Primary Radiation Therapy in Patients With Localized Orbital Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT Lymphoma)

Son, Seung Hyun; Choi, Byung Ock; Kim, Gi Won; Yang, Suk Woo; Hong, Young Seon; Choi, Inyoung; Kim, Yeon Sil

doi:10.1016/j.ijrobp.2009.04.018

Cited by 60 publications

(59 citation statements)

References 19 publications

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“…14,25,34,43,44 Similarly, RT achieved local control in 97% of our Ann Arbor stage I POAML patients. However, there is still no consensus on the optimal dose of RT.…”

Section: Discussionmentioning

confidence: 80%

“…30,33 Only few studies demonstrated conjunctival involvement as the most common anatomical location of tumor. 28,34 It is possible that there are some geographical changes in the anatomical predisposition of POAML. However, in our cohort as well as in previous studies, it was uncommon to observe POAML solitary localized to the eyelid.…”

Section: Discussionmentioning

confidence: 99%

“…15,24,25,27,31,34 Previous studies either did not analyze the association between bilateral involvement and clinical outcome or did not have significant statistical power to show such an association due to the small number of analyzed cases. Herein, we demonstrate that bilateral involvement is an independent clinical variable associated with inferior outcome in univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…However, some studies report excellent outcomes with doses lower than 25 Gy 31,45,46 while other studies showed good responses at higher doses of 36 Gy. 25 Ejima et al 24 and Son et al 34 suggested doses of 30 to 30.6Gy. Fung et al, 3 who analyzed 53 cases of MALT, reported 5-year local control rate of 81% vs 100% in patients treated with RT at doses of ,30 Gy and $30 Gy, respectively (P , .01).…”

Section: Discussionmentioning

confidence: 99%

“…The contradictory reports on effectiveness of different RT doses also most likely stem from the small number of patients with a limited power to show statistically significant differences in local control and did not analyze the impact of RT dose on PFS. 13,14,16,34 Irrespective of the RT dose and despite an excellent initial clinical response to RT in patients with Ann Arbor stage I POAML, local and systemic relapses occurred continuously over time, with an estimated cumulative relapse or progression of 5.1% at 1 year, 17.5% at 5 years, and 31% at 10 years. Fung et al 3 showed that in 39 cases with stage I MALT lymphoma, the freedom from distant relapse rate was 75% and 45% at 5 and 10 years, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Long-term course of patients with primary ocular adnexal MALT lymphoma: a large single-institution cohort study

Desai

Joag

Lekakis

et al. 2017

Blood

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Key Points• POAML (specifically Ann Arbor stage I disease) has an excellent clinical outcome, with only a few patients succumbing to lymphoma.• POAML patients face a continuous risk of distant relapse, including in the central nervous system, and transformation to aggressive lymphoma.While primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (POAML) is the most common orbital tumor, there are large gaps in knowledge of its natural history. We conducted a retrospective analysis of the largest reported cohort, consisting of 182 patients with POAML, diagnosed or treated at our institution to analyze long-term outcome, response to treatment, and incidence and localization of relapse and transformation. The majority of patients (80%) presented with stage I disease. Overall, 84% of treated patients achieved a complete response after first-line therapy. In patients with stage I disease treated with radiation therapy (RT), doses ‡30.6 Gy were associated with a significantly better complete response rate (P 5 .04) and progression-free survival (PFS) at 5 and 10 years (P < .0001). Median overall survival and PFS for all patients were 250 months (95% confidence interval [CI], 222 [upper limit not reached]) and 134 months (95% CI, 87-198), respectively. Kaplan-Meier estimates for the PFS at 1, 5, and 10 years were 91.5% (95% CI, 86.1% to 94.9%), 68.5% (95% CI, 60.4% to 75.6%), and 50.9% (95% CI, 40.5% to 61.6%), respectively. In univariate analysis, age >60 years, radiation dose, bilateral ocular involvement at presentation, and advanced stage were significantly correlated with shorter PFS (P 5 .006, P 5 .0001, P 5 .002, and P 5 .0001, respectively). Multivariate analysis showed that age >60 years (hazard ratio [HR] 2.44) and RT<30.6Gy (HR54.17) were the only factors correlated with shorter PFS (P 5 .01 and P 5 .0003, respectively). We demonstrate that POAMLs harbor a persistent and ongoing risk of relapse, including in the central nervous system, and transformation to aggressive lymphoma (4%), requiring long-term follow-up. (Blood. 2017;129(3):324-332)

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“…14,25,34,43,44 Similarly, RT achieved local control in 97% of our Ann Arbor stage I POAML patients. However, there is still no consensus on the optimal dose of RT.…”

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Long-term course of patients with primary ocular adnexal MALT lymphoma: a large single-institution cohort study

Desai

Joag

Lekakis

et al. 2017

Blood

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Long‐term outcomes of patients with conjunctival extranodal marginal zone lymphoma

et al. 2022

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Comprehensive information on clinical features and long‐term outcomes of primary conjunctival extranodal marginal zone lymphoma (PCEMZL) is scarce. We present a large single‐institution retrospective study of 72 patients. The median age was 64 years, and 63.9% were female. Stage I was present in 87.5%. Radiation therapy (RT) alone was the most common treatment (70.8%). Complete response (CR) was 87.5%, and 100% in RT‐treated patients. With a median follow‐up of 6.7 years, relapse/progression and death occurred in 19.4% each, with one relapse within the RT field. The 10‐year progression‐free survival (PFS) and overall survival (OS) were 68.4% (95% CI 52.8%–79.8%) and 89.4% (95% CI 77.4%–95.2%), respectively. The 10‐year rate for time to progression from diagnosis was 22.5% (95% CI 11.6%–35.7%). The 10‐year PFS and OS of MALT‐IPI 0 versus 1–2 were 83.3% versus 51.3%, (p = .022) and 97.6% versus 76.6%, (p = .0052), respectively. The following characteristics were associated with shorter survival: age > 60 years (PFS: HR = 2.93, 95% CI 1.08–7.95; p = .035, OS: HR = 9.07, 95% CI 1.17–70.26; p = .035) and MALT‐IPI 1–2 (PFS: HR = 2.67, 95% CI 1.12–6.31; p = .027, OS: HR = 6.64, 95% CI 1.45–30.37; p = .015). CR following frontline therapy was associated with longer PFS (HR = 0.13, 95% CI 0.04–0.45; p = .001), but not OS. Using the Fine and Gray regression model with death without relapse/progression as a competing risk, RT and CR after frontline therapy were associated with lower risk of relapse (SHR = 0.34, 95% CI 0.12–0.96 p = .041 and SHR = 0.11, 95% CI 0.03–0.36; p < .001, respectively). Patients with PCEMZL treated with frontline RT exhibit excellent long‐term survival, and the MALT‐IPI score appropriately identifies patients at risk for treatment failure.

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Long‐term follow‐up and health‐related quality of life among cancer survivors with stage IEA orbital‐type lymphoma after external photon‐beam radiotherapy: Results from a longitudinal study

Hoffmann

Rating

Bechrakis

et al. 2022

Hematological Oncology

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We assessed the long-term outcomes and treatment-related adverse effects of patients with Stage I, "orbital-type" lymphomas that were uniformly treated with photons. All consecutive patients diagnosed with low-grade, Ann Arbor Stage IEA orbital lymphoma treated between 1999 and 2020 at our department were retrospectively reviewed. We excluded patients with exclusive conjunctival involvement, typically treated with en face electrons. In order to quantify radiotherapy related side effects we applied the CTCAE criteria, analyzed changes in visual acuity, quantified dry eye symptoms by use of the Ocular Surface Disease Index (OSDI) score and applied the EORTC QLQ-C30 questionnaire for quality of life (QoL) assessment. In total 66 eyes of 62 patients were irradiated with a median dose of 30.6 Gy. The median follow-up was 43.5 months. The predominant histological subtype were MALT lymphomas. No local failure occurred in this cohort. Of nine outfield relapses, six solely occurred in the contralateral eye. The 5-and 10-years distant progression free survival rates (PFS) were 81.4% and 63.5%. The 5-and 10years overall survival rates were 85.1% and 71.9% without any tumor related death.Of the acute toxicities none was higher than CTCAE grade 1. The predominant late toxicities were dry eyes (21.2%) of CTCAE Grade <2 and radiation induced cataracts (19.7%). During long-term follow up the average visual acuity did not deteriorate. The global QoL was worst before treatment and improved significantly after 24 months (p = 0.007). External beam radiotherapy of "orbital-type" lymphomas with photons is an effective and gentle treatment option with excellent local controlThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Primary Radiation Therapy in Patients With Localized Orbital Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT Lymphoma)

Cited by 60 publications

References 19 publications

Long-term course of patients with primary ocular adnexal MALT lymphoma: a large single-institution cohort study

Long-term course of patients with primary ocular adnexal MALT lymphoma: a large single-institution cohort study

Long‐term outcomes of patients with conjunctival extranodal marginal zone lymphoma

Long‐term follow‐up and health‐related quality of life among cancer survivors with stage IEA orbital‐type lymphoma after external photon‐beam radiotherapy: Results from a longitudinal study

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