Primary radiotherapy for localized orbital MALT lymphoma

Le, Quynh Thu; Eulau, Stephen M.; George, Tracy I.; Hildebrand, R; Warnke, Roger A.; Donaldson, Sarah S.; Hoppe, Richard T.

doi:10.1016/s0360-3016(01)02729-8

Cited by 116 publications

(60 citation statements)

References 20 publications

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“…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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Section: Discussionmentioning

confidence: 99%

“…Radiation therapy (RT) is currently a well-accepted treatment option for limited stage POAML, resulting in up to 85% to 100% longterm complete remission (CR) rates. 8,16,17 However, cohort size and follow-up duration are limited in many of these studies. Furthermore, there is no consensus on the optimal radiation dose.…”

Section: Introductionmentioning

confidence: 99%

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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“…However, in a few series, no distinction was made between low-grade and high-grade lymphoma or between radiotherapy alone and combined radiotherapy/chemotherapy, making it difficult to interpret the final results. Regardless of the histologic subtype of lymphoma, MALT lymphoma, 24,28,29 and low-grade or high-grade lymphoma, [13][14][15][16][17][18][19][20][21][22][23][25][26][27]30 radiotherapy induces a very high rate of control of ophthalmologic sites, with local control rates ranging from 86% to 100%, and a local recurrence rate ranging between 0% and 15%. However, these apparently very good results must be interpreted in light of 2 observations.…”

Section: Radiotherapy and Oalmentioning

confidence: 99%

“…15,17,19,20,22,23,[25][26][27][28]30 Second, disseminated recurrences after radiotherapy have been reported in 6% to 50% of patients, with a mean disseminated recurrence rate of 17%. 13,[15][16][17]20,23,[24][25][26][27][28]30 These findings underscore the fact that radiotherapy of OAL sites induces a high local control rate, with a disseminated recurrence rate of 10% to 25% and mild but frequent ophthalmic toxicity that should be considered before any treatment decision is made.…”

Section: Radiotherapy and Oalmentioning

confidence: 99%

“…11 Although combination chemotherapy with highdose methotrexate is the basis of treatment of primary central nervous system and intraocular lymphomas, 10,12 radiotherapy has been the standard treatment for low-grade ophthalmologic lymphomas. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] However, other treatment options, such as therapy with monoclonal anti-CD20 antibody, 31,32 may constitute a promising alternative to external beam irradiation and its potential toxicity. In addition, some reports have suggested a possible value of anti-Chlamydia psittaci antibiotic therapy.…”

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Ocular adnexal lymphoma: a review of clinicopathologic features and treatment options

Decaudin

Crémoux

Vincent‐Salomon

et al. 2006

Blood

133

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IntroductionLymphoproliferations of the eye, including intraocular and ocular adnexal non-Hodgkin lymphoma (NHL), constitute a heterogeneous group of neoplasms that represent less than 1% of all NHLs 1 and 5% to 15% of all extranodal sites. 2 First described in 1952, 3 they are the most frequent malignant tumors of the eye and ocular adnexae; in fact, in the Florida cancer registry, they represent up to 55% of all orbital tumors. 4 As for all NHLs, a marked increase of the incidence of ocular adnexal NHL has also been observed. 4 The clinical features and natural history of ocular adnexal lymphoma (OAL) is completely different from those of intraocular lymphoma, which emphasizes the need to distinguish between the therapeutic management of both. Intraocular lymphoma is a subset of primary central nervous system lymphoma, 5-7 and intraocular involvement is found in approximately 15% of affected patients. 8 The histologic subtype of intraocular lymphoma is almost always high grade 9,10 and it can occur in the context ofAIDS-related lymphoproliferations. In contrast, OALs-including lesions of the conjunctiva, lacrimal gland, orbit, and eyelids-are mainly low-grade tumors not associated with HIV infection. 11 Although combination chemotherapy with highdose methotrexate is the basis of treatment of primary central nervous system and intraocular lymphomas, 10,12 radiotherapy has been the standard treatment for low-grade ophthalmologic lymphomas. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] However, other treatment options, such as therapy with monoclonal anti-CD20 antibody, 31,32 may constitute a promising alternative to external beam irradiation and its potential toxicity. In addition, some reports have suggested a possible value of anti-Chlamydia psittaci antibiotic therapy. 33,34 In this review, which is exclusively focused on ophthalmologic lymphomas, we first present the pathologic, clinical, and prognostic factors of these lymphomas and then discuss all available treatment options in terms of safety and efficacy and their respective indications. Biology of ophthalmologic lymphomas Diagnosis of OALAs for all other forms of nodal and extranodal NHL, confirming a positive diagnosis of OAL is often long and difficult because the tumor is very small in most patients. Positive diagnosis must be based on histologic examination of a sufficient tumor sample obtained by surgical biopsy that is large enough to allow rigorous definition of lymphoproliferative disease according to the World Health Organization (WHO) classification. 35 Histopathologic examination consists of morphologic examination of cellular proliferation (cellular appearance and architectural pattern), usually combined with immunohistochemical analysis and molecular analysis.The exact modalities of biopsy depend on the anatomic site of the lesion and its relation to the eye: biopsy may be performed of the conjunctiva, an eyelid lesion, an orbital mass, or the lacrimal gland. However, sometimes patients have nodal involvement, an...

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Lymphoproliferative Diseases of the Ocular Adnexa in Korea

Kim²

2007

Arch Ophthalmol

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cases of patients with ocular lymphoid tumors treated at the Samsung Medical Center were retrospectively reviewed. Results: The mean patient age was 46.3 years (range, 1-87 years). The major histopathologic subtypes were mucosa-associated lymphoid tissue (MALT) lymphoma in 96 patients (75.0%), lymphoid hyperplasia in 11 (8.6%), diffuse large B-cell lymphoma in 6 (4.7%), and mantle cell lymphoma in 4 (3.1%). Ocular lymphoproliferative lesions were located in the conjunctiva (53 patients), the eyelid (33 patients), and the orbit (42 patients). Twenty patients had tumor relapses (15.6%), and 9 died of lymphoma during follow-up (7.0%). Regarding the analysis of prognostic factors, most patients with MALT lymphoma evidenced local disease, required local treatment, and exhibited a superior prognosis. Conclusions: Lymphomas of the MALT type constitute most ocular adnexal lymphoproliferative diseases and occur more frequently in South Korea than in Western countries. Patients with MALT lymphoma have favorable outcomes compared with patients with other types of lymphoma.

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Primary radiotherapy for localized orbital MALT lymphoma

Cited by 116 publications

References 20 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

Ocular adnexal lymphoma: a review of clinicopathologic features and treatment options

Lymphoproliferative Diseases of the Ocular Adnexa in Korea

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