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Abstract

Background

Definitive radiotherapy (RT) doses ≥ 30 Gy are traditionally applied for Helicobacter pylori-independent stage IE gastric mucosa-associated lymphoid tissue (MALT) lymphoma, achieving excellent control. Although 24 Gy may offer comparable efficacy with reduced toxicity, high-quality comparative data are limited. This study aimed to compare the efficacy, toxicity, and long-term outcomes of 24 and 30 Gy RT.

Methods

We retrospectively analyzed 202 patients treated with RT for stage IE gastric MALT lymphoma between 2009 and 2023 (24 Gy, n = 74; 30 Gy, n = 128) at a single tertiary institution. Outcomes included complete remission (CR), freedom from treatment failure (FFTF), overall survival (OS), and grade 2 acute toxicity. Statistical methods included Fisher’s exact test, logistic regression, and Kaplan–Meier estimation, with additional technique-adjusted subgroup analyses to account for temporal changes in RT practice.

Results

Median follow-up was 55 months (24 Gy, 36 months; 30 Gy, 69 months; p < 0.001). All patients achieved CR, with 94.1% achieving within 6 months. The 5-year FFTF and OS rates were 99.4% and 100%, respectively. Grade 2 acute toxicity was significantly lower in the 24 Gy group (39.2%) than in the 30 Gy group (60.9%; p = 0.003). Nausea (39.6%) and dyspepsia (18.8%) were most common. Multivariable analysis identified higher-dose RT and female sex as independent predictors of toxicity. Only two patients (1.0%) experienced recurrence.

Conclusion

Given its comparable disease control to 30 Gy and significantly lower acute toxicity, RT at 24 Gy should be considered the standard dose of choice in this setting.

Affiliations

Jong Yun Baek 1, Do Hoon Lim 2, Jae J Kim 3, Jun Haeng Lee 3, Byung-Hoon Min 3, Hyuk Lee 3
1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea. dh8lim@skku.edu.
3Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.