Management of Orbital Lymphona Using Radiation Therapy

Abstract

The aim of this study is to retrospectively review disease outcome, survival analysis, and complications experienced by orbital lymphoma patients after completion of radiotherapy. We retrospectively analyzed medical records of 50 patients (36 women and 14 men, age range 33-92, average age 67.7 years with a median age of 71.5 years) dating from 1984 to 2017 from two institutions – Southern California Kaiser Permanente in Los Angeles, California and the Cancer Care Institute in San Jose, California. All patients underwent biopsy for clinically proven diagnosis of orbital lymphoma. 32 patients were diagnosed with Stage 1 orbital lymphoma, one patient with Stage 2, 2 patients with Stage 3, and 15 patients with Stage 4.The histological grade was low in 42 (84%), intermediate in 7 (14%), and high in 1 (2%). For treatment, 41 patients were treated with radiotherapy alone while 9 patients received chemotherapy for treatment of lymphoma at other sites before or after radiotherapy for orbital lymphoma. The median dose for total patients was 3040 cGy (range 2000-4000). Five-year local relapse-free survival was determined using the Kaplan-Meier method. The average follow-up for patients post-radiation was 49 months (range 4 days-325 months) and the median follow-up was 27.5 months. At 5 years, the overall survival rate for total patients was 70%. For Stage 1 patients (n=32), the 5-year survival rates were 82%. Only one patient was diagnosed with Stage 2 (n=1) orbital lymphoma and survived for 22 months. For Stage 3 patients (n=2), the 5- year survival rate was 50%. For Stage 4 (n=15) patients, the 5-year survival rate was 60%. Ten patients reported cataract formation as a result of radiotherapy. Dry eye syndrome was recorded in 6 patients, but none were reported as severe. Twenty-five patients reported no complications after completion of radiation. One patient died during treatment. Other complications amongst patients included conjunctivitis (n=4), diplopia (n=2), ptosis (n=2), keratitis (n=2), tearing (n=1), and decreased vision (n=1). Radiotherapy is a safe and effective treatment option in the management of orbital lymphoma with good response rates. The majority of complications experienced reported by patients from radiation treatment were minimal and did not require medical intervention.