胃肠道淋巴瘤放疗进展

原发胃肠道淋巴瘤是最常见的结外非霍奇金淋巴瘤。胃肠道淋巴瘤为异质性的肿瘤，弥漫大B细胞淋巴瘤和粘膜相关淋巴瘤是最常见的病理类型，放疗在不同部位和病理类型的淋巴瘤治疗中地位不同。原发胃淋巴瘤接受保留胃功能的治疗可取得良好预后，弥漫大B细胞淋巴瘤化疗后（包括完全缓解）接受放疗可提高局控率和生存率，美罗华时代大肿块患者仍需要接受放疗以提高局部控制率。早期胃MALT淋巴瘤抗HP失败后，接受单纯放疗即可取得良好的预后。原发肠道侵袭性淋巴瘤的治愈手段仍为外科治疗，惰性淋巴瘤亦可选择放疗。

Recent progress in radiation therapy for primary gastrointestinal lymphoma

The gastrointestinal tract is the most common extranodal site of non-Hodgkin lymphoma. The gastrointestinal lymphoma represents a heterogeneous disease, where diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are the most common subtypes. The role of radiotherapy varies in the treatment of lymphomas from different sites or with different subtypes. Conservative treatment using chemotherapy and/or radiotherapy produced favorable outcomes in gastric lymphoma. In gastric DLBCL, radiotherapy after chemotherapy improved locoregional control and survival, even for patients who achieved complete response after chemotherapy. In the era of rituximab, radiotherapy also improved locoregional control in patients with bulky disease. In gastric MALT lymphoma, radiotherapy alone could yield excellent outcomes for patients who are unresponsive to H. pylori eradication. However, surgery remains the mainstay of radical treatment for intestinal lymphoma, and radiotherapy is also a choice for indolent subtypes.