The outcome of radiation therapy as a primary treatment in orbital lymphoma: a systematic review

Oktariana, Thalia Puteri; Andriana, Aisha; Nugroho, Rafiq Sulistyo

doi:10.5603/rpor.a2022.0065

Cited by 3 publications

(6 citation statements)

References 37 publications

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“…In the study by Rehn, ultra-low-dose RT (4-6 Gy) was associated with a significantly lower rate of grade 2 late toxicities, as compared to standard dose (24-30.6 Gy) or high dose (>30.6 Gy), 0% vs. 6% and 31%, respectively (11). In a recent systemic review showed similar findings (6). In the published studies evaluating ultra-lowdose radiation, very low rate of patient patients experienced acute ocular side effects, as per CTCAE grading, from treatment (7)(8)(9)(10)(11).…”

Section: Discussionmentioning

confidence: 79%

“…Conventional external beam radiation with dose of 30-36 Gy has local control rates close to 100% (6,14,15). Due to toxicity concerns, efforts were made to investigate the efficacy of low dose (4 Gy) radiation regimen for orbital lymphoma.…”

Section: Discussionmentioning

confidence: 99%

“…The first line of treatment for early-stage indolent lymphomas is irradiation (4). Conventional radiation with doses of 24-30 Gy provides high local control rates (5,6). However, the orbital structures are uniquely sensitive to radiation and may develop toxicities including dry eye, conjunctivitis, cataracts, keratoconjunctivitis sicca, and radiation retinopathy (6).…”

Section: Introductionmentioning

confidence: 99%

“…Conventional radiation with doses of 24-30 Gy provides high local control rates (5,6). However, the orbital structures are uniquely sensitive to radiation and may develop toxicities including dry eye, conjunctivitis, cataracts, keratoconjunctivitis sicca, and radiation retinopathy (6). Given the competing goals of local control and minimizing ocular toxicities, the ultra-low-dose (4 Gy in 2 fractions) treatment regimen, colloquially termed "boom-boom," has been investigated (7)(8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

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High local control and low ocular toxicity using ultra-low-dose “boom-boom” radiotherapy for indolent orbital lymphoma

Shelukar¹,

Fernandéz²,

Baş³

et al. 2022

Chin Clin Oncol

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Background: The first line definitive treatment for early-stage indolent B-cell lymphoma is radiation therapy (RT). Due to the sensitivity of orbital structures to radiation, ultra-low-dose RT (4 Gy in 2 fractions, "boom-boom") has and been utilized as an attractive option for orbital lymphoma. In this retrospective study, we evaluated the outcome and toxicity of "boom-boom" RT for indolent orbital lymphoma with an emphasis on ophthalmologic toxicity.Methods: This is a retrospective case series with 17 patients with orbital lymphoma who received boomboom RT at a single tertiary referral center between January 2017 and June 2022. Medical records, imaging and radiation treatment plans were reviewed. Endpoints included response rate, progression, and ocular toxicity per oncologist and ophthalmology reports.Results: A total of 17 patients (12 female and 5 male) with 19 indolent orbital lymphomas were included.Median follow-up was 39 months. Complete, partial, and stable response was achieved in 65%, 24%, and 12% of patients, respectively. Only 1 patient developed local recurrent 47 month after radiation treatment, and was successfully salvaged with standard dose radiation (24 Gy). Five-year distant progression rate is 18%. Oncologist-reported Common Terminology Criteria for Adverse Events (CTCAE) toxicity rates were 6% grade 1 and 0% grade 2+. Ophthalmologist reported 33.3% new post-RT toxicities including dry eye, cataract, and chorioretinal atrophy. There is no significant vision acuity change after RT.Conclusions: "Boom-Boom" RT (4 Gy in 2 fractions) provides excellent control for indolent orbital lymphoma. While minimal toxicity was documented by radiation oncologists, higher rates were noted by ophthalmologists, highlighting the radiosensitivity of orbital structures and potentially underreported ocular toxicity in "boom-boom" and standard regimens. Further prospective randomized studies are needed to better define the outcome and toxicity of ultra-low-dose (4 Gy) RT for ocular lymphoma.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High local control and low ocular toxicity using ultra-low-dose “boom-boom” radiotherapy for indolent orbital lymphoma

Shelukar¹,

Fernandéz²,

Baş³

et al. 2022

Chin Clin Oncol

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“…In this study, among 9 patients who received only surgical treatment with no subsequent treatments, tumor recurrence occurred 2-30mo after the operation. For low-grade lymphoma such as EMZL, a moderate dose of radiotherapy has good treatment efficacy [10][11][12][13][14] , while for tumors with relatively highgrade malignancies, such as diffuse large B-cell lymphoma, chemotherapy or chemoradiotherapy is generally needed [14] . In this study, chemoradiotherapy or combination therapy by two or more methods was associated with higher DFS.…”

Section: Pathological Subtypesmentioning

confidence: 99%

Predicting the prognosis of primary orbital lymphoma by clinical characteristics and imaging features

Zhu¹,

Zhang²,

Wang³

2023

Int J Ophthalmol

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AIM: To analyze the 5-year disease-free survival (DFS) of primary orbital lymphoma (POL) by clinical characteristics and imaging features. METHODS: A total of 72 patients, 43 males and 29 females, with histologically confirmed POL, were retrospectively recruited between January 2012 and May 2017. The information on clinical characteristics, imaging features, and 5-year DFS was obtained. Univariate and multivariate forward logistic regression analyses were used to identify the variables significantly associated with 5-year DFS. Kaplan-Meier was applied for survival analysis. RESULTS: Univariate analysis revealed that uni- or bilateral orbital involvement, single or multiple lesions, treatment methods, and contrast enhancement pattern on images were significant for 5-year DFS (P=0.022, 0.042, <0.001, and 0.028, respectively), while in multivariate logistic regression analysis, only uni- or bilateral orbital involvement, treatment methods and contrast enhancement pattern on images were significant (r=0.453, 0.897, and 0.556, P=0.038, <0.001 and 0.022, respectively). The survival curves for DFS were obtained. CONCLUSION: The majority of POL are B-cell lymphomas. Unilateral orbital involvement, homogeneous contrast enhancement on images, and the appropriate treatment schemes result to be significant factors for a good prognosis for POL.

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Epidemiology and Clinical Features Analysis of Orbital and Adnexal Lymphoma in the Western Area of Gyeongsangnam-do

Jeong,

Kim,

Seo

2023

J Korean Ophthalmol Soc

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Purpose: We compared the epidemiology and clinical features of patients with orbital and adnexal lymphoma in western Gyeongsangnam-do with those reported previously, domestically and internationally.Methods: Of the 25 patients diagnosed with lymphoproliferative disorder, a retrospective analysis was conducted on 21 patients with orbital and adnexal lymphoma between January 2010 and December 2021.Results: In total, 21 patients were diagnosed with orbital and adnexal lymphoma, with an average annual incidence rate of 0.18 per 100,000 people, exceeding the national average in Korea. The median age of the patients was 57 years and the ratio of 1.1 to 1. The most common presenting symptoms included proptosis, conjunctival mass, conjunctival injection, eyelid swelling and epiphora. Primary and metastatic lesions accounted for 85.7% and 14.3% of cases, respectively. Histologically, the most common subtype was extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (90.4%). Furthermore, diffuse large B-cell lymphoma and NK/T-cell lymphoma of T-cell origin each accounted for 4.8% of cases.Conclusions: The reported incidence rate in the present study exceeded the national average in Korea. However, no significant differences were observed in clinical symptoms, primary and metastatic lesions, histological classification, or post-treatment effects compared to findings from domestic and international studies.

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The outcome of radiation therapy as a primary treatment in orbital lymphoma: a systematic review

Abstract: This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited.

Cited by 3 publications

References 37 publications

High local control and low ocular toxicity using ultra-low-dose “boom-boom” radiotherapy for indolent orbital lymphoma

High local control and low ocular toxicity using ultra-low-dose “boom-boom” radiotherapy for indolent orbital lymphoma

Predicting the prognosis of primary orbital lymphoma by clinical characteristics and imaging features

Epidemiology and Clinical Features Analysis of Orbital and Adnexal Lymphoma in the Western Area of Gyeongsangnam-do

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