Long‐term follow‐up and health‐related quality of life among cancer survivors with stage IEA orbital‐type lymphoma after external photon‐beam radiotherapy: Results from a longitudinal study

Abstract

We assessed the long-term outcomes and treatment-related adverse effects of patients with Stage I, "orbital-type" lymphomas that were uniformly treated with photons. All consecutive patients diagnosed with low-grade, Ann Arbor Stage IEA orbital lymphoma treated between 1999 and 2020 at our department were retrospectively reviewed. We excluded patients with exclusive conjunctival involvement, typically treated with en face electrons. In order to quantify radiotherapy related side effects we applied the CTCAE criteria, analyzed changes in visual acuity, quantified dry eye symptoms by use of the Ocular Surface Disease Index (OSDI) score and applied the EORTC QLQ-C30 questionnaire for quality of life (QoL) assessment. In total 66 eyes of 62 patients were irradiated with a median dose of 30.6 Gy. The median follow-up was 43.5 months. The predominant histological subtype were MALT lymphomas. No local failure occurred in this cohort. Of nine outfield relapses, six solely occurred in the contralateral eye. The 5-and 10-years distant progression free survival rates (PFS) were 81.4% and 63.5%. The 5-and 10years overall survival rates were 85.1% and 71.9% without any tumor related death.Of the acute toxicities none was higher than CTCAE grade 1. The predominant late toxicities were dry eyes (21.2%) of CTCAE Grade <2 and radiation induced cataracts (19.7%). During long-term follow up the average visual acuity did not deteriorate. The global QoL was worst before treatment and improved significantly after 24 months (p = 0.007). External beam radiotherapy of "orbital-type" lymphomas with photons is an effective and gentle treatment option with excellent local controlThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Long-Term Follow-Up of Patients with Conjunctival Lymphoma after Individualized Lens-Sparing Electron Radiotherapy: Results from a Longitudinal Study

“…We compared the above data with a previously published patient cohort consisting of orbital-type lymphoma patients that were uniformly irradiated with whole-orbit photon irradiation using a non-lens-sparing approach. The applied median doses for both groups were comparable (conjunctival-type: 31.0 Gy, orbital-type: 30.6 Gy) (Figure 2A) [21]. No local failure occurred in the photon group but the difference between the cumulative incidence curves were not significant (Gray's test p = 0.0546).…”

“…We used a previously published cohort consisting of patients with stage I, "orbitaltype", low-grade lymphomas that were uniformly treated with whole-orbit photon irradiation as the control group concerning outfield recurrences and cataract formation. These patients were treated with a non-lens-shielding technique and a median dose of 30.6 Gy [21].…”

“…The remaining patients received Rituximab in combination with Bendamustin. We compared the above data with a previously published patient cohort consisting of orbital-type lymphoma patients treated with photon radiotherapy [21]. There was no statistically significant difference between the cumulative incidences of outfield recurrences between both tumor localizations, although the incidences were numerically higher for orbital lymphomas Gray's test p = 0.172).…”

“…At this department, lymphomas that are restricted to the conjunctiva are routinely treated with en face electrons. Irradiation of the whole-orbit with photons is used in case of intraorbital tumor spread or whenever combined conjunctival and intraorbital involvement occurs [20,21].…”

“…To quantify radiotherapy related side effects, we applied the CTCAE criteria and evaluated changes in visual acuity. We used a previously published cohort of orbital-type lymphoma patients that were treated with non-lens-sparing whole-orbit irradiation as a control group [21].…”