Times Not to Forget Radiotherapy When Treating Patients With Lymphoma

Charles A. Enke, MD


J Oncol Pract. 2019;15(4):167-172. 

In This Article

Conjunctival and Orbital Lymphoma

Conjunctival and orbital lymphoma frequently present in the conjunctiva, although involvement of the lacrimal gland or other orbital retrobulbar structures is possible. Marginal zone lymphoma is the most common histology, although DLBCL and follicular lymphoma have also been described. Bilateral involvement occurs in a minority of presentations. These conjunctival and orbital presentations are managed differently from intraocular lymphoma. The most common presentation is stage I disease in these tumors, which respond extremely well to ISRT. Marginal zone lymphoma presentations usually require doses of 24 Gy, which minimize the risk of serious late adverse effects.[17] Tumors involving the conjunctiva usually require treatment to the entire conjunctiva but not the orbit. Tumors involving other orbital adnexal structures, such as the lacrimal gland and retrobulbar areas, require treatment of the entire orbit.[5] Patients may experience symptoms of conjunctivitis, epiphora, and photophobia at the end of treatment, although the symptoms usually resolve within 2 to 3 weeks after treatment completion. The development of a cataract within the treated eye is a potential late adverse effect occurring in approximately 50% of patients. Serious late ocular adverse effects are rare, and local control rates are excellent. In keeping with a trend in reducing the radiation dose used to treat indolent lymphomas, the group from Stanford published their experience with using two fractions of 2 Gy to treat 27 sites of ocular adnexal lymphoma, including conjunctival sites. They reported a complete response rate of 85%. In patients with a complete response, the 2-year freedom from relapse was 100%. This approach does not eliminate the use of definitive retreatment in the event of relapse.[18]