Hematologic Cancer

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MO_42_2652 - Long-term Results of Radiation Therapy for Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphomas

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Long-term Results of Radiation Therapy for Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphomas
M. Niwa1, S. Ishikura1, N. Takama2, E. Kato2, and Y. Shibamoto1; 1Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 2Nagoya medical center, Nagoya, Japan

Purpose/Objective(s): The purpose of this study was to evaluate the long-term efficacy and toxicity of radiation therapy in patients with primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma.

Materials/Methods: Patients who were pathologically diagnosed as Stage IE/IIE ocular adnexal MALT lymphoma and treated by radiation therapy were the subject of this retrospective analysis. From 2006 through 2016, 90 patients were identified in our database and reviewed. Eighty-six patients had Stage IE disease and 4 had Stage IIE. There were 49 men and 41 women. Their median age was 67 years (range, 29-90 years). Local control (LC), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method.

Results: The median follow-up period was 52 months (range, 1-134 months). The median radiation dose was 30 Gy (range, 30-36 Gy in 15-18 fractions). Oral steroid was used for six patients who had double vision at the beginning of treatment, while others were treated by radiation therapy alone. 6MV photon beams with a wedged pair of fields were used for 58 patients. 9 MeV electron beams with a single anterior field were used for 28 patients, and 16 MeV were used for one patient. Combination of 6MV photon beams and 9MeV electron beams were used for four patients. Twenty patients were treated with a lead lens block. Eleven patients had bilateral lesions and were treated simultaneously. The 5- and 10-year LC rates were both 100%. Although local recurrence was suspected in three patients after radiation therapy, two were diagnosed by biopsy as IgG4-related inflammation and one as intense inflammatory cell infiltration. The 5- and 10-year OS were 97.5% and 91.3%, and the 5- and 10-year PFS were 91.3% and 77.9%, respectively. Six patients had recurrence at distant sites. The median time to recurrence was 33 months. The recurrences occurred at various sites such as the contralateral conjunctiva, parotid gland, cervix, lung, intraperitoneal cavity, and femur. One patient incidentally had retinal detachment during radiotherapy and then underwent surgery. There was no other Grade 3 or higher acute morbidity. Fourteen patients had Grade 2 late morbidity (dry eye, 3; superficial punctate keratitis, 4; cataract, 7). Twenty-five patients had Grade 3 cataract. Otherwise there was no Grade 3 or higher late adverse event.

Conclusion: Radiation therapy alone achieved excellent local control and long-term survival in ocular adnexal MALT lymphoma, but long-term observation with careful attention to recurrence at distant sites is necessary. In the case of suspected local recurrence, the possibility of IgG4-related disease should also be considered.

Author Disclosure: M. Niwa: None. S. Ishikura: None. N. Takama: None. Y. Shibamoto: None.

Masanari Niwa, MD

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