Treatment Of Orbital Lymphoma Research Articles

Surgical resection and orbital iodine-125 brachytherapy for orbital malignancy: a novel treatment for orbital lymphoma

ObjectivesOrbital lymphoma is one of the most common adult orbital malignancies, accounting for approximately 10% of all orbital tumors. This study aimed to analyze the effects of surgical resection and orbital iodine-125 brachytherapy implantation for orbital lymphoma.Patients and methodsThis was a retrospective study. Clinical data of 10 patients were collected from October 2016 to November 2018 and followed up to March 2022. Patients underwent the primary surgery for maximal safe removal of the tumor. After a pathologic diagnosis of a primary orbital lymphoma was established, iodine-125 seed tubes were designed based on the tumor size and invasion range, and direct vision was placed into the nasolacrimal canal or/and under the orbital periosteum around the resection cavity during the secondary surgery. Then, follow-up data, including the general situation, ocular condition, and tumor recurrence, were recorded.ResultsOf the 10 patients, the pathologic diagnoses included extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (6 cases), small lymphocytic lymphoma (1 case), mantle cell lymphoma (2 cases), and diffuse large B-cell lymphoma (1 case). The number of seeds implanted ranged from 16 to 40. The follow-up period ranged between 40 and 65 months. All patients in this study were alive and well had tumors that were completely controlled. No tumor recurrences or metastases occurred. Three patients had dry eye syndrome and two patients had abnormal facial sensation. No patient had radiodermatitis involving the skin around the eye, and no patient had radiation-related ophthalmopathy.ConclusionsBased on preliminary observations, iodine-125 brachytherapy implantation appeared to be a reasonable alternative to external irradiation for orbital lymphoma.

Dosimetric study of the medical Agility grating system in radiotherapy of orbital lymphoma

AbstractObjectiveThe spatial location of the orbital lymphoma target area is special; improving the quality of the orbital lymphoma plan and protecting the eye are important focus areas for doctors and physicists. This study aimed to investigate the dosimetric characteristics of the Agility grating system in orbital lymphoma.MethodsA total of 10 patients with orbital lymphoma who underwent radiotherapy at the Ninth People's Hospital, affiliated with Shanghai Jiaotong University School of Medicine, from 1 May 2016 to 30 May 2018 were selected. The Monaco treatment planning system was used for calculation, and the MLCi2 and Agility grating data were selected, respectively. Dynamic intensity adjustment was carried out. In the calculation, the limit of other tissues is fixed, and only the limit of the patient's affected side crystal is changed. The limit range is changed from 4 to 20 Gy. The function is Serial, and each change is 2 Gy. The whole eye, the crystal, the optic nerve, and the target area's conformal index, homogeneity index, and planned hop count were calculated, respectively.ResultsWith increased limitation of the affected side crystal, Agility was more advantageous in the parameters of conformal index, homogeneity index, the affected side of the optic nerve, the average amounts of the affected eye and side of the eye, and the planned number of hops. The conformal index difference rate was 27.12%. After dropping to 5.11%, the difference rate of the homogeneity index decreased from 11.52% to 1.57%, and the downward trend gradually slowed down (P < 0.01). There were statistically significant differences: the difference rate of the affected side optic nerve decreased from 11.99% to 1.53% (P < 0.01); the mean difference rate of the affected side crystals decreased from 20.59% to 3.55% (P < 0.01); and the mean value of the affected side eye was <10 Gy when the crystal limit was <10 Gy. The difference in learning was >10 Gy, and there was no statistical difference. The calculation results of the contralateral crystal, MLCi2, are more advantageous (P < 0.01), indicating there is a statistically significant difference.ConclusionThe results of Agility gratings are more dosimetric than MLCi2 gratings in the treatment of orbital lymphoma. Agility grating should be used for radiotherapy of orbital lymphoma.

Low-Dose Radiation Therapy (2 Gy × 2) in the Treatment of Orbital Lymphoma

Low-dose radiation has become increasingly used in the management of indolent non-Hodgkin lymphoma (NHL), but has not been studied specifically for cases of ocular adnexal involvement. The objective of this study is to investigate the effectiveness of low-dose radiation in the treatment of NHL of the ocular adnexa. We reviewed the records of 20 NHL patients with 27 sites of ocular adnexal involvement treated with low-dose radiation consisting of 2 successive fractions of 2 Gy at our institution between 2005 and 2011. The primary endpoint of this study is freedom from local relapse (FFLR). At a median follow-up time of 26 months (range 7-92), the overall response rate for the 27 treated sites was 96%, with a complete response (CR) rate of 85% (n=23) and a partial response rate of 11% (n=3). Among all treated sites with CR, the 2-year FFLR was 100%, with no in-treatment field relapses. The 2-year freedom from regional relapse rate was 96% with 1 case of relapse within the ipsilateral orbit (outside of the treatment field). This patient underwent additional treatment with low-dose radiation of 4 Gy to the area of relapse achieving a CR and no evidence of disease at an additional 42 months of follow-up. Orbital radiation was well tolerated with only mild acute side effects (dry eye, conjunctivitis, transient periorbital edema) in 30% of treated sites without any reports of long-term toxicity. Low-dose radiation with 2 Gy × 2 is effective and well tolerated in the treatment of indolent NHL of the ocular adnexa with high response rates and durable local control with the option of reirradiation in the case of locoregional relapse.

Dose Response to Radiation Therapy for Primary Ocular Lymphomas

Lympho proliferative lesions are the most common primary orbital malignancies. Primary lymphoma of the orbit and ocular adnexa accounts for 59 years [4]. Orbital Lymphoma (OL) commonly presents with proptosis and is typically a painless, progressive orbital lesion; however, the conjunctival lesions appear clinically as fleshy salmon patch lesions [5,6]. The treatment options are surgical excision, chemotherapy, Radiation Therapy (RT), or combination of chemoradiation. Radiation therapy alone is the most effective treatment modality for the orbital lymphoma with excellent local tumor control [7-12]. The local and systemic relapse rate was reported to be less after treatment of OL by RT due to the indolent nature of the MALT variants. Different radiation techniques and doses (with or without adjuvant chemotherapy) were used by the several authors depending on the extent of the disease and severity. Kennerdell et al. reported 100% complete response of the lymphoid lesions of the orbit and ocular adnexa with low-dose RT (24-25.5 Gy) with very few acute and chronic side effects [8]. Several authors advocated 30-40 Gy for low to intermediate grade lymphomas with good local control and better 5 year survival. In a retrospective chart review of 31 cases of orbital MALT lymphoma, Le et al. observed a complete local control of the tumor with an overall 10 year survival of 73%. However, they did not find a significant difference in the outcomes among patients treated with RT dose of ≤ 30 Gy versus the >30 Gy and recommended that RT dose of 30-30.6 Gy provides excellent local control of tumor with minimal long-term side effects [9]. Galieni et al. observed complete response to the radiotherapy in seven patients of low-grade MALT lymphoma treated with RT dose of 36-40 Gy over a median follow-up of 51 months. However, among the patients treated with chemotherapy, local relapse was observed in 3/15, which resolved completely to the local irradiation [13]. In a multi-institutional, retrospective study by Uno et al. complete tumor response was seen in 26 patients (mean RT dose 36 Gy) and partial response in 20 others (mean RT dose 37.5 Gy) [11]. The local tumor recurrence was noted in 6 of the patients with partial or no response. They concluded that the age ( 60 years), gender, location (conjunctiva versus others), laterality (unilateral versus bilateral) or the dose of radiation therapy (≤ 30 Gy versus >30 Gy) did not contribute to the local tumor recurrence and felt the initial tumor response to RT influenced the probability of local recurrence. The overall 5-year survival rate for all the patients was 91% with a median follow-up of 46 months. Fung et al. noted 4 cases with local recurrence of the 98 cases of MALT lymphoma. Three of the 4 had stage I disease (primary orbital tumor treated with RT dose of 30 Gy) [7]. The systemic relapse-free survival rate among the stage I MALT lymphoma patients which comprise major group in their study was 75% at 5 years and the overall 5-year survival rate was 95%. However for the stage III-IV MALT lymphoma in the same study the 5 year disease specific survival rate was 49% and the overall survival rate was 39%. To summarize, excellent local tumor control rates were observed with radiation therapy with doses 2430 Gy in most studies.

Application of Magnetic Resonance Imaging and Three-Dimensional Treatment Planning in the Treatment of Orbital Lymphoma

Radiotherapy for lymphoma of the orbit must be individualized for each patient and clinical setting. Most techniques focus on optimizing the dose to the tumor while sparing the lens. This study describes a technique utilizing magnetic resonance imaging (MRI) and three dimensional (3D) planning in the treatment of orbital lymphoma. A patient presented with an intermediate grade lymphoma of the right orbit. The prescribed tumor dose was 4050 cGy in 18 fractions. Three D planning was carried out and tumor volumes, retina, and lens were subsequently outlined. Dose calculations including dose volume histograms of the target, retina, and lens were then performed. Part of the retina was outside of the treatment volume while 50% of the retina received 90% or more of the prescribed dose. The patient was clinically NED when last seen 2 years following therapy with no treatment-related morbidity.Patients with lymphomas of the orbit can be optimally treated using MRI based 3D treatment planning.

Radiotherapy is successful treatment for orbital lymphoma

Radiotherapy is successful treatment for orbital lymphoma

Radiologic Treatment of Orbital Lymphoma

Radiologic Treatment of Orbital Lymphoma