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EXTERNAL BEAM RADIATION FOR CHOROIDAL LYMPHOMA

Efficacy and Complications

Mashayekhi, Arman MD; Hasanreisoglu, Murat MD; Shields, Carol L. MD; Shields, Jerry A. MD

doi: 10.1097/IAE.0000000000001026
Original Study
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Purpose: To determine the efficacy and safety of external beam radiation for treatment of choroidal lymphoma (CL).

Design: Retrospective case series.

Participants: Twenty-five eyes of 24 patients with CL treated with external beam radiation.

Method: Review of medical records.

Main Outcome Measures: Tumor control, visual acuity, and radiation complications.

Results: The mean age of the patients was 62 years (median, 65; range, 32–89 years). Only 2 patients (8%) had a history of systemic lymphoma. The most common symptom was painless blurred vision in 14 eyes (58%) and the mean duration of ocular symptoms was 12 months (median, 7; range, 1–36 months). Initial best-corrected visual acuity was 20/40 or better in 10 eyes (40%), 20/50 to 20/150 in 12 eyes (48%), and 20/200 or less in the other 3 eyes (12%). The fovea was involved by the CL in 16 eyes (64%). Mean tumor thickness was 3.1 mm (median, 3.0; range 1.1–6.3 mm). Anterior and posterior transscleral extension of CL were present in 15 (60%) and 14 eyes (56%), respectively. All patients, except 3 (13%), had some form of ocular biopsy confirming the diagnosis of ocular lymphoma. The mean total radiation dose was 2,867 cGy (median, 3,000; range, 1,200–3,600 cGy). At final examination, after a mean follow-up period of 58 months (median, 35; range, 13–228 months), 18 eyes (72%) showed complete regression of CL and 7 eyes (28%) showed partial regression. All eyes (100%) with initial serous retinal detachment (14 eyes), subfoveal fluid (8 eyes), and macular edema (5 eyes) achieved complete resolution of subretinal or intraretinal fluid after treatment. Recurrence of CL after initial partial response developed in only 1 eye (4%). Compared with the initial evaluation, final best-corrected visual acuity had increased in 11 (44%), was stable in 8 (32%), and had decreased in 6 eyes (24%). Only 2 eyes (8%) showed signs of mild nonproliferative retinopathy.

Conclusion: In this study, external beam radiation was an effective and safe modality for treatment of CL, achieving long-term tumor regression in 96% and stable or improved vision in 76% after mean follow-up period of 6 years.

External beam radiation achieved long-term regression of choroidal lymphoma and serous retinal detachment in 96% of treated eyes. There were no instances of radiation papillopathy and two eyes showed mild radiation retinopathy.

Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.

Reprint requests: Arman Mashayekhi, MD, Oncology Service, Wills Eye Hospital, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107; e-mail: arman@shields.md

Support provided by the Eye Tumor Research Foundation, Philadelphia (C.L.S and J.A.S) and Mellon Charitable Giving from the Martha W. Rogers Charitable Trust (C.L.S).

None of the authors have any conflicting interests to disclose.

© 2016 by Ophthalmic Communications Society, Inc.