A retrospective analysis of different modalities for treatment of primary orbital non-Hodgkin's lymphomas.
We have reviewed 37 patients with primary orbital lymphoma, using the Ann Arbor criteria and the Working Formulation and its modification. Thirty-one patients had stage I disease, four stage II, one stage III and one stage IV. The male to female ratio was 2.7:1. There were 34 low-grade tumours (including 24 mantle zone) and three intermediate-grade. Patients were divided into three groups according to their primary treatment. Group 1: radiotherapy (17 cases); Group 2: surgery alone (13 cases); Group 3: chemotherapy (seven cases). Patients were followed up from 5 months to 24.3 years, with a mean and median of 7.6 and 6.2 years, respectively. The BMDP software package was used for survival estimation (Kaplan-Meier) and determination of prognostic variable (univariate Cox regression). Local relapse-free survival at 10 years was 100% in Group 1, 0% in Group 2 and 42% in Group 3 with a statistically significant difference (p < 0.01) in favour of radiotherapy. Statistically significant good prognostic features were: complete remission (CR) in response to initial treatment, primary radiotherapy and older age. For stage I cases, there was no difference in distant relapse-free survival in the three groups. The overall cause-specific survival for stage I patients at 10 years was 100% for each group and at 20 years was 100, 67 and 0% for Groups 1, 2 and 3. The difference between the primary radiotherapy and chemotherapy-treated groups was significant at the p = 0.08 level. Statistically significant prognostic factors were early stage, low-grade histology and primary radiotherapy. In one patient, ptosis and diplopia appeared after surgery. One case of glaucoma required enucleation, one patient suffered severe dry eye syndrome. All patients (11/11) in whom the lens received direct radiation developed cataracts of different degrees if follow-up was long enough. Cataract formation was prevented by adequate lens shielding. One patient in CR from a stage I low-grade tumour died from chemotherapy-induced marrow aplasia. Primary orbital lymphoma is an indolent, usually stage I disease, showing low to intermediate-grade histology. After biopsy the best treatment is 30 (low-grade) to 40 Gy (intermediate-grade) carefully planned, lens-sparing megavoltage radiation without adjuvant chemotherapy.
Esik
O
O
National Cancer Center, Tokyo, Japan.
Ikeda
H
H
Mukai
K
K
Kaneko
A
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D001763:Blepharoptosis / Q000209:etiology; D001855:Bone Marrow Diseases / Q000139:chemically induced; D002386:Cataract / Q000209:etiology / Q000517:prevention & control; D004172:Diplopia / Q000209:etiology; D018572:Disease-Free Survival; D015352:Dry Eye Syndromes / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000209:etiology; D006801:Humans; D007908:Lens, Crystalline / Q000528:radiation effects; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009918:Orbital Neoplasms / Q000628:therapy*; D011183:Postoperative Complications; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011835:Radiation Protection; D011882:Radiotherapy, High-Energy; D012044:Regression Analysis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate
D000970:Antineoplastic Agents