Ultra-low dose external beam radiotherapy for presumed choroidal lymphoma: a case report

Abstract

Primary choroidal lymphoma is a rare, slowly progressive intraocular malignancy. Most are low grade B cell lymphomas, often involving tissues adjacent to the choroid such as the subconjunctival space, lacrimal gland or orbit. Ideally, these lesions are biopsied to establish histopathological diagnosis. The most accessible ocular structure is biopsied. Obtaining tissue by transvitreal choroidal biopsy imparts a small but significant risk of ocular morbidity, including the need for multiple surgeries, retinal detachment and vision loss.External beam radiotherapy (EBRT) is a common and effective treatment of low-grade lymphomas. EBRT has been found to very successfully treat primary marginal zone lymphomas of the ocular adnexa, which are typically of the same cell type as most primary choroid lymphomas. Ultra-low dose EBRT, most commonly using a total dose of 4 Gy, has been shown to be as effective as higher doses of radiotherapy for follicular or marginal zone lymphomas. The use of this low dose regimen for conjunctival lymphomas has been recently explored. The role of EBRT, and especially ultra-low dose EBRT, for treatment of primary choroidal lymphoma has been confined to case reports.We describe a case of presumed primary choroidal lymphoma diagnosed on clinical findings alone as the risks of ocular biopsy were deemed too high, and report outcome following treatment with ultra-low dose EBRT.

Long-Term Survival and Factors Associated with Increased Mortality in Patients with Ocular Adnexal Lymphomas

“…Usually, RTx is chosen in patients with low-grade and localized (stage IE) primary lymphomas, showing a good effect on local control [ 35 ]. Furthermore, the use of RTx favorably altered the illness trajectory for OAL patients, with a particular reference to the improvement of linear accelerators able to progressively reduce the dose for marginal types from 40 Gy to 20 Gy and, in recent years, even less than 5 Gy [ 36 ], achieving an effective control of the disease and significantly reducing side effects. Regarding the therapeutic regimen, in our study, 63.8% of patients with EMZL received EBRT, a result in line with the current literature [ 37 , 38 ] showing the advantages of the use of EBRT in most cases of primary OAL, especially for low-grade lymphomas such as EMZL.…”