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DOI http://dx.doi.org/10.1016/S0360-3016(97)80640-2
Title Primary radiotherapy is curative for CS I{sub E} orbital malt lymphoma
Creator/Author Eulau, Stephen M. ; Hildebrand, Richard ; Warnke, Roger ; Donaldson, Sarah S. ; Hoppe, Richard T
Publication Date1997 Jul 01
OSTI IdentifierOSTI ID: 20423123
Other Number(s)ISSN 0360-3016; IOBPD3 ; TRN: US03R3678006796
Resource TypeJournal Article
Resource RelationInternational Journal of Radiation Oncology, Biology and Physics ; VOL. 39 ; ISSUE: 2,suppl.1 ; PII: S0360301697806402; Copyright (c) 1997 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 1997
Subject62 RADIOLOGY AND NUCLEAR MEDICINE ; ELECTRON BEAMS; EYES; LYMPHOMAS; MUCOUS MEMBRANES; RADIOTHERAPY; VISION; X RADIATION
Description/Abstract PURPOSE: With the adoption of the International Lymphoma Study Group (ILSG) recommendations for classification of the non-Hodgkin's lymphomas, low grade extranodal lymphoma of mucosa associated lymphoid tissue (MALT) has become an increasingly more common pathologic diagnosis. Due to its relatively recent description, natural history and optimal management of MALT lymphomas remains unsettled. We have identified 22 cases of orbital MALT lymphoma and report on their outcome. MATERIALS and METHODS: Pathologic biopsies of 92 patients with CS I extranodal lymphoma were reviewed and reclassified using the ILSG recommendations. Twenty-two cases of low grade orbital MALT lymphoma were identified. Fifteen cases were conjunctival and 7 were retrobulbar. Staging workup included chest radiograph in 100%, Head/Orbital CT scan in 95%, Abdominopelvic CT scan in 79%, lymphangiogram in 32%, and bone marrow biopsy in 50%. Conjunctival lymphomas were treated with anterior superficial x-rays or 9-12 MeV electrons utilizing a central eye bar. Retrobulbar lymphomas were treated with 4-6 MV photons utilizing wedged pairs, arcs or single anterior photon fields (with eye bar). Mean dose was 34 Gy (range 30-40 Gy). No patient received chemotherapy or curative intent surgery. RESULTS: With mean follow-up of 7.7 years (range 2 mo - 19 yr), the 10 year actuarial overall and disease specific survival was 90%. At 10 years, actuarial freedom from local recurrence was 100% while freedom from any relapse was 71%. Among 9 patients followed for longer than 10 years none have experienced a relapse. Among patients (pts) who relapsed, all failed in extranodal sites where MALT lymphomas have been described (larynx - 1 pt, abdomen - 1 pt, lung - 1 pt, and contralateral conjunctiva - 1 pt) and none failed in a nodal site. Acute toxicity included excessive tearing (3 pts), mild diplopia (1 pt), periorbital edema (3 pts), and marked erythema (1 pt). Two patients required a one week treatment break and no patient required a dose reduction. Late toxicity included mild dryness (5 pts), cataract (1 pt), transient optic nerve edema (1 pt), mild diplopia (1 pt) and excessive tearing (1 pt). Two patients experienced significant visual loss. One patient developed a retinal bleed 3 years after receiving 34 Gy orbital photon therapy while one patient developed radiation retinopathy 11 years after receiving a calculated dose of 37.4 Gy to the retina. CONCLUSION: In this retrospective analysis, clinical stage I{sub E} orbital MALT lymphoma is well controlled with 30-40 Gy primary radiotherapy. Relapses have occurred in other extranodal mucosal sites revealing a natural history distinct from other low grade lymphomas and implying a possible homing mechanism for MALT lymphoma cells. Although radiotherapy is generally well tolerated, significant visual loss has been observed at doses greater than 34 Gy. Given excellent local control rates we currently recommend a dose of 30 Gy in order to minimize risk of late toxicity.
Country of PublicationUnited States
LanguageEnglish
Formatpage(s) 176
System Entry Date2004 Feb 23

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