Radiation therapy for primary orbital and ocular adnexal lymphoma. (January 2023)

• Record Type: Journal Article
• Authors: Pereira-Da Silva, Maria Valeria; Di Nicola, Maria Laura; Altomare, Filiberto; Xu, Wei; Tsang, Richard; Laperriere, Normand; Krema, Hatem
• Is Part Of: Clinical and translational radiation oncology. Volume 38(2023)
• Page Start: 15
• Page End: 20
• Publication Date: 2023-01
• Subjects: Lymphoma -- Ocular adnexa -- Orbit -- Periocular -- Radiotherapy; Cancer -- Radiotherapy -- Periodicals; Oncology -- Periodicals; Cancer -- Radiotherapy; Oncology; Radiation Oncology; Neoplasms -- radiotherapy; Translational Medical Research; Periodicals; Electronic journals; Periodicals; 616.9940642
• DOI: 10.1016/j.ctro.2022.10.001
• Languages: English
• ISSNs: 2405-6308

Abstract

Highlights: Primary Orbital and Ocular adnexal Lymphoma represents 8% of all extra nodal lymphomas, and it is the most common primary orbital malignancy in adults. Lymphoma treatment generally may include radiotherapy (RT), chemotherapy, immunomodulating therapy, primary antibiotic treatment, surgical excision, or combination therapy. The choice of treatment depends on systemic staging and the tumor histopathologic type at the initial presentation. Radiotherapy at a dose of 20–25 Gy fractionated in 10–15 sessions with use of lens shielding, whenever indicated, is an efficacious and safe option for Primary Orbital and Ocular adnexal Lymphoma treatment, with excellent local control and low incidence of late manageable ocular toxicities. Abstract: Objective: To report the efficacy and toxicity of External beam Radiotherapy (EBRT) as a sole treatment for MALT and Follicular Primary Orbital and Ocular adnexal Lymphoma (POOAL) Methods: Retrospective review of all POOAL patients treated with EBRT utilizing megavoltage photon or electron beam radiotherapy between 2003 and 2015. Patient demographics, tumour extent and pathology, radiotherapy techniques, and treatment outcomes were reviewed. The actuarial rates of tumour control and radiation toxicities were calculated using Kaplan-Meier estimates. Results: This study included 167 tumours, of which MALT lymphoma involved 149 (89 %). The conjunctiva and orbit were equally involved as the predominant site (48 %). Megavoltage photon radiotherapy was used in 60 % of predominantly orbital lymphoma and Electron beam with lens shielding in 77 % of the conjunctival lymphoma. The majority (95 %) were treated with a total dose of 25 Gy in 10 fractions. Local control rate was 98 % (CI: 93–100 %) at 5 years. The long-term RT toxicities included dry eye in 27 eyes (16 %) and cataract in 22 (13 %). None of the patients developed significant structural or functional radiation toxicity. Conclusion: External Beam Radiotherapy, with lens shielding whenever indicated, at a dose of 20–30 Gy delivered over 10–20 fractions is an efficacious and safe primary treatment option for POOAL lymphoma, with excellent local control and low incidence of late manageable ocular toxicities.