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Radiotherapy Alone for Stage IE Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphomas: Long-Term Results

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Radiotherapy Alone for Stage IE Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphomas: Long-Term Results

Masanari Niwa et al. Radiat Oncol.

Abstract

Background: To evaluate the long-term efficacy and toxicity of radiation therapy in patients with Stage IE primary ocular adnexal mucosa-associated lymphoid tissue lymphoma.

Methods: We designed a retrospective analysis to evaluate 81 patients with ocular adnexal mucosa-associated lymphoid tissue lymphoma treated with radiation therapy between 2006 and 2016. The median radiation dose was 30 Gy (range, 30-36 Gy in 15-18 fractions). Local control, progression-free survival, overall survival, and cumulative incidence of Grade 3 cataract were calculated by using the Kaplan-Meier method.

Result: The median follow-up time was 74 months (range, 4-157 months). The 5-year local control was 100%. Although local relapse was suspected in 3 patients after radiation therapy, 2 patients were pathologically diagnosed as IgG4-related inflammation and in 1 patient as intense inflammatory cell infiltration. The 5-year progression-free survival was 94.4%. Five patients had relapse at distant sites. The 5-year overall survival was 98.8%. Twenty patients had Grade 3 cataract. The 5-year cumulative incidences of Grade ≥ 3 and Grade ≥ 2 cataract for 58 patients treated without a lens shield were 38 and 40%, respectively. The incidence of Grade ≥ 3 cataract was 42% for 50 patients treated with 6-MV X-rays (estimated lens dose: 29 Gy) and 17% for 8 patients treated with 9-MeV electrons (estimated lens dose: 24 Gy).

Conclusions: Radiation therapy alone yielded excellent local control and long-term survival in Stage IE ocular adnexal mucosa-associated lymphoid tissue lymphoma. Long-term observation with careful attention to relapse at distant sites is necessary. In the case of suspected local relapse, IgG4-related disease should be carefully ruled out.

Keywords: Cataract; MALT lymphoma; Ocular adnexal; Radiation therapy.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Curves of local control (LC, open circle), progression-free survival (PFS, filled circle), and overall survival (OS, triangle) for 81 patients with orbital MALT lymphoma
Fig. 2
Fig. 2
Cumulative incidence of Grade ≥ 3 cataract in all 58 patients treated without a lens shield (open circle), in 50 patients treated with 6-MV X-rays (filled circle), and in 8 patients 9-MeV electrons (triangle). The median age at the start of RT was 69 (range, 90–29), 70 (range, 90–43), and 64 (range, 88–29) years, respectively

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