Management of MALT lymphoma depends significantly on the site of the disease.
Gastric MALT Lymphoma
Helicobacter pylori eradication with triple therapy is the first step in treatment of gastric MALT lymphoma. This is effective in eradicating H. pylori in over 90% of patients. Median response time is 5 months.
If there is persistence of lymphoma after H. pylori eradication is an indication for radiotherapy. Radiotherapy has close to a 100% response rate.
- Patients should be treated early in the morning to ensure a small, reproducible stomach volume.
- Some centres use metoclopramide to promote stomach emptying.
- The volume usually includes the stomach with a small margin for CTV, a significant expansion for ITV and the usual margin for PTV. Alternatively a 2 cm expansion from the stomach to create the PTV is likely to cover all significant areas, accounting for patient respiration.
- Dose is usually 30 Gy in 15 fractions
- Limiting organs include both kidneys (particularly the left)
Chemotherapy has limited effectiveness when compared to radiotherapy and H. pylori eradication.