Localized orbital mucosa-associated lymphoma tissue lymphoma managed with primary radiation therapy: efficacy and toxicity

Author(s): Goda JS, LeLW, Lapperriere NJ, Millar BA, Payne D, et al.


Purpose:To evaluate the clinical outcomes and late effects of radiation therapy (RT) in localized primary orbital mucosa-associated lymphoma tissue (MALT) lymphoma (POML).

Methods and materials:From 1989 to 2007, 89 patients with Stage IE POML received RT. The median age was 56 years old. Sites involved conjunctiva (59 patients [66%]), lacrimal gland (20 patients [23%]), and soft tissue (10 patients [11%]). Megavoltage beam(s) was used in 91%, electrons in 7%, and orthovoltage in 2% of cases. The dose given was 25 Gy in 97% and 30 Gy in 3% of patients. Lens shielding was possible in 57% of patients.

Results:The median follow-up was 5.9 years. Complete response or unconfirmed complete response was seen in 88 patients (99%). Relapse occurred in 22 patients (25%). First relapse sites were local (2 patients [9%]), in the contralateral orbit (5 patients [23%]), and distant (15 patients [68%]). The 7-year overall survival (OS), cause-specific survival (CSS), relapse-free survival (RFS), and local control (LC) rates were 91%, 96%, 64%, and 97%, respectively. Radiation-related late sequelae were documented in 40 patients (45%). Cataracts were observed in 22 patients (Grade 1 in 2 patients; Grade 3 in 20 patients). The incidence of Grade 3 cataract at 7 years was 25%. Other late sequelae (n = 28) were dry eye(s) (22 patients [Grade 1 in 14 patients; Grade 2 in 2 patients; Grade 3 in 2 patients; n/s in 4 patients), keratitis (3 patients), macular degeneration/cystoid edema (2 patients), and vitreous detachment (1 patient). Five patients developed Grade 3 noncataract late effects. Lens shielding reduced the incidence of Grade 3 cataract and all Grade ≥2 late sequelae. Seventeen patients (16 with cataracts) underwent surgery; 23 patients were treated conservatively. The outcome for managing late effects was generally successful, with 30 patients completely improved, and 9 patients with persisting late sequelae (10%).

Conclusions:POML responds favorably to moderate doses of RT but results in significant late morbidity. The majority of late effects were successfully managed. Lens shielding reduced the risk of cataracts and other late sequelae.

Similar Articles

WHO classification: tumors of hematopoietic and lymphoid tissues

Author(s): Jaffe ES, Harris NL, Stein H, Vardiman JW

Lymphoreticular tumors of the orbit

Author(s): Fitzpatrick PJ, Macko S

Malignant tumors of the orbit

Author(s): Margo CE, Mulla ZD

Ocular adnexal lymphoma: clinical behavior of distinct World Health Organization classification subtypes

Author(s): Fung CY, Tarbell NJ, Lucarelli MJ, Goldberg SI, Linggood RM, et al.

Orbital lymphoma: radiotherapy outcome and complications

Author(s): Stafford SL, Kozelsky TF, Garrity JA

Role of radiotherapy for primary orbital lymphoma

Author(s): Lee SW, Suh CO, Kim GE

Radiation dose to the lens and cataract formation

Author(s): Henk JM, Whitelocke RA, Warrington AP

Primary radiotherapy for localized orbital MALT lymphoma

Author(s): Le QT, Eulau SM, George TI