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

Fasola, C.; Jones, Jennifer C.; Huang, Derek; Le, Quynh‐Thu; Hoppe, Richard T.; Donaldson, Sarah S.

doi:10.1016/j.ijrobp.2013.04.035

Cited by 101 publications

(92 citation statements)

References 18 publications

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“…In the Stanford series of ultra–low-dose treatment of orbital low-grade non-Hodgkin lymphoma, 1 patient was treated for MCL, and this patient did not have an in-field relapse. 11 In our current study, the only in-field relapse occurred in a patient treated for MCL. Despite this relapse, we still consider patients with MCL for ultra–low-dose therapy given the known radiosensitivity of MCL and the almost uniform existence of systemic disease in patients with MCL.…”

Section: Discussionmentioning

confidence: 47%

“…In that study, 20 patients with low-grade B-cell OAL with 27 sites of orbital involvement were treated with 4 Gy in 2 fractions. 11 With a median follow-up time of just over 2 years, the overall response rate was 96%, and the CR rate was 85%. Among patients who achieved a CR, the local control rate was 100% with no in-field relapses.…”

Section: Discussionmentioning

confidence: 94%

“…10 In patients with indolent OAL treated for palliation or in cases of reirradiation, doses of 4 Gy have been reported to yield excellent control rates. Fasola et al 11 reported a complete response (CR) rate of roughly 85% for 27 sites of ocular adnexal involvement in 20 patients with non-Hodgkin lymphoma treated with 4 Gy total dose of radiation. For the orbital sites in which a CR was observed, the 2-year local control rate was 100%.…”

Section: Introductionmentioning

confidence: 99%

“…For the orbital sites in which a CR was observed, the 2-year local control rate was 100%. 11 Given the radiosensitivity of indolent non-Hodgkin lymphoma and MCL, and the fact that local relapses of these diseases are salvageable and non-life-threatening, in 2013, we began offering ultra-low-dose RT for indolent B-cell lymphoma and MCL affecting the ocular adnexa. Here, we report the results of a retrospective evaluation of the toxicity and efficacy of delivering 4 Gy in 2 fractions of external beam RT in patients with OAL treated at our institution.…”

Section: Introductionmentioning

confidence: 99%

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Ultra–low‐dose radiotherapy for definitive management of ocular adnexal B‐cell lymphoma

et al. 2017

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Background. The purpose of this study was to report the response to and toxicity of ultra–low-dose radiotherapy (RT) for B-cell ocular adnexal lymphoma (OAL). Methods. We conducted a retrospective review of patients with indolent B-cell and mantle cell OAL treated with 4 Gy to the orbit(s) in two 2-Gy fractions. Disease response was assessed clinically and/or radiographically at 2 to 4-month intervals after RT. Data collected included rates of overall response, complete response (CR), partial response (PR), and treatment-related toxic effects. Results. Twenty-two patients (median age, 65 years) had the following histologic subtypes: mucosa-associated lymphoid tissue (MALT; 14 patients; 64%); follicular lymphoma (5 patients; 23%); mantle cell lymphoma (MCL; 2 patients; 9%); and unclassifiable (1 patient, 4%). The overall response rate was 100%; 19 patients (86%) had a CR and 3 patients (14%) had a PR. The only acute toxic effect was grade 1 dry eye syndrome in 1 patient. Conclusion. Ultra–low-dose RT in patients with OAL is associated with high response rates and minimal toxic effects, and is much shorter in duration and cost.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultra–low‐dose radiotherapy for definitive management of ocular adnexal B‐cell lymphoma

et al. 2017

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“…296,297 Even in patients who have received prior radiation therapy, reirradiation for local disease progression that is resulting in progressive visual loss or symptoms can be considered.…”

Section: Orbital Lymphomamentioning

confidence: 99%

Orbital, Ocular, and Optic Nerve Tumors

Lucas¹,

Greven²,

Greven³

2016

Clinical Radiation Oncology

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Response-Adapted Ultralow-Dose Radiation Therapy for Orbital Indolent B-Cell Lymphoma

Pinnix,

Dabaja,

Gunther

et al. 2024

JAMA Oncol

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ImportanceRadiation therapy to doses of 24 to 36 Gy is currently used to treat indolent B-cell lymphoma of the ocular adnexa; however, ocular adverse effects are common.ObjectiveTo determine if a response-adapted radiation therapy strategy will result in excellent disease outcomes while reducing orbital morbidity.Design, Setting, and ParticipantsThis single-institution, phase 2 prospective nonrandomized controlled trial of a response-adapted strategy involved 50 evaluable patients with stage I to IV indolent B-cell lymphoma of the ocular adnexa enrolled between July 2015 and January 2021. This treatment approach was also retrospectively evaluated with a separate 55-patient cohort treated between March 2013 and October 2021. All data were analyzed between November 2021 and December 2023.InterventionsPatients were treated with ultralow-dose radiation therapy to 4 Gy in 2 fractions and assessed for response at 3-month intervals. Patients with persistent orbital lymphoma were offered an additional 20 Gy in 10 fractions to complete the response-adapted treatment.Main Outcome and MeasuresThe primary end point was 2-year local orbital control within the irradiated field after response-adapted therapy. Secondary end points included overall survival and complete response rate.ResultsThe 50 prospective patients were a median (range) of 63 (29-88) years old, and 31 (62%) were female. Among the 50 patients, 32 (64%) had mucosa-associated lymphoid tissue lymphoma, 12 (24%) had follicular lymphoma, and 6 (12%) had unclassifiable low-grade B-cell lymphoma. Thirty-one patients (62%) had stage I disease, and 36 (72%) were newly diagnosed. At a median follow-up of 37.4 (95% CI, 33.7-52.5) months, the 2-year local control rate was 89.4% (95% CI, 81.0%-98.7%), and the 2-year overall survival rate was 98.0% (95% CI, 94.1%-100%); 45 patients (90.0%; 95% CI, 78.2%-96.7%) experienced a complete response to response-adapted radiation, including 44 patients with a complete response to ultralow-dose radiation and 1 patient with a complete response after an additional 20 Gy. No local recurrences were observed among patients with a complete response to response-adapted therapy. No grade 3 or higher toxic effects were observed. In a planned subset analysis of 22 patients with newly diagnosed, untreated stage I mucosa-associated lymphoid tissue lymphoma, the 2-year local control rate was 90.7% (95% CI, 79.2%-100%), and the 2-year freedom from distant relapse rate was 95.2% (95% CI, 86.6%-100%).Conclusion and RelevanceIn this nonrandomized controlled trial, response-adapted ultralow-dose therapy for indolent orbital B-cell lymphoma resulted in reduced radiation exposure, negligible toxic effects, and excellent disease outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT02494700

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

Abstract: 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.

Cited by 101 publications

References 18 publications

Ultra–low‐dose radiotherapy for definitive management of ocular adnexal B‐cell lymphoma

Ultra–low‐dose radiotherapy for definitive management of ocular adnexal B‐cell lymphoma

Orbital, Ocular, and Optic Nerve Tumors

Response-Adapted Ultralow-Dose Radiation Therapy for Orbital Indolent B-Cell Lymphoma

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