Radiotherapy in the management of orbital lymphoma

Bolek, Timothy W.; Moyses, Harry; Marcus, Robert B.; Gorden, Lemuel; Maiese, Russell L.; Almasri, Nidal M.; Mendenhall, Nancy P.

doi:10.1016/s0360-3016(98)00535-5

Cited by 129 publications

(74 citation statements)

References 8 publications

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“…Various pejorative prognostic factors have been identified in the published studies, such as high-grade subtype lymphomas, 11,13,18,20,27,40,41,45,46 and non-MALT lymphomas. 39,42 In particular, MALT lymphoma was found not to have any prognostic impact 11,29,44 except in one series.…”

Section: Org Frommentioning

confidence: 99%

“…39,42 In particular, MALT lymphoma was found not to have any prognostic impact 11,29,44 except in one series. 18 In many series, advanced-stage disease 11,13,18,20,27,40,41,45,46 and age greater than 60 to 64 years, 11,18,27,45 the presence of B symptoms (though rarely reported), 11 nodal involvement, 11,88 nonconjunctival sites, 87 and elevated serum LDH level have been identified as factors. 11,27,39,88 Finally, a few reports have shown a pejorative prognostic impact of p53 expression 41,45 and of p21 and pRb positivity.…”

Section: Org Frommentioning

confidence: 99%

“…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%

“…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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confidence: 99%

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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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Section: Org Frommentioning

confidence: 99%

Section: Org Frommentioning

confidence: 99%

Section: Radiotherapy and Oalmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…Rituximab, which is an anti-CD20 monoclonal antibody, is strongly suggested in a systemic disease (20). This case was an EBV-negative lymphoma and the disease extent was limited to the eye; therefore, we decided that a local radiotherapy would be the treatment modality because radiotherapy is one of the competent options among the treatment modalities for orbital MALT lymphoma (21)(22)(23)(24)(25). Recent studies reported that a radiotherapy dose range of 25∼35 Gy achieved ex-cellent survival rates for stage IEA orbital MALT lymphoma (26).…”

Section: Case Reportmentioning

confidence: 99%

Bilateral Conjunctival Mucosa-Associated Lymphoid Tissue Type Lymphoma in a Kidney Transplant Recipient

Chang

Yang

et al. 2018

Korean J Transplant

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Lymphoproliferative disorder in a posttransplant setting has emerged as a difficult problem in kidney transplantation (KT).Lymphoma involving adnexa of the eye has rarely been reported due to scarcity of lymphoreticular tissue in the ocular area. This report presents a case of a 37-year-old KT recipient who was diagnosed with conjunctival mucosa-associated lymphoid tissue lymphoma with a chief complaint of seeing black spots. Unlike other post-transplant lymphoproliferative diseases associated with the Epstein-Barr virus (EBV) reactivation via immunosuppression, the lesion was not related to the virus. The patient received radiotherapy with concomitant conversion from the tacrolimus to the sirolimus. Overall, the results presented herein indicate lymphoma may be an important differential diagnosis when KT recipients complain of ocular discomfort. Case Report INTRODUCTIONKidney transplantation (KT) is an emerging option for renal replacement therapy that improves the quality of life, as compared to dialysis. However, immunosuppressive therapy for the prevention of rejection can lead to lymphoproliferative disease after KT up to 1% to 20%(1). The extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type that belonged to the indolent B-cell lymphomas which is mainly an observed gastric mucosa and it is associated with the Helicobacter pylori infection(2-5), has been rarely reported as originating from other sites. We herein report a case of a KT recipient who is diagnosed with extranodal marginal zone lymphoma involving both conjunctivae. CASE REPORTA 37-year-old woman with end-stage renal disease due to lupus nephritis received a living-donor KT after 5 years of peritoneal dialysis. The donor was her mother, and the human leukocyte antigen mismatch number was 2. She underwent induction therapy by using basiliximab, and thereafter maintained immunosuppression with tacrolimus, mycophenolic acid, and deflazacort. The trough level of tacrolimus has been maintained between 4∼5 ng/mL. The allograft function was kept stable with an estimated glomerular filtration rate of 60 mL/min/1.73 m Cytomegalovirus and Epstein-Barr virus (EBV) were not detected in the real-time polymerase chain reaction test. In the ophthalmic examination, multiple cystic nodules located in both lower conjunctivae were found. The cystic nodules were biopsied and diagnosed with extranodal marginal zone lymphoma of MALT type (Fig. 1). During the staging workup for lymphoma, orbital magnetic resonance imaging and positron emission tomography computed tomography (PET-CT) showed hypertrophic changes in the lower conjunctivae of both eyes and tonsils (Fig. 2). The bone marrow finding was normal, and the chromosome analysis of hematology/oncology showed no atypical clone. The stain for EBV was negative. The patient also underwent esophagogastroduodenoscopy with a negative result of H. pylori It is generally known that MALT lymphoma most frequently develops in the stomach due to the H. pylori infection(12). Only rare nongastric MA...

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Response-Adapted Ultralow-Dose Radiation Therapy for Orbital Indolent B-Cell Lymphoma

Pinnix,

Dabaja,

Gunther

et al. 2024

JAMA Oncol

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ImportanceRadiation therapy to doses of 24 to 36 Gy is currently used to treat indolent B-cell lymphoma of the ocular adnexa; however, ocular adverse effects are common.ObjectiveTo determine if a response-adapted radiation therapy strategy will result in excellent disease outcomes while reducing orbital morbidity.Design, Setting, and ParticipantsThis single-institution, phase 2 prospective nonrandomized controlled trial of a response-adapted strategy involved 50 evaluable patients with stage I to IV indolent B-cell lymphoma of the ocular adnexa enrolled between July 2015 and January 2021. This treatment approach was also retrospectively evaluated with a separate 55-patient cohort treated between March 2013 and October 2021. All data were analyzed between November 2021 and December 2023.InterventionsPatients were treated with ultralow-dose radiation therapy to 4 Gy in 2 fractions and assessed for response at 3-month intervals. Patients with persistent orbital lymphoma were offered an additional 20 Gy in 10 fractions to complete the response-adapted treatment.Main Outcome and MeasuresThe primary end point was 2-year local orbital control within the irradiated field after response-adapted therapy. Secondary end points included overall survival and complete response rate.ResultsThe 50 prospective patients were a median (range) of 63 (29-88) years old, and 31 (62%) were female. Among the 50 patients, 32 (64%) had mucosa-associated lymphoid tissue lymphoma, 12 (24%) had follicular lymphoma, and 6 (12%) had unclassifiable low-grade B-cell lymphoma. Thirty-one patients (62%) had stage I disease, and 36 (72%) were newly diagnosed. At a median follow-up of 37.4 (95% CI, 33.7-52.5) months, the 2-year local control rate was 89.4% (95% CI, 81.0%-98.7%), and the 2-year overall survival rate was 98.0% (95% CI, 94.1%-100%); 45 patients (90.0%; 95% CI, 78.2%-96.7%) experienced a complete response to response-adapted radiation, including 44 patients with a complete response to ultralow-dose radiation and 1 patient with a complete response after an additional 20 Gy. No local recurrences were observed among patients with a complete response to response-adapted therapy. No grade 3 or higher toxic effects were observed. In a planned subset analysis of 22 patients with newly diagnosed, untreated stage I mucosa-associated lymphoid tissue lymphoma, the 2-year local control rate was 90.7% (95% CI, 79.2%-100%), and the 2-year freedom from distant relapse rate was 95.2% (95% CI, 86.6%-100%).Conclusion and RelevanceIn this nonrandomized controlled trial, response-adapted ultralow-dose therapy for indolent orbital B-cell lymphoma resulted in reduced radiation exposure, negligible toxic effects, and excellent disease outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT02494700

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Radiotherapy in the management of orbital lymphoma

Cited by 129 publications

References 8 publications

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

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

Bilateral Conjunctival Mucosa-Associated Lymphoid Tissue Type Lymphoma in a Kidney Transplant Recipient

Response-Adapted Ultralow-Dose Radiation Therapy for Orbital Indolent B-Cell Lymphoma

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