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Radiotherapy in the Management of Orbital Lymphoma: A Single Institution’s Experience Over 4 Decades

Kharod, Shivam, M., BS*; Herman, Michael, P., MD*; Morris, Christopher, G., MS*,†; Lightsey, Judith, MD*; Mendenhall, William, M., MD*; Mendenhall, Nancy, P., MD*,†

American Journal of Clinical Oncology: January 2018 - Volume 41 - Issue 1 - p 100–106
doi: 10.1097/COC.0000000000000229
Original Articles: Head and Neck

Purpose: To report our institution’s treatment techniques, disease outcomes, and complication rates after radiotherapy for the management of lymphoma involving the orbits.

Patients and Methods: We retrospectively reviewed the medical records of 44 patients curatively treated with radiotherapy for stage IAE (75%) or stage IIAE (25%) orbital lymphoma between 1969 and 2013. Median follow-up was 4.9 years. Thirty-eight patients (86%) had low-grade lymphoma and 6 (14%) had high-grade lymphoma. Radiation was delivered with either a wedge-pair (61%), single-anterior (34%), or anterior with bilateral wedges (5%) technique. The median radiation dose was 25.5 Gy (range, 15 to 47.5 Gy). Lens shielding was performed when possible. Cause-specific survival and freedom from distant relapse were calculated using the Kaplan-Meier method.

Results: The 5-year local control rate was 98%. Control of disease in the orbit was achieved in all but 1 patient who developed an out-of-field recurrence after irradiation of a lacrimal tumor. The 5-year regional control rate was 91% (3 patients failed in the contralateral orbit and 1 patient failed in the ipsilateral parotid). Freedom from disease, cause-specific survival, and overall survival rates at 5 and 10 years were 70% and 55%, 89% and 89%, and 76% and 61%, respectively. Acute toxicity was minimal. Ten patients (23%) reported worsened vision following radiotherapy, and cataracts developed in 17 patients. Cataracts developed in 13 of 28 patients treated without lens shielding (46%) and 4 of 16 patients (25%) treated with lens shielding.

Conclusion: Radiotherapy is a safe and effective local treatment in the management of orbital lymphoma.

*Department of Radiation Oncology, University of Florida, Gainesville

University of Florida Proton Therapy Institute, Jacksonville, FL

The authors declare no conflicts of interest.

Reprints: Nancy P. Mendenhall, MD, University of Florida Proton Therapy Institute, 2015N Jefferson Street, Jacksonville, FL 32206. E-mail: menden@shands.ufl.edu.

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