgGermany

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