Search

Main idea of this article is to make a short overview of modern MALT lymphoma treatment approaches. Historically, surgery was the leading treatment modality. Discovery of H.pylori involvement, invention of new drugs and chemotherapy protocols, wide use of monoclonal antibodies, significantly raised the effectiveness of conservative treatment. Routine use of CT scanning, invention of conformal, precise radiotherapy techniques allowed to achieve fine radiotherapy treatment results, especially in the case of combined chemo – radiotherapy protocols. That is why nowadays conservative treatment plays more significant role. However, complete remission cannot be achieved in all the cases. More research is required and thorough analyze of advantages and disadvantages of every technique and their combinations.

Background We aimed to evaluate the effect of hypofractionated post-operative radiotherapy on overall survival, disease-free survival (DFS), and local control rate in completely resected stage IA–IIIB non-small-cell lung cancer (NSCLC); to estimate radiation-induced toxicity. Methods We retrospectively investigated 306 (266 male, 40 female) patients with stage IA–IIIB NSCLC who underwent complete resection of the lung tumour followed by post-operative radiotherapy in our institution from 1995 through 2012. Patients underwent pneumonectomy (34%), lobectomy (5%), bilobectomy (55%), or segmentectomy (6%). The post-operative pathological stages were I (41%), II (32%), and III (27%). Histology concluded adenocarcinoma (26%), squamous cell carcinoma (59%) or other (15%) pathologies. Following surgery, 149 patients received post-operative radiotherapy of 36 Gy in 12 daily fractions of 3 Gy (group 1), and 157 patients received post-operative radiotherapy of 44 Gy in 22 daily fractions of 2 Gy (group 2). Median follow-up was 25 months. Radiotherapy toxicity was scored in accordance to RTOG scale. Findings In group 1 and group 2, respectively, 5-year overall survival was 49.5 ± 5.2% and 45.6 ± 4.3%, 5-year DFS was 54.1 ± 5.1% and 52.1 ± 4.1%, and 5-year local control rate was 88.0 ± 4.5% and 87.0 ± 4.5%. Grade 1 oesophagitis was observed in 82.8% patients (group 1 79.8%; group 2 86.0%), grade 2 in 15% patients (group 1 17.8%; group 2 12.1%), and grade 3 in 2.2% patients (group 1 2.4%; group 2 1.9%). No late oesophageal toxicity was observed in either group. Grade 1 subclinical radiotherapy-induced pneumonitis was detected in about 67% of patients. Symptomatic radiation pneumonitis (grade ⩾ 2) was not detected in either group. Interpretation Hypofractionated post-operative radiotherapy achieved local disease control in 88% of patients with NSCLC without increasing treatment-related toxicity compared with a conventional irradiation regimen. Decreasing the number of fractions and length of the treatment allows radiation apparatuses to be occupied 30% less, and in turn allows more patients to be treated.