Management Of Orbital Lymphoma Research Articles

Management of orbital diffuse large cell b lymphoma: a case report

Orbital lymphoma is a very rare location of large cell lymphomas. It accounts for 10% of orbital tumors. Proptosis is the most frequent sign, but it should be noted that the clinical presentation depends greatly on the initial site of the tumor. The diagnosis is suspected on clinical and radiological elements and confirmed by anatomopathologica exam. Chemotherapy is the main treatment in the management of orbital lymphoma, often combined with radiation therapy and surgery. We present a case of orbital diffuse large cell B lymphoma treated with chemothérapy with RCHOP protocol and external radiothérapy, and we discusse current recommendations from the literature

Orbital Lymphoma: Clinical Features and Management at Dr. M. Djamil General Hospital in 2018

Background: Orbital lymphoma is found in 50-60% of ocular adnexal lymphomas, with approximately 90% of orbital lymphomas being Non-Hodgkin's lymphomas. Clinical features may include proptosis, ptosis, limitation of eye movement, and salmon patch lesions on the conjunctiva. If an orbital tumor is present, an accurate histopathological examination is important in the management of orbital lymphoma. Because of nonspecific clinical signs and symptoms, some diagnostic delays may occur. The purpose of the study was to evaluate the clinical features, diagnostic approach, and treatment choice in orbital lymphomas.
 Methods: We identified patients diagnosed with orbital lymphoma in an outpatient clinic in Dr. M. Djamil General Hospital from January to December 2018. Patients’ medical records were reviewed retrospectively.
 Results: The patient group consisted of 6 patients (five males and one female) with a median age of 58 years. Proptosis and orbital swelling were the leading clinical symptoms, mainly found unilateral (five cases). The diagnosis was confirmed by a surgical biopsy. One histology result showed lymph node hyperplasia, which didn't suit the clinical manifestation and got re-reviewed. All histology results then showed non-Hodgkin’s lymphoma with the small lymphocytic type (100%). Five patients received systemic chemotherapy with the CHOP regimen protocol, and one patient refused to get further chemotherapy treatment.
 Conclusion: When unmatched orbital symptoms with histology results are present, re-reviewing the histology result is essential. Once the diagnosis is established, systemic chemotherapy is indicated and can proceed so there will be no delay in treatment

Radiotherapy in the Management of Orbital Lymphoma: A Single Institution's Experience Over 4 Decades.

To report our institution's treatment techniques, disease outcomes, and complication rates after radiotherapy for the management of lymphoma involving the orbits. We retrospectively reviewed the medical records of 44 patients curatively treated with radiotherapy for stage IAE (75%) or stage IIAE (25%) orbital lymphoma between 1969 and 2013. Median follow-up was 4.9 years. Thirty-eight patients (86%) had low-grade lymphoma and 6 (14%) had high-grade lymphoma. Radiation was delivered with either a wedge-pair (61%), single-anterior (34%), or anterior with bilateral wedges (5%) technique. The median radiation dose was 25.5 Gy (range, 15 to 47.5 Gy). Lens shielding was performed when possible. Cause-specific survival and freedom from distant relapse were calculated using the Kaplan-Meier method. The 5-year local control rate was 98%. Control of disease in the orbit was achieved in all but 1 patient who developed an out-of-field recurrence after irradiation of a lacrimal tumor. The 5-year regional control rate was 91% (3 patients failed in the contralateral orbit and 1 patient failed in the ipsilateral parotid). Freedom from disease, cause-specific survival, and overall survival rates at 5 and 10 years were 70% and 55%, 89% and 89%, and 76% and 61%, respectively. Acute toxicity was minimal. Ten patients (23%) reported worsened vision following radiotherapy, and cataracts developed in 17 patients. Cataracts developed in 13 of 28 patients treated without lens shielding (46%) and 4 of 16 patients (25%) treated with lens shielding. Radiotherapy is a safe and effective local treatment in the management of orbital lymphoma.

Management of Orbital Lymphona Using Radiation Therapy

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.

The progress in the diagnosis and management of orbital lymphoma

Lymphoma is one of the most common malignant tumor of the orbit in adults. Orbital lymphoma mainly consists of extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue, follicular lymphoma, diffuse large B-cell lymphoma, mantle cell lymphoma, infrequent NK/T cell lymphoma and Burkitt lymphoma. Diagnosis on orbital lymphoma remains challenging in that it is difficult to distinguish it from benign lesions, especially for low degree lymphomas. Combined examinations of histological, cytological and molecular features are required to make final differentiation. There are many treatment options for diagnosis of orbital lymphoma, such as surgical resection, radiotherapy, chemotherapy, monoclonal antibody targeted therapy, immunotherapy. The appropriate scenario of treatment on orbital lymphoma should be made based on the Ann Arbor or TNM staging system to determine the stage of orbital lymphoma at the moment for maximizing the results. The latest concepts on diagnosis and management of orbital lymphoma are reviewed in this paper. (Chin J Ophthalmol, 2017, 53: 632-636).

Radiation Therapy in the Management of Orbital Lymphoma

To report our institution’s treatment techniques, disease outcomes, and complication rates after radiation therapy for the management of lymphoma involving the orbits. We retrospectively reviewed the medical records of 44 patients diagnosed with stage IAE (77%) or stage IIAE (23%) orbital lymphoma and curatively treated with radiation therapy between May 1969 and April 2013. The median follow-up was 4.9 years. Thirty-eight patients (86%) had low-grade lymphoma and 6 patients (14%) had high-grade lymphoma. Patients received treatment with one or more of the following beam energies: 250 kVP (34%), 60Co (36%), 2 MV (5%), 4 MV (16%), 6 MV (20%), or 8 MV (5%). Radiation was delivered with either wedge pair (61%), single anterior (34%), or anterior with bilateral wedges (5%) techniques. The median radiation dose was 25.5 Gy (range, 15 Gy – 47.5 Gy). Lens shielding was performed when possible. Cause-specific survival and freedom from distant relapse were calculated using the Kaplan-Meier method. The 5-year local control rate was 98%. Control of disease in the orbit was achieved in all but one patient who developed an out-of-field recurrence after irradiation of a lacrimal tumor and was salvaged successfully with further radiation therapy. The 5-year regional control rate was 91% (3 patients failed in the contralateral orbit and 1 patient failed in the ipsilateral parotid). Freedom from metastasis, cause-specific survival, and overall survival rates at 5 years were 76%, 89%, and 76%, respectively. Acute toxicity was minimal. Eight patients (18%) reported worsened vision following radiation therapy, and cataracts developed in eight patients. Cataracts developed in 6 of 28 patients treated without lens shielding (21%) and 2 of 16 patients (13%) treated with lens shielding. No patient developed significant late lacrimal toxicity. Radiation therapy is a safe and effective local treatment in the management of orbital lymphoma.

Shifts in Stereotactic Radiosurgery Platform Utilization for Brain Metastases in the United States

survival and freedom from distant relapse were calculated using the Kaplan-Meier method. Results: The 5-year local control rate was 98%. Control of disease in the orbit was achieved in all but one patient who developed an outof-field recurrence after irradiation of a lacrimal tumor and was salvaged successfully with further radiation therapy. The 5-year regional control rate was 91% (3 patients failed in the contralateral orbit and 1 patient failed in the ipsilateral parotid). Freedom from metastasis, cause-specific survival, and overall survival rates at 5 years were 76%, 89%, and 76%, respectively. Acute toxicity was minimal. Eight patients (18%) reported worsened vision following radiation therapy, and cataracts developed in eight patients. Cataracts developed in 6 of 28 patients treated without lens shielding (21%) and 2 of 16 patients (13%) treated with lens shielding. No patient developed significant late lacrimal toxicity. Conclusion: Radiation therapy is a safe and effective local treatment in the management of orbital lymphoma. Author Disclosure: S. Kharod: None.M.P. Herman: None. C.G. Morris: None. J. Lightsey: None. W.M. Mendenhall: None. N.P. Mendenhall: None.

528 Poster Primary radiotherapy in the management of orbital lymphoma

528 Poster Primary radiotherapy in the management of orbital lymphoma

Radiotherapy in the management of orbital lymphoma

Purpose: This retrospective study reviews the treatment technique, disease outcome, and complications of radiotherapy used in the management of lymphoma involving the orbits. Patients & Methods: Thirty-eight patients were treated between May 1969 and January 1995, with a median follow-up of 8.3 years. All patients had biopsy-proven orbital lymphoma. Twenty patients who had limited disease were treated with curative intent, and 18 patients who had known systemic disease were treated with palliative intent. Of the 20 patients treated with curative intent, 14 had low-grade and 6 had intermediate- or high-grade disease. None received chemotherapy. Most patients received treatment with 250 kVP or 60Co radiation, using either an en face anterior field or wedged anterior and lateral fields. Median treatment dose was 25 Gy. Lens shielding was performed if possible. For patients treated for cure, cause-specific survival and freedom from distant relapse were calculated using the Kaplan-Meier method. Results: Control of disease in the orbit was achieved in all but 1 patient, who developed an out-of-field recurrence after irradiation of a lacrimal tumor and was salvaged with further radiotherapy. In the patients treated curatively, the 5-year rate of actuarial freedom from distant relapse was 61% for those with low-grade and 33% for those with intermediate/high-grade disease ( p = 0.08). Cause-specific survival at 5 years was 89% for patients with low-grade and 33% for those with intermediate/high-grade disease ( p = 0.005). Two patients with low-grade disease had contralateral orbital failures; both were salvaged with further irradiation. Acute toxicity was minimal. Cataracts developed in 7 of 21 patients treated without lens shielding and 0 of 17 patients treated with lens shielding. No patient developed significant late lacrimal toxicity. Conclusion: Radiotherapy is a safe and effective local treatment in the management of orbital lymphoma.

2157 Radiotherapy in the management of orbital lymphoma

2157 Radiotherapy in the management of orbital lymphoma

Radiotherapy is successful treatment for orbital lymphoma

Purpose : To describe the clinical presentation, treatment technique, outcome and complications in a large single institutional experience using radiotherapy for treatment of orbital lymphoma. Methods and Materials : Twenty-five patients with lymphoma of the orbit or ocular adnexa were treated with radiotherapy at Stanford University Medical Center during the fourteen year period, 1977–1991. Patients were staged using the Ann Arbor criteria with chest x-ray, computerized tomography of abdomen and orbits, lymphangiogram, and bone marrow biopsy. Patients with disease localized to the orbits as well as those with disseminated disease and symptomatic orbital lesions were treated. Thirty-one involved eyes were treated. Mean radiotherapy dose was 35.3 Gy, with a range of 28 Gy to 40.2 Gy. Lens protection was used in all cases. Two patients with diffuse large cell lymphoma also received chemotherapy as part of their initial treatment. Follow-up ranged from 10 months to 13 years, with a mean follow-up time of 4 years. Results : Twenty patients had disease confined to one or both orbits (Stage 1). One patient had a monoclonal atypical infiltrate, while the remainder had a histologic diagnosis of malignant lymphoma: diffuse small lymphocytic, 13; follicular mixed, 3; diffuse small cleaved, 3; diffuse large cell, 2; follicular small cleaved, 1; follicular and diffuse small cleaved, 1; undifferentiated, 1. Two local relapses occurred; the actuarial 5-year freedom from local relapse is 89%. Actuarial 5-year freedom from distant relapse, freedom from any relapse and overall survival are 77%, 70%, and 93%, respectively. Acute complications of treatment were mild. Late complications included transient cystoid macular edema (one patient), asymptomatic subcapsular and medial sector cataract formation (two patients), retinopathy (two patients), mild eyelid retraction (one patient), and dry eye with secondary conjunctivitis (one patient). Conclusion : Carefully planned radiotherapy with lens shielding is an effective and safe treatment in the management of orbital lymphoma. We recommend megavoltage radiation doses of 30–35 Gy in 180–200 cGy fractions for low grade lesions, and 36–40 Gy for intermediate and high grade lesions.

Role of radiotherapy in the management of orbital lymphoma

Role of radiotherapy in the management of orbital lymphoma

The role of radiation therapy in the management of orbital lymphoma

The role of radiation therapy in the management of orbital lymphoma