Single-fraction low-energy electronic brachytherapy for conjunctival lymphoma

Abstract

Purpose Conjunctival lymphoma represents an uncommon tumor, accounting for 5-10% of total extranodal lymphomas. Although radiotherapy is a frequent treatment option, limited capacities and lack of specialized centers are common problems in Peru, forcing radiation oncologists to apply short courses of radiotherapy. Here, we report a case series of patients treated with a novel single-shot scheme. Additionally, we present a literature review of the current short-course irradiation strategies. Cases presentation Three cases of conjunctival marginal zone (B-cell) lymphoma (marginal zone lymphoma [MZL]/mucosa-associated lymphoid tissue [MALT]) of the fornix are presented. Following biopsy and sonographic assessment of the lesion thickness, we applied a focused single dose of 14 Gy kilovoltage brachytherapy (prescribed to the maximum thickness of the lesion). Follow-up was scheduled in quarterly intervals. After 28, 31, and 40 months of follow-up, none of the three patients treated exhibited acute or chronic toxicities and remained local or distant disease-free. Conclusions Single dose kilovoltage brachytherapy was effective and safe in this small cohort of patients. Based on the literature, there is an evidence that local treatment in short-course radiotherapy is effective and should be considered amongst therapeutic options for these patients; however, this novel approach should be evaluated prospectively in a larger cohort.

The outcome of radiation therapy as a primary treatment in orbital lymphoma: a systematic review

“…In addition, IMRT patients had significantly fewer acute toxicities and a trend toward lower late toxicities, compared to 3D-CRT or electrons patients. Three cases of conjunctival MALT of the fornix were treated with a focused single dose of 14 Gy kilovoltage brachytherapy that prescribed to the maximum thickness of the lesion, and after 40 months of follow-up, none of the three patients treated had any acute or chronic toxicities and were disease-free locally and distantly [ 20 ].…”

Long‐term outcomes of patients with conjunctival extranodal marginal zone lymphoma

“…Lee et al demonstrated in a large cohort study that lower RT dosing (≤25.2Gy vs. >25.2Gy) significantly correlates with lower cataract rates while not leading to increased relapse 26 . Case series and retrospective studies utilizing ultra‐low‐dose RT (4Gy) have reported promising local control results and low toxicity profile; however, prospective and long‐term follow‐up studies are still lacking 43–45 . A retrospective study from Japan demonstrated that lens shielding could reduce the incidence of cataracts by half 46 .…”

“…26 Case series and retrospective studies utilizing ultra-low-dose RT (4Gy) have reported promising local control results and low toxicity profile; however, prospective and long-term follow-up studies are still lacking. [43][44][45] A retrospective study from Japan demonstrated that lens shielding could reduce the incidence of cataracts by half. 46 In addition to its protective effect, the use of lens shielding also helps build up the RT dose focused on the lesion site.…”