title: Localized orbital mucosa-associated lymphoma tissue lymphoma managed with primary radiation therapy: efficacy and toxicity.
abstract: OBJECTIVE
  To evaluate the clinical outcomes and late effects of radiation therapy (RT) in localized primary orbital mucosa-associated lymphoma tissue (MALT) lymphoma (POML).
  
  
  METHODS
  From 1989 to 2007, 89 patients with Stage IE POML received RT. The median age was 56 years old. Sites involved conjunctiva (59 patients [66%]), lacrimal gland (20 patients [23%]), and soft tissue (10 patients [11%]). Megavoltage beam(s) was used in 91%, electrons in 7%, and orthovoltage in 2% of cases. The dose given was 25 Gy in 97% and 30 Gy in 3% of patients. Lens shielding was possible in 57% of patients.
  
  
  RESULTS
  The median follow-up was 5.9 years. Complete response or unconfirmed complete response was seen in 88 patients (99%). Relapse occurred in 22 patients (25%). First relapse sites were local (2 patients [9%]), in the contralateral orbit (5 patients [23%]), and distant (15 patients [68%]). The 7-year overall survival (OS), cause-specific survival (CSS), relapse-free survival (RFS), and local control (LC) rates were 91%, 96%, 64%, and 97%, respectively. Radiation-related late sequelae were documented in 40 patients (45%). Cataracts were observed in 22 patients (Grade 1 in 2 patients; Grade 3 in 20 patients). The incidence of Grade 3 cataract at 7 years was 25%. Other late sequelae (n = 28) were dry eye(s) (22 patients [Grade 1 in 14 patients; Grade 2 in 2 patients; Grade 3 in 2 patients; n/s in 4 patients), keratitis (3 patients), macular degeneration/cystoid edema (2 patients), and vitreous detachment (1 patient). Five patients developed Grade 3 noncataract late effects. Lens shielding reduced the incidence of Grade 3 cataract and all Grade ≥2 late sequelae. Seventeen patients (16 with cataracts) underwent surgery; 23 patients were treated conservatively. The outcome for managing late effects was generally successful, with 30 patients completely improved, and 9 patients with persisting late sequelae (10%).
  
  
  CONCLUSIONS
  POML responds favorably to moderate doses of RT but results in significant late morbidity. The majority of late effects were successfully managed. Lens shielding reduced the risk of cataracts and other late sequelae.
authors.affiliation: Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jayant Sastri
authors.initials: JS
authors.lastname: Goda
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Le
authors.forename: Normand J
authors.initials: NJ
authors.lastname: Lapperriere
authors.forename: Barbara-Ann
authors.initials: BA
authors.lastname: Millar
authors.forename: David
authors.initials: D
authors.lastname: Payne
authors.forename: Mary K
authors.initials: MK
authors.lastname: Gospodarowicz
authors.forename: Woodrow
authors.initials: W
authors.lastname: Wells
authors.forename: David C
authors.initials: DC
authors.lastname: Hodgson
authors.forename: Alexander
authors.initials: A
authors.lastname: Sun
authors.forename: Rand
authors.initials: R
authors.lastname: Simpson
authors.forename: Richard W
authors.initials: RW
authors.lastname: Tsang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D003230:Conjunctival Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D015352:Dry Eye Syndromes / Q000209:etiology; D004583:Electrons / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D007766:Lacrimal Apparatus Diseases / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018442:Lymphoma, B-Cell, Marginal Zone / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D009918:Orbital Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D058958:Organs at Risk / Q000528:radiation effects; D017785:Photons / Q000627:therapeutic use; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011835:Radiation Protection / Q000379:methods; D011879:Radiotherapy Dosage; D012074:Remission Induction; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult