What volume and dose would you use for a Stage I MALT lymphoma of the lung?

MALT lymphomas are highly radiosensitive. Curative standard doses are 24 Gy in 12 fractions and 30 Gy in 20 fractions. The latter and slower dose fractionation (30 Gy in 20) is best used specifically in the setting of stage IAE Gastric MALT - a unique site with significant risk of radiation induced nausea and vomiting. As such, a slightly lower dose/fraction was initially utilized for MALT NHL in this organ - the most common location for MALT lymphoma.

In the Lowry et al trial published in 2011 (https://www.ncbi.nlm.nih.gov/pubmed/21664710) 361 sites of indolent NHL (predominantly follicular NHL and marginal zone lymphoma) were randomized to receive 40-45Gy in 20-23 fractions or 24Gy in 12 fractions. It demonstrated equivalent disease contr...

Alternatively, could consider 2 Gy x 2 (Girinsky T et al., Low Dose Radiation Therapy in Pulmonary MALT Lymphoma. Int J Radiation Oncol Biol Phys 2012;83:e385-389)