How would you approach a patient with gastric MALT lymphoma who has CREST syndrome?

The quick answer is, very carefully. To elaborate - I first had to look up what CREST syndrome is - the short answer is limited extent scleroderma, usually the distal upper and lower extremities, but occasionally the head and neck region and most relevant to this question, the esophagus. The literature on the interactions between radiation and scleroderma is sparse but there is a good recent article from Hopkins and the Univ. of Pittsburgh:

Shah et al., PMID 29316366.

The great majority of the lit...

I would try antibiotics like any other MALT and if persists, then would favor 2 Gy X 2 to see if sufficient like other site MALT lymphoma. If persists, then favor other non RT options.