title: Long-term outcome and patterns of failure in primary ocular adnexal mucosa-associated lymphoid tissue lymphoma treated with radiotherapy.
abstract: OBJECTIVE
  To evaluate the long-term treatment outcome and disease behavior of primary ocular adnexal MALT (mucosa-associated lymphoid tissue) lymphoma (POAML) after treatment with radiotherapy.
  
  
  METHODS
  Seventy-eight patients (42 male, 36 female) diagnosed with stage I POAML between 1991 and 2010 at Kobe University Hospital were included. The median age was 60 years (range, 22-85 years). The median radiation dose administered was 30.6 Gy. Rituximab-based targeted therapy and/or chemotherapy was performed in 20 patients (25.6%). Local control (LC), recurrence-free survival (RFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  The median follow-up duration was 66 months. Major tumor sites were conjunctiva in 37 patients (47.4%), orbita in 29 (37.2%), and lacrimal glands in 12 (15.4%). The 5- and 10-year OS rates were 98.1% and 95.3%, respectively. The 5- and 10-year LC rates were both 100%, and the 5- and 10-year RFS rates were 88.5% and 75.9%, respectively. Patients treated with a combination of radiotherapy and targeted therapy and/or chemotherapy had a trend for a better RFS compared with those treated with radiotherapy alone (p = 0.114). None developed greater than Grade 2 acute morbidity. There were 14 patients who experienced Grade 2 morbidities (cataract: 14; retinal disorders: 7; dry eye: 3), 23 patients who had Grade 3 morbidities (cataract: 23; dry eye: 1), and 1 patient who had Grade 4 glaucoma.
  
  
  CONCLUSIONS
  Radiotherapy for POAML was shown to be highly effective and safe for LC and OS on the basis of long-term observation. The absence of systemic relapse in patients with combined-modality treatment suggests that lower doses of radiation combined with targeted therapy may be worth further study.
authors.affiliation: Division of Radiation Oncology, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Ryohei
authors.initials: R
authors.lastname: Sasaki
authors.forename: Hideki
authors.initials: H
authors.lastname: Nishimura
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshida
authors.forename: Daisuke
authors.initials: D
authors.lastname: Miyawaki
authors.forename: Masao
authors.initials: M
authors.lastname: Nakayama
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Uehara
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ejima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Azumi
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Matsui
authors.forename: Kazuro
authors.initials: K
authors.lastname: Sugimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D002423:Cause of Death; D003520:Cyclophosphamide / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005134:Eye Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D000069283:Rituximab; D017211:Treatment Failure; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone