title: Local Disease Control in Ocular Adnexal Lymphoproliferative Disorders: Comparative Outcomes of MALT Versus Non-MALT Histologies.
abstract: Ocular adnexal lymphoproliferative disorders (OALDs) are almost exclusively of B-cell origin, with the majority being extra-nodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT). The comparative efficacy of involved field radiation therapy (IFRT) in MALT vs. non-MALT OALDs is not known.
  
  
  
  We present a single-center, large cohort, retrospective study of the efficacy of IFRT in OALDs. Failure-free survival (FFS), complete remission, and local, regional, and distant failure were determined for 112 patients with MALT OALDs (n = 71) and non-MALT OALDs (n = 41) cohorts.
  
  
  
  Fifty-six patients with MALT OALD and 26 patients with non-MALT OALD received IFRT only (without any planned concurrent or sequential systemic chemothereapy or chemo-immunotherapies). Among the OALD cohorts treated with only IFRT, complete remission was achieved in 49 (87.5%) patients in the MALT cohort and 23 (88.4%) in the non-MALT cohort (P = .99). Clinically, resolution of symptoms occurred in 83.3% and 93.3% of the patients in the MALT and non-MALT cohorts, respectively. Local failure occurred in 4 (7.1%) patients in the MALT cohort, compared with 4 (15.3%) patients in the non-MALT cohort (P = .24). Regional failure (or extra-orbital failure) occurred in 5 (8.9%) patients in the MALT cohort and in 3 (11.5%) patients in the non-MALT cohort (P = .71). Distant failure was reported in 1 (1.7%) and 2 patients (7.6%) in the MALT and non-MALT cohorts, respectively (P = .18). The median follow-up of survivors was 5.1 years (range, 0.1-22.5 years) in the MALT cohort and 3.9 years (range, 0.1-22.9 years) in the non-MALT cohort. The 5-year and 10-year FFS was 95% (95% confidence interval [CI], 88%-100%) and 83% (95% CI, 70%-98%) for the ocular MALT and 67% (95% CI, 48%-94%) and 56% (95% CI, 34%-91%) for the non-MALT cohorts, respectively (log rank for P = .025). On multivariate analyses, age (hazard ratio [HR], 1.06; 95% CI, 1.10-1.12; P = .03), presence of non-MALT histology (HR, 13.9; 95% CI, 2.05-94.4; P = .007), and radiation dose < 30.6 Gy (HR, 5.27; 95% CI, 1.14-24.3; P = .03) were associated with worse FFS. The 5-year and 10-year overall survival was 92% (95%, CI 83%-100%) and 80% (95% CI, 66%-96%) for the MALT and 78% (95% CI, 61%-100%) and 62% (95% CI, 38%-100%) for the non-MALT cohorts, respectively (P = .80).
  
  
  
  Our results reveal that IFRT provided excellent disease control with superior FFS in the MALT cohort when compared with the non-MALT group.
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Binod
authors.initials: B
authors.lastname: Dhakal
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Fenske
authors.affiliation: Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Sridevi
authors.initials: S
authors.lastname: Ramalingam
authors.affiliation: Department of Radiation Oncology, Radiation Oncology Associates, Reno, NV.
authors.forename: Jamie
authors.initials: J
authors.lastname: Shuff
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Narendranath
authors.initials: N
authors.lastname: Epperla
authors.affiliation: Department of Pathology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Paul
authors.initials: P
authors.lastname: Hosking
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rein
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Anjisnu
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Hari
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Anita
authors.initials: A
authors.lastname: D'Souza
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Nirav
authors.initials: N
authors.lastname: Shah
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Malika
authors.initials: M
authors.lastname: Siker
authors.affiliation: Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Griepentrog
authors.affiliation: Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Harris
authors.affiliation: Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Wells
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Erickson
authors.affiliation: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI. Electronic address: mhamadani@mcw.edu.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005134:Eye Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008223:Lymphoma / Q000473:pathology / Q000532:radiotherapy*; D018442:Lymphoma, B-Cell, Marginal Zone / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Eye; IFRT; Non-Hodgkin lymphoma; OALD; Orbit lymphoma; Radiation