{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:22:48Z","timestamp":1780507368835,"version":"3.54.1"},"reference-count":116,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T00:00:00Z","timestamp":1644451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Gastric marginal zone lymphoma (gMZL) of mucosa-associated lymphoid tissue (MALT) may persist even after H. pylori eradication, or it can be primarily Helicobacter pylori (H. pylori) independent. For patients without the successful eradication of lymphoma, or with progressive disease, treatment options have historically included partial or total gastrectomy. Presently, in these instances, curative radiation therapy (RT) is the current standard of care. This review emphasizes the historically changing role of radiation therapy in gMZL, progressing from large-volume RT without surgery, to localized RT, on its own, as a curative organ-preserving treatment. This overview shows the substantial progress in radiation therapy during the recent two to three decades, from high-dose, large-field techniques to low-dose, localized target volumes based on advanced imaging, three-dimensional treatment planning, and advanced treatment delivery techniques. RT has evolved from very large extended field techniques (EF) with prophylactic treatment of the whole abdomen and the supradiaphragmatic lymph nodes, applying doses between 30 and 50 Gy, to involved-field RT (IF), to the current internationally recommended involved site radiation therapy (ISRT) with a radiation dose of 24\u201330 Gy in gMZL. Stage-adapted RT is a highly effective and safe treatment with excellent overall survival rates and very rare acute or late treatment-related toxicities, as shown not only in retrospective studies, but also in large prospective multicenter studies, such as those conducted by the German Study Group on Gastrointestinal Lymphoma (DSGL). Further de-escalation of the radiation treatments with low-dose 20 Gy, as well as ultra-low-dose 4 Gy radiation therapy, is under investigation within ongoing prospective clinical trials of the International Lymphoma Radiation Oncology Group (ILROG) and of the German Lymphoma Alliance (GLA).<\/jats:p>","DOI":"10.3390\/cancers14040873","type":"journal-article","created":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T02:37:46Z","timestamp":1644547066000},"page":"873","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Development of Organ-Preserving Radiation Therapy in Gastric Marginal Zone Lymphoma"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7733-6854","authenticated-orcid":false,"given":"Daniel","family":"Rolf","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, University Hospital of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4869-5986","authenticated-orcid":false,"given":"Gabriele","family":"Reinartz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospital of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Rehn","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospital of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Kittel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospital of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans Theodor","family":"Eich","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospital of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"vi144","DOI":"10.1093\/annonc\/mdt343","article-title":"Gastric marginal zone lymphoma of MALT type: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"24","author":"Zucca","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2515","DOI":"10.1002\/1097-0142(19840601)53:11<2515::AID-CNCR2820531125>3.0.CO;2-C","article-title":"Extranodal malignant lymphoma arising from mucosa-associated lymphoid tissue","volume":"53","author":"Isaacson","year":"1984","journal-title":"Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/0140-6736(93)91409-F","article-title":"Regression of primary low-grade B-cell gastric lymphoma of mucosa-associated lymphoid tissue type after eradication of Helicobacter pylori","volume":"342","author":"Wotherspoon","year":"1993","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1002\/1097-0142(19900915)66:6<1283::AID-CNCR2820660631>3.0.CO;2-4","article-title":"Increasing incidence of primary gastric lymphoma","volume":"66","author":"Severson","year":"1990","journal-title":"Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2470","DOI":"10.1016\/j.ejca.2008.07.005","article-title":"Gastric MALT lymphoma: Epidemiology and high adenocarcinoma risk in a nation-wide study","volume":"44","author":"Capelle","year":"2008","journal-title":"Eur. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1093\/annonc\/mds643","article-title":"ESMO Consensus conferences: Guidelines on malignant lymphoma. Part 2: Marginal zone lymphoma, mantle cell lymphoma, peripheral T-cell lymphoma","volume":"24","author":"Dreyling","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.cgh.2009.07.017","article-title":"Effects of Helicobacter pylori Eradication on Early Stage Gastric Mucosa\u2013Associated Lymphoid Tissue Lymphoma","volume":"8","author":"Zullo","year":"2010","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1093\/annonc\/mdn760","article-title":"Long-term outcome following Helicobacter pylori eradication in a retrospective study of 105 patients with localized gastric marginal zone B-cell lymphoma of MALT type","volume":"20","author":"Stathis","year":"2009","journal-title":"Ann. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1136\/gut.2010.224949","article-title":"EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT","volume":"60","author":"Fischbach","year":"2011","journal-title":"Gut"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1016\/S0360-3016(99)00522-2","article-title":"Low-grade MALT lymphoma of the stomach: A review of treatment options","volume":"46","author":"Schechter","year":"2000","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1136\/gut.2006.096420","article-title":"Most patients with minimal histological residuals of gastric MALT lymphoma after successful eradication of Helicobacter pylori can be managed safely by a watch and wait strategy: Experience from a large international series","volume":"56","author":"Fischbach","year":"2007","journal-title":"Gut"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1038\/bjc.1998.82","article-title":"A 15-year series of gastrointestinal non-Hodgkin\u2019s lymphomas: A population-based study","volume":"77","author":"Ducreux","year":"1998","journal-title":"Br. J. Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/01.sla.0000129356.81281.0c","article-title":"The Diminishing Role of Surgery in the Treatment of Gastric Lymphoma","volume":"240","author":"Yoon","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3874","DOI":"10.1200\/JCO.2001.19.18.3874","article-title":"Primary Gastrointestinal Non-Hodgkin\u2019s Lymphoma: II. Combined Surgical and Conservative or Conservative Management Only in Localized Gastric Lymphoma\u2014Results of the Prospective German Multicenter Study GIT NHL 01\/92","volume":"19","author":"Koch","year":"2001","journal-title":"J. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/0167-8140(88)90203-4","article-title":"Treatment results of primary stage I and II non-Hodgkin\u2019s lymphoma of the stomach","volume":"11","author":"Burgers","year":"1988","journal-title":"Radiother. Oncol."},{"key":"ref_16","first-page":"780","article-title":"Non-Hodgkin\u2019s lymphoma of the stomach","volume":"78","author":"Mittal","year":"1983","journal-title":"Am. J. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/10428199109107052","article-title":"Alternatives in the Management of Gastric Lymphoma","volume":"4","author":"Varsos","year":"1991","journal-title":"Leuk. Lymphoma"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1038\/bjc.1993.141","article-title":"Primary gastrointestinal non-Hodgkin\u2019s lymphoma: A review of 175 British National Lymphoma Investigation cases","volume":"67","author":"Morton","year":"1993","journal-title":"Br. J. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/0016-5085(93)91061-L","article-title":"Primary digestive tract lymphoma: A prospective multicentric study of 91 patients","volume":"105","author":"Aegerter","year":"1993","journal-title":"Gastroenterology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/0016-5085(94)90742-0","article-title":"Gastrointestinal lymphoma in adults: Clinical features and management of 300 cases","volume":"106","author":"Amer","year":"1994","journal-title":"Gastroenterology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1055\/s-2008-1058772","article-title":"Kombinierte konservative Behandlung von lokalisierten Magenlymphomen","volume":"119","author":"Sonnen","year":"1994","journal-title":"DMW-Dtsch. Med. Wochenschr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3109\/10428199509059619","article-title":"A Retrospective Analysis of Treatment Outcome in 106 Cases of Localized Gastric Non-Hodgkin Lymphomas","volume":"18","author":"Brincker","year":"1995","journal-title":"Leuk. Lymphoma"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1002\/hon.2900130305","article-title":"Prognostic factors for primary gastrointestinal lymphoma","volume":"13","author":"Liang","year":"1995","journal-title":"Hematol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3861","DOI":"10.1200\/JCO.2001.19.18.3861","article-title":"Primary Gastrointestinal Non-Hodgkin\u2019s Lymphoma: I. Anatomic and Histologic Distribution, Clinical Features, and Survival Data of 371 Patients Registered in the German Multicenter Study GIT NHL 01\/92","volume":"19","author":"Koch","year":"2001","journal-title":"J. Clin. Oncol."},{"key":"ref_25","unstructured":"Armitage, J.O., Coiffier, B., Dalla-Favera, R., Harris, N., and Mauch, P.M. (2009). The history of radiation therapy of lymphomas and description of early trials. On-Hodgkin\u2019s Lymphomas, Lippincott Williams & Wilkins. [2nd ed.]."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1056\/NEJM199803193381205","article-title":"Molecular Analysis of the Progression fromHelicobacter pylori\u2013Associated Chronic Gastritis to Mucosa-Associated Lymphoid-Tissue Lymphoma of the Stomach","volume":"338","author":"Zucca","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ijrobp.2015.01.009","article-title":"Modern Radiation Therapy for Extranodal Lymphomas: Field and Dose Guidelines from the International Lymphoma Radiation Oncology Group","volume":"92","author":"Yahalom","year":"2015","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1007\/s00066-019-01446-5","article-title":"Erfolgreiche Strahlenfeldverkleinerung bei gastralem Marginalzonenlymphom: Erfahrungen der Deutschen Studiengruppe Gastrointestinale Lymphome (DSGL)","volume":"195","author":"Reinartz","year":"2019","journal-title":"Strahlenther. Onkol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.ijrobp.2015.01.040","article-title":"Long-Term Outcomes and Patterns of Relapse of Early-Stage Extranodal Marginal Zone Lymphoma Treated with Radiation Therapy with Curative Intent","volume":"92","author":"Teckie","year":"2015","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1182\/bloodadvances.2020003992","article-title":"Involved-site radiotherapy for Helicobacter pylori\u2013independent gastric MALT lymphoma: 26 years of experience with 178 patients","volume":"5","author":"Yahalom","year":"2021","journal-title":"Blood Adv."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/00000658-196908000-00011","article-title":"Primary Lymphoma of the Gastrointestinal Tract","volume":"170","author":"Loehr","year":"1969","journal-title":"Ann. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1093\/jnci\/85.23.1932","article-title":"Second Cancers Among Long-term Survivors of Non-Hodgkin\u2019s Lymphoma","volume":"85","author":"Travis","year":"1993","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1093\/jnci\/djr533","article-title":"Second Malignant Neoplasms and Cardiovascular Disease Following Radiotherapy","volume":"104","author":"Travis","year":"2012","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/S1470-2045(14)70036-1","article-title":"4 Gy versus 24 Gy radiotherapy for patients with indolent lymphoma (FORT): A randomised phase 3 non-inferiority trial","volume":"15","author":"Hoskin","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.radonc.2011.05.013","article-title":"Reduced dose radiotherapy for local control in non-Hodgkin lymphoma: A randomised phase III trial","volume":"100","author":"Lowry","year":"2011","journal-title":"Radiother. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"650","DOI":"10.6004\/jnccn.2019.0029","article-title":"NCCN Guidelines Insights: B-Cell Lymphomas, Version 3.2019","volume":"17","author":"Zelenetz","year":"2019","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Reinartz, G., Baehr, A., Kittel, C., Oertel, M., Haverkamp, U., and Eich, H. (2021). Biophysical Analysis of Acute and Late Toxicity of Radiotherapy in Gastric Marginal Zone Lymphoma\u2014Impact of Radiation Dose and Planning Target Volume. Cancers, 13.","DOI":"10.3390\/cancers13061390"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/S0360-3016(99)00475-7","article-title":"Operative and conservative management of primary gastric lymphoma: Interim results of a German multicenter study","volume":"46","author":"Willich","year":"2000","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1200\/JCO.1990.8.2.266","article-title":"Stomach conservation in stages IE and IIE gastric non-Hodgkin\u2019s lymphoma","volume":"8","author":"Maor","year":"1990","journal-title":"J. Clin. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1093\/oxfordjournals.annonc.a058390","article-title":"The clinical spectrum and treatment of primary non-Hodgkin\u2019s lymphoma of the stomach","volume":"4","author":"Taal","year":"1993","journal-title":"Ann. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0167-8140(96)01832-4","article-title":"Radiotherapy for treatment of localized gastrointestinal non-Hodgkin\u2019s lymphoma","volume":"42","author":"Kocher","year":"1997","journal-title":"Radiother. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1916","DOI":"10.1200\/JCO.1998.16.5.1916","article-title":"Treatment of mucosa-associated lymphoid tissue lymphoma of the stomach with radiation alone","volume":"16","author":"Schechter","year":"1998","journal-title":"J. Clin. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"B66","DOI":"10.1007\/PL00022794","article-title":"Management of localized (stage I and II) clinically aggressive lymphomas","volume":"80","author":"Tsang","year":"2001","journal-title":"Ann. Hematol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"7050","DOI":"10.1200\/JCO.2005.04.031","article-title":"Treatment Results in Localized Primary Gastric Lymphoma: Data of Patients Registered within the German Multicenter Study (GIT NHL 02\/96)","volume":"23","author":"Koch","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.ijrobp.2004.10.025","article-title":"Radiation treatment planning techniques for lymphoma of the stomach","volume":"62","author":"Hunt","year":"2005","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1385\/MO:22:1:057","article-title":"Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach: Results of a controlled clinical trial","volume":"22","author":"Nambo","year":"2005","journal-title":"Med. Oncol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1269\/jrr.11018","article-title":"Intrafractional gastric motion and interfractional stomach deformity using CT images","volume":"52","author":"Watanabe","year":"2011","journal-title":"J. Radiat. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.radonc.2008.02.012","article-title":"Long-term results of stomach-conserving therapy in gastric MALT lymphoma","volume":"87","author":"Vrieling","year":"2008","journal-title":"Radiother. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.radonc.2008.12.004","article-title":"Favorable outcomes of radiotherapy for early-stage mucosa-associated lymphoid tissue lymphoma","volume":"90","author":"Tomita","year":"2009","journal-title":"Radiother. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1111\/j.1440-1746.2009.06204.x","article-title":"Long-term treatment of localized gastric marginal zone B-cell mucosa associated lymphoid tissue lymphoma including incidence of metachronous gastric cancer","volume":"25","author":"Ono","year":"2010","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3815","DOI":"10.1002\/cncr.25226","article-title":"Long-term outcome in localized extranodal mucosa-associated lymphoid tissue lymphomas treated with radiotherapy","volume":"116","author":"Goda","year":"2010","journal-title":"Cancer"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1055\/s-0029-1246012","article-title":"Outcome and quality of life favour a conservative treatment of patients with primary gastric lymphoma","volume":"49","author":"Fischbach","year":"2011","journal-title":"Z. Gastroenterol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1093\/annonc\/mds623","article-title":"Long-term outcome for gastric marginal zone lymphoma treated with radiotherapy: A retrospective, multi-centre, International Extranodal Lymphoma Study Group study","volume":"24","author":"Wirth","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1093\/jjco\/hyt097","article-title":"A Retrospective Study of 5-year Outcomes of Radiotherapy for Gastric Mucosa-associated Lymphoid Tissue Lymphoma Refractory to Helicobacter pylori Eradication Therapy","volume":"43","author":"Abe","year":"2013","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.radonc.2015.08.029","article-title":"Exclusive moderate-dose radiotherapy in gastric marginal zone B-cell MALT lymphoma: Results of a prospective study with a long term follow-up","volume":"117","author":"Fabiani","year":"2015","journal-title":"Radiother. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1093\/jrr\/rrw044","article-title":"Radiotherapy for localized gastric mucosa\u2013associated lymphoid tissue lymphoma: Long-term outcomes over 10 years","volume":"58","author":"Ohkubo","year":"2017","journal-title":"J. Radiat. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.ijrobp.2019.02.002","article-title":"Outcomes After Reduced-Dose Intensity Modulated Radiation Therapy for Gastric Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma","volume":"104","author":"Pinnix","year":"2019","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"100714","DOI":"10.1016\/j.adro.2021.100714","article-title":"Comparable Efficacy of Reduced Dose Radiation Therapy for the Treatment of Early Stage Gastric Extranodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue","volume":"6","author":"Saifi","year":"2021","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_59","first-page":"332","article-title":"Lymphosarcoma of the stomach, diagnosis and treatment","volume":"42","author":"Archer","year":"1939","journal-title":"Am. J. Roentgenol."},{"key":"ref_60","first-page":"425","article-title":"Prognostic significance of primary site after radiotherapy in non-Hodgkin\u2019s lymphomata","volume":"2","author":"Musshoff","year":"1975","journal-title":"Br. J. Cancer Suppl."},{"key":"ref_61","first-page":"168","article-title":"A summary of the results of a review of 405 patients with non-Hodgkin\u2019s lymphoma at Stanford University","volume":"2","author":"Rosenberg","year":"1975","journal-title":"Br. J. Cancer Suppl."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S0167-8140(85)80086-4","article-title":"Role of radiation therapy in localized non-Hodgkin\u2019s lymphoma","volume":"4","author":"Sutcliffe","year":"1985","journal-title":"Radiother. Oncol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s000660050047","article-title":"Analysis of Failures after Whole Abdominal Irradiation in Gastrointestinal Lympomas. Is Prophylactic Irradiation of Inguinal Lymph Nodes Required? German Multicenter Study Group on GI-NHL, University of Muenster","volume":"175","author":"Reinartz","year":"1999","journal-title":"Strahlenther. Onkol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1097\/00000658-198202000-00013","article-title":"Management of Primary Gastric Lymphoma","volume":"195","author":"Shiu","year":"1982","journal-title":"Ann. Surg."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1002\/1097-0142(19800701)46:1<215::AID-CNCR2820460136>3.0.CO;2-6","article-title":"Gastrointestinal involvement in non-Hodgkin\u2019s lymphoma","volume":"46","author":"Herrmann","year":"1980","journal-title":"Cancer"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1148\/92.6.1349","article-title":"Primary Lymphoma of the Gastrointestinal Tract","volume":"92","author":"Bush","year":"1969","journal-title":"Radiology"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1002\/bjs.1800740620","article-title":"Primary gastric lymphoma","volume":"74","author":"Hockey","year":"1987","journal-title":"Br. J. Surg."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/S0002-9610(88)80268-X","article-title":"Primary gastric lymphoma: Problems in staging and management","volume":"155","author":"Jones","year":"1988","journal-title":"Am. J. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/00000658-198005000-00011","article-title":"Primary Lymphoma of the Gastrointestinal Tract","volume":"191","author":"Contreary","year":"1980","journal-title":"Ann. Surg."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1097\/00000658-198706000-00004","article-title":"Is an Aggressive Surgical Approach to the Patient with Gastric Lymphoma Warranted?","volume":"205","author":"Rosen","year":"1987","journal-title":"Ann. Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.1002\/1097-0142(19831201)52:11<2044::AID-CNCR2820521113>3.0.CO;2-5","article-title":"Primary gastric lymphoma. An analysis with emphasis on prognostic factors and radiation therapy","volume":"52","author":"Shimm","year":"1983","journal-title":"Cancer"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1053\/gast.2000.19579","article-title":"Primary gastric B-Cell lymphoma: Results of a prospective multicenter study","volume":"119","author":"Fischbach","year":"2000","journal-title":"Gastroenterology"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1002\/1097-0142(197704)39:4<1715::AID-CNCR2820390449>3.0.CO;2-M","article-title":"Factors in the prognosis of gastric lymphoma","volume":"39","author":"Lim","year":"1977","journal-title":"Cancer"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/S1470-2045(20)30686-0","article-title":"4 Gy versus 24 Gy radiotherapy for follicular and marginal zone lymphoma (FoRT): Long-term follow-up of a multicentre, randomised, phase 3, non-inferiority trial","volume":"22","author":"Hoskin","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"4157","DOI":"10.1200\/JCO.2003.06.085","article-title":"Localized Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy Has Excellent Clinical Outcome","volume":"21","author":"Tsang","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.6004\/jnccn.2021.0054","article-title":"NCCN Clinical Practice Guidelines in Oncology: Non-Hodgkin\u2019s Lymphomas. NCCN Guidelines Insights: B-Cell Lymphomas, Version 5.2021","volume":"19","author":"Zelenetz","year":"2021","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1002\/hed.24717","article-title":"Ultra-low-dose radiotherapy for definitive management of ocular adnexal B-cell lymphoma","volume":"39","author":"Pinnix","year":"2017","journal-title":"Head Neck"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"e4250","DOI":"10.1097\/MD.0000000000004250","article-title":"Clinical characteristics and prognostic factors of primary gastric lymphoma: A retrospective study with 165 cases","volume":"95","author":"Wang","year":"2016","journal-title":"Medicine"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"6062","DOI":"10.3748\/wjg.v19.i36.6062","article-title":"Clinical outcomes of radiation therapy for early-stage gastric mucosa-associated lymphoid tissue lymphoma","volume":"19","author":"Kim","year":"2013","journal-title":"World J. Gastroenterol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1002\/1097-0142(19820315)49:6<1135::AID-CNCR2820490612>3.0.CO;2-E","article-title":"The role of surgery in the management of gastric lymphoma","volume":"49","author":"Fleming","year":"1982","journal-title":"Cancer"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/00000658-193908000-00004","article-title":"Primary lymphosarcoma of the stomach","volume":"110","author":"Taylor","year":"1939","journal-title":"Ann. Surg."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1984","DOI":"10.1002\/1097-0142(197805)41:5<1984::AID-CNCR2820410544>3.0.CO;2-8","article-title":"Diffuse histiocytic lymphoma involving the gas-trointestinal tract","volume":"41","author":"Hande","year":"1978","journal-title":"Cancer"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1016\/0277-5379(85)90015-X","article-title":"A prospective study of the treatment of high-grade histology non-Hodgkin\u2019s lymphoma involving the gastrointestinal tract","volume":"21","author":"Steward","year":"1985","journal-title":"Eur. J. Cancer Clin. Oncol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"2188","DOI":"10.1002\/1097-0142(19800415)45:8<2188::AID-CNCR2820450830>3.0.CO;2-E","article-title":"Diffuse histiocytic lymphoma presenting with gastrointestinal tract lesions the stan-ford experience","volume":"45","author":"Rosenfelt","year":"1980","journal-title":"Cancer"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1001\/archsurg.1990.01410200030003","article-title":"Gastrointestinal Lymphoma: A case for primary surgical resection","volume":"125","author":"Talamonti","year":"1990","journal-title":"Arch. Surg."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/S0360-3016(98)00083-2","article-title":"Outcomes of high-dose unilateral kidney irradiation in patients with gastric lymphoma","volume":"41","author":"Maor","year":"1998","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/0360-3016(92)90955-H","article-title":"Evidence for a renovascular component in hypertensive patients with late radiation nephropathy","volume":"30","author":"Verheij","year":"1994","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_88","first-page":"79","article-title":"Decreased heart dose with deep inspiration breath hold for the treatment of gastric lymphoma with IMRT","volume":"24","author":"Christopherson","year":"2020","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1097\/COC.0000000000000747","article-title":"Radiotherapy in Early-stage Gastric MALT","volume":"43","author":"Bates","year":"2020","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1002\/1097-0142(19871015)60:8<1876::AID-CNCR2820600834>3.0.CO;2-S","article-title":"Gastric adenocarcinoma after gastric lymphoma","volume":"60","author":"Baron","year":"1987","journal-title":"Cancer"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1002\/1097-0142(197810)42:4<2039::AID-CNCR2820420454>3.0.CO;2-0","article-title":"Primary gastric malignant lymphoma followed by gastric adenocarcino-ma. Report of 4 cases and review of the literature","volume":"42","author":"Shani","year":"1978","journal-title":"Cancer"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/BF01948122","article-title":"Lymphoma of the stomach following gastric surgery for benign peptic ulcers","volume":"8","author":"Ghahremani","year":"1983","journal-title":"Gastrointest. Radiol."},{"key":"ref_93","first-page":"103","article-title":"Why does intestinal metaplasia develop early on gastric mucosa of mucosa-associated lymphoid tissue lymphoma patients?","volume":"33","author":"Zullo","year":"2020","journal-title":"Ann. Gastroenterol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1136\/jcp.47.12.1123","article-title":"Lymphocytic gastritis, gastric adenocarcinoma, and primary gastric lymphoma","volume":"47","author":"Griffiths","year":"1994","journal-title":"J. Clin. Pathol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/00008469-199403030-00003","article-title":"Helicobacter pylori: The link with gastric cancer","volume":"3","author":"Buset","year":"1994","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.canlet.2010.07.014","article-title":"Helicobacter pylori in the pathogenesis of gastric cancer and gastric lymphoma","volume":"305","author":"Kim","year":"2011","journal-title":"Cancer Lett."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1023\/A:1008328226599","article-title":"Incidence of second neoplasms in patients with MALT lymphoma: No increase in risk above the background population","volume":"10","author":"Au","year":"1999","journal-title":"Ann. Oncol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.3109\/10428194.2012.743657","article-title":"Risk of second malignant neoplasms after cyclophosphamide-based chemotherapy with or without radiotherapy for non-Hodgkin lymphoma","volume":"54","author":"Xu","year":"2012","journal-title":"Leuk. Lymphoma"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"e471","DOI":"10.1016\/j.prro.2017.03.001","article-title":"Daily CT guidance improves target coverage during definitive radiation therapy for gastric MALT lymphoma","volume":"7","author":"Wang","year":"2017","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"e85","DOI":"10.1016\/j.prro.2012.02.001","article-title":"Determination of planning target volume for whole stomach irradiation using daily megavoltage computed tomographic images","volume":"2","author":"Johnson","year":"2012","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1007\/s00066-016-0949-0","article-title":"4D-Listmode-PET-CT und 4D-CT f\u00fcr die Optimierung des PTV-Sicherheitsabstandes bei Magenlymphomen: Erfassung der intra- und interfraktionellen Magenbewegung","volume":"192","author":"Reinartz","year":"2016","journal-title":"Strahlenther. Onkol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/1748-717X-7-98","article-title":"Incorporating breath holding and image guidance in the adjuvant gastric cancer radiotherapy: A dosimetric study","volume":"7","author":"Hu","year":"2012","journal-title":"Radiat. Oncol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1007\/s00535-018-1517-4","article-title":"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","volume":"54","author":"Schmelz","year":"2018","journal-title":"J. Gastroenterol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/j.ijrobp.2013.04.035","article-title":"Low-Dose Radiation Therapy (2 Gy \u00d7 2) in the Treatment of Orbital Lymphoma","volume":"86","author":"Fasola","year":"2013","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"e781","DOI":"10.1016\/j.ijrobp.2010.10.013","article-title":"Palliation by Low-Dose Local Radiation Therapy for Indolent Non-Hodgkin Lymphoma","volume":"81","author":"Chan","year":"2011","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/hon.2900120102","article-title":"Potential role for low dose limited-field radiation therapy (2 \u00d7 2 grays) in advanced low-grade non-Hodgkin\u2019s lymphomas","volume":"12","author":"Ganem","year":"1994","journal-title":"Hematol. Oncol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1093\/annonc\/mdn529","article-title":"Response to low-dose involved-field radiotherapy in patients with non-Hodgkin\u2019s lymphoma","volume":"19","author":"Luthy","year":"2008","journal-title":"Ann. Oncol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1016\/j.ejca.2005.04.033","article-title":"Effective palliation by low dose local radiotherapy for recurrent and\/or chemotherapy refractory non-follicular lymphoma patients","volume":"41","author":"Haas","year":"2005","journal-title":"Eur. J. Cancer"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S0167-8140(96)01854-3","article-title":"Low dose palliative radiotherapy in low grade non-Hodgkin\u2019s lymphoma","volume":"42","author":"Sawyer","year":"1997","journal-title":"Radiother. Oncol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"2474","DOI":"10.1200\/JCO.2003.09.542","article-title":"High Response Rates and Lasting Remissions After Low-Dose Involved Field Radiotherapy in Indolent Lymphomas","volume":"21","author":"Haas","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.ijrobp.2012.11.016","article-title":"FoRT: A Phase 3 Multi-Center Prospective Randomized Trial of Low Dose Radiation Therapy for Follicular and Marginal Zone Lymphoma","volume":"85","author":"Hoskin","year":"2013","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"436","DOI":"10.4161\/cc.7.4.5441","article-title":"The role of the p53 pathway in the treatment of follicular lymphoma","volume":"7","author":"Knoops","year":"2008","journal-title":"Cell Cycle"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1182\/blood-2007-01-067579","article-title":"In vivo p53 response and immune reaction underlie highly effective low-dose radiotherapy in follicular lymphoma","volume":"110","author":"Knoops","year":"2007","journal-title":"Blood"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"674","DOI":"10.2967\/jnumed.107.043752","article-title":"In Vitro Evaluation of Radioprotective and Radiosensitizing Effects of Rituximab","volume":"49","author":"Kapadia","year":"2008","journal-title":"J. Nucl. Med."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1269\/jrr.46.241","article-title":"Pretreatment with Rituximab Enhances Radiosensitivity of Non-Hodgkin\u2019s Lymphoma Cells","volume":"46","author":"Skvortsova","year":"2005","journal-title":"J. Radiat. Res."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1269\/jrr.47.183","article-title":"Rituximab Enhances Radiation-Triggered Apoptosis in Non-Hodgkin\u2019s Lymphoma Cells Via Caspase-dependent and-Independent Mechanisms","volume":"47","author":"Skvortsova","year":"2006","journal-title":"J. Radiat. 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