1
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Hoffmann C, Ringbaek T, Eckstein A, Deya W, Santiago A, Heintz M, Lübcke W, Indenkämpen F, Sauerwein W, Flühs A, Le Guin C, Huettmann A, von Tresckow J, Göricke S, Deuschl C, Moliavi S, Poettgen C, Gauler T, Guberina N, Johansson P, Bechrakis N, Stuschke M, Guberina M. Long-Term Follow-Up of Patients with Conjunctival Lymphoma after Individualized Lens-Sparing Electron Radiotherapy: Results from a Longitudinal Study. Cancers (Basel) 2023; 15:5433. [PMID: 38001692 PMCID: PMC10670077 DOI: 10.3390/cancers15225433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
Irradiation with electrons is the primary treatment regime for localized conjunctival low-grade lymphomas. However, radiation-induced cataracts are a major cause of treatment-related morbidity. This study investigates whether lens-sparing electron irradiation produces sufficient disease control rates while preventing cataract formation. All consecutive patients with strictly conjunctival, low-grade Ann Arbor stage IE lymphoma treated with superficial electron irradiation between 1999 and 2021 at our department were reviewed. A total of 56 patients with 65 treated eyes were enrolled with a median follow-up of 65 months. The median dose was 30.96 Gy. A lens-spearing technique featuring a hanging rod blocking the central beam axis was used in 89.2% of all cases. Cumulative incidences of 5- and 10-year infield recurrences were 4.3% and 14.6%, incidences of 5- and 10-year outfield progression were 10.4% and 13.4%. We used patients with involvement of retroorbital structures treated with whole-orbit photon irradiation without lens protection-of which we reported in a previous study-as a control group. The cumulative cataract incidence for patients treated with electrons and lens protection was significantly lower (p = 0.005) when compared to patients irradiated without lens protection. Thus, electrons are an effective treatment option for conjunctival low-grade lymphomas. The presented lens-sparing technique effectively prevents cataract formation.
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Affiliation(s)
- Christian Hoffmann
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Toke Ringbaek
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Anja Eckstein
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Ophthalmology, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany
| | - Wolfgang Deya
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Alina Santiago
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Martin Heintz
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Wolfgang Lübcke
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Frank Indenkämpen
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Wolfgang Sauerwein
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
| | - Andrea Flühs
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Claudia Le Guin
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Ophthalmology, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany
| | - Andreas Huettmann
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Hematology, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany
| | - Julia von Tresckow
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Hematology, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany
| | - Sophia Göricke
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Cornelius Deuschl
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Sourour Moliavi
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Christoph Poettgen
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Thomas Gauler
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Patricia Johansson
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Institute of Cell Biology (Cancer Research), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Nikolaos Bechrakis
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Ophthalmology, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
| | - Maja Guberina
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
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2
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Vest SD, Coupland SE, Esmaeli B, Finger PT, Graue GF, Grossniklaus HE, Hindso TG, Holm F, Honavar SG, Khong JJ, Kirkegaard MK, McKelvie PA, Mikkelsen LH, Mulay K, Rasmussen PK, Siersma V, Sjö LD, Sniegowski MC, Thuro BA, Vemuganti GK, Heegaard S. Specific location of ocular adnexal lymphoma and mortality: an international multicentre retrospective study. Br J Ophthalmol 2023; 107:1231-1238. [PMID: 35512851 DOI: 10.1136/bjophthalmol-2021-320466] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Abstract
AIMS To examine whether the specific location of ocular adnexal lymphoma (OAL) and the American Joint Committee on Cancer (AJCC) TNM tumour stage are prognostic factors for mortality in the main OAL subtypes. METHODS Clinical and survival data were retrospectively collected from seven international eye cancer centres. All patients from 1980 to 2017 with histologically verified primary or secondary OAL were included. Cox regression was used to compare the ocular adnexal tumour locations on all-cause mortality and disease-specific mortality. RESULTS OAL was identified in 1168 patients. The most frequent lymphoma subtypes were extranodal marginal zone B-cell lymphoma (EMZL) (n=688, 59%); follicular lymphoma (FL) (n=150, 13%); diffuse large B-cell lymphoma (DLBCL) (n=131, 11%); and mantle cell lymphoma (MCL) (n=89, 8%). AJCC/TNM tumour-stage (T-stage) was significantly associated with disease-specific mortality in primary ocular adnexal EMZL and increased through T-categories from T1 to T3 disease. No associations between AJCC/TNM T-stage and mortality were found in primary ocular adnexal FL, DLBCL, or MCL. EMZL located in the eyelid had a significantly increased disease-specific mortality compared with orbital and conjunctival EMZL, in both primary EMZL and the full EMZL cohort. In DLBCL, eyelid location had a significantly higher disease-specific mortality compared with an orbital or lacrimal gland location. CONCLUSION Disease-specific mortality is associated with AJCC/TNM T-stage in primary ocular adnexal EMZL patients. Lymphoma of the eyelid has the highest disease-specific mortality in primary EMZL, and in the full cohort of EMZL and DLBCL patients.
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Affiliation(s)
- Stine Dahl Vest
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, UK
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Paul T Finger
- The New York Eye Cancer Center, New York City, New York, USA
| | - Gerardo F Graue
- The New York Eye Cancer Center, New York City, New York, USA
| | - Hans E Grossniklaus
- Section of Ocular Oncology, Emory University Eye Center, Atlanta, Georgia, USA
| | | | - Frederik Holm
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Santosh G Honavar
- Department of Ocular Oncology and Oculoplastics, LV Prasad Eye Institute, Hyderabad, India
- Department of Ophthalmic and Facial Plastic Surgery, Orbit and Ocular Oncology, Centre for Sight, Hyderabad, India
| | - Jwu Jin Khong
- Orbital, Plastic, and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | | | - Penelope A McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Lauge Hjorth Mikkelsen
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology, Centre for Sight, Hyderabad, India
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Lene Dissing Sjö
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Matthew C Sniegowski
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Bradley A Thuro
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Geeta K Vemuganti
- Kallam Anji Reddy Campus, School of Medical Sciences, University of Hyderabad, Hyderabad, India
- Visiting Faculty, Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Steffen Heegaard
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
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Croley CR, Pumarol J, Delgadillo BE, Cook AC, Day F, Kaceli T, Ward CC, Husain I, Husain A, Banerjee S, Bishayee A. Signaling pathways driving ocular malignancies and their targeting by bioactive phytochemicals. Pharmacol Ther 2023:108479. [PMID: 37330112 DOI: 10.1016/j.pharmthera.2023.108479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
Ocular cancers represent a rare pathology. The American Cancer Society estimates that 3,360 cases of ocular cancer occur annually in the United States. The major types of cancers of the eye include ocular melanoma (also known as uveal melanoma), ocular lymphoma, retinoblastoma, and squamous cell carcinoma. While uveal melanoma is one of the primary intraocular cancers with the highest occurrence in adults, retinoblastoma remains the most common primary intraocular cancer in children, and squamous cell carcinoma presents as the most common conjunctival cancer. The pathophysiology of these diseases involves specific cell signaling pathways. Oncogene mutations, tumor suppressor mutations, chromosome deletions/translocations and altered proteins are all described as causal events in developing ocular cancer. Without proper identification and treatment of these cancers, vision loss, cancer spread, and even death can occur. The current treatments for these cancers involve enucleation, radiation, excision, laser treatment, cryotherapy, immunotherapy, and chemotherapy. These treatments present a significant burden to the patient that includes a possible loss of vision and a myriad of side effects. Therefore, alternatives to traditional therapy are urgently needed. Intercepting the signaling pathways for these cancers with the use of naturally occurring phytochemicals could be a way to relieve both cancer burden and perhaps even prevent cancer occurrence. This research aims to present a comprehensive review of the signaling pathways involved in various ocular cancers, discuss current therapeutic options, and examine the potential of bioactive phytocompounds in the prevention and targeted treatment of ocular neoplasms. The current limitations, challenges, pitfalls, and future research directions are also discussed.
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Affiliation(s)
- Courtney R Croley
- Healthcare Corporation of America, Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Hudson, FL 34667, USA
| | - Joshua Pumarol
- Ross University School of Medicine, Miramar, FL 33027, USA
| | - Blake E Delgadillo
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Andrew C Cook
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Faith Day
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Tea Kaceli
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Caroline C Ward
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | - Imran Husain
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Ali Husain
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Sabyasachi Banerjee
- Department of Pharmaceutical Chemistry, Gupta College of Technological Sciences, Asansol 713 301, India
| | - Anupam Bishayee
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA.
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4
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Hoffmann C, Mohr C, Johansson P, Eckstein A, Huettmann A, von Tresckow J, Göricke S, Deuschl C, Poettgen C, Gauler T, Guberina N, Moliavi S, Bechrakis N, Stuschke M, Guberina M. MRI-based long-term follow-up of indolent orbital lymphomas after curative radiotherapy: imaging remission criteria and volumetric regression kinetics. Sci Rep 2023; 13:4792. [PMID: 36959374 PMCID: PMC10036339 DOI: 10.1038/s41598-023-31941-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 03/20/2023] [Indexed: 03/25/2023] Open
Abstract
We systematically analyzed the kinetics of tumor regression, the impact of residual lesions on disease control and the applicability of the Lugano classification in follow-up MRI of orbital non-Hodgkin lymphomas that were irradiated with photons. We retrospectively analyzed a total of 154 pre- and post-irradiation MRI datasets of 36 patients with low-grade, Ann-Arbor stage I, orbital non-Hodgkin lymphomas. Patients with restricted conjunctival involvement were excluded. Lymphoma lesions were delineated and volumetrically analyzed on T1-weighted sequences. Tumor residues were present in 91.2% of all cases during the first six months after treatment. Volumetric partial response rates (> 50% volume reduction) were 75%, 69.2%, and 50% at 12-24 months, 36-48 months and > 48 months after the end of treatment. The corresponding complete response (CR) rates according to the Lugano classification were 20%, 23.1% and 50%. During a median clinical follow-up of 37 months no significant differences in progression free survival (PFS) rates were observed between the CR and non-CR group (p = 0.915). A residual tumor volume below 20% of the pretreatment volume should be expected at long-term follow-up beyond one year after radiotherapy.
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Affiliation(s)
- Christian Hoffmann
- Department of Radiotherapy, University Hospital of Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Christopher Mohr
- Department of Oral and Maxillofacial Surgery, University of Duisburg-Essen, Kliniken-Essen-Mitte, Essen, Germany
| | - Patricia Johansson
- Institute of Cell Biology (Cancer Research), Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital of Essen, Essen, Germany
| | | | | | - Sophia Göricke
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Christoph Poettgen
- Department of Radiotherapy, University Hospital of Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Thomas Gauler
- Department of Radiotherapy, University Hospital of Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, University Hospital of Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Sourour Moliavi
- Department of Radiotherapy, University Hospital of Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Nikolaos Bechrakis
- Department of Ophthalmology, University Hospital of Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, University Hospital of Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Maja Guberina
- Department of Radiotherapy, University Hospital of Essen, Hufelandstrasse 55, 45147, Essen, Germany
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Merli M, Arcaini L. Management of marginal zone lymphomas. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:676-687. [PMID: 36485086 PMCID: PMC9901419 DOI: 10.1182/hematology.2022000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Marginal zone lymphomas (MZLs) represent about 7% of B-cell non-Hodgkin lymphomas and include 3 different subtypes-namely, extranodal (EMZL), nodal, and splenic (SMZL). The initial assessment requires specific diagnostic and staging procedures depending on organ-related peculiarities. In particular, although positron emission tomography/computed tomography was not initially recommended, recent data have reassessed its role in the routine staging of MZL, especially when only localized treatment is planned or there is a suspicion of histologic transformation. Recent findings have improved the risk stratification of MZL patients, highlighting the association of early progression after frontline therapy with worse overall survival. A significant fraction of MZL cases may be related to specific bacterial (ie, Helicobacter pylori in gastric EMZL) or viral infections (hepatis C virus), and in the earlier phases of disease, a variable percentage of patients may respond to anti-infective therapy. Involved-site radiotherapy has a central role in the management of localized EMZL not amenable to or not responding to anti-infective therapy. Although rituximab-based treatments (bendamustine- rituximab in advanced EMZL or rituximab monotherapy in SMZL) have demonstrated favorable results, the current therapeutic scenario is predicted to rapidly change as emerging novel agents, especially Bruton's tyrosine kinase inhibitors, have demonstrated promising efficacy and safety profiles, leading to their approval in the relapsed setting. Moreover, a large variety of novel agents (phosphatidylinositol 3-kinase inhibitors, chimeric antigen receptor T-cells, bispecific antibodies) are being tested in MZL patients with encouraging preliminary results.
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Affiliation(s)
- Michele Merli
- Division of Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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6
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Guo Q, Liu R, Zhang X, Yang B, Ma J. Local recurrence as extraocular muscle lymphoma after 6 years of chronic myositis: a case report. BMC Ophthalmol 2022; 22:403. [PMID: 36209053 PMCID: PMC9548203 DOI: 10.1186/s12886-022-02623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Extraocular muscle is usually affected by thyroid disease or inflammatory pseudotumor, but seldom by neoplastic process. Primary malignant lymphoma involving isolated extraocular muscle is very rare, especially after 6 years of chronic myositis. Case presentation A middle-aged female presented with swelling of the lower lid of the right eye for 2 months. Magnetic resonance imaging showed significant enlargement of the right inferior rectus muscle belly. The patient first presented 6 years prior with upper eyelid swelling. A total of 5 surgical biopsies of the right eye were performed during 6 years with the following successive findings: inflammatory pseudotumor, chronic inflammation, inflammatory lesions, IgG4-related ophthalmic disease, and lastly, extraocular muscle extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). Conclusion MALT lymphoma may have occurred as a result of chronic extraocular myositis. Malignancy should be considered in patients with recurrent painless extraocular muscle hypertrophy. Differential diagnosis can rule out thyroid-associated ophthalmopathy (TAO), whose symptoms are similar. Diagnosis confirmation by biopsy is warranted if necessary.
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Affiliation(s)
- Qihan Guo
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Rui Liu
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xuan Zhang
- Ophthalmology, Taian City Central Hospital, Tai'an, Shandong Province, China
| | - Bentao Yang
- Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jianmin Ma
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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7
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Pereira-Da Silva MV, Di Nicola ML, Altomare F, Xu W, Tsang R, Laperriere N, Krema H. Radiation therapy for primary orbital and ocular adnexal lymphoma. Clin Transl Radiat Oncol 2022; 38:15-20. [PMID: 36353653 PMCID: PMC9637715 DOI: 10.1016/j.ctro.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To report the efficacy and toxicity of External beam Radiotherapy (EBRT) as a sole treatment for MALT and Follicular Primary Orbital and Ocular adnexal Lymphoma (POOAL). METHODS Retrospective review of all POOAL patients treated with EBRT utilizing megavoltage photon or electron beam radiotherapy between 2003 and 2015. Patient demographics, tumour extent and pathology, radiotherapy techniques, and treatment outcomes were reviewed. The actuarial rates of tumour control and radiation toxicities were calculated using Kaplan-Meier estimates. RESULTS This study included 167 tumours, of which MALT lymphoma involved 149 (89 %). The conjunctiva and orbit were equally involved as the predominant site (48 %). Megavoltage photon radiotherapy was used in 60 % of predominantly orbital lymphoma and Electron beam with lens shielding in 77 % of the conjunctival lymphoma. The majority (95 %) were treated with a total dose of 25 Gy in 10 fractions. Local control rate was 98 % (CI: 93-100 %) at 5 years. The long-term RT toxicities included dry eye in 27 eyes (16 %) and cataract in 22 (13 %). None of the patients developed significant structural or functional radiation toxicity. CONCLUSION External Beam Radiotherapy, with lens shielding whenever indicated, at a dose of 20-30 Gy delivered over 10-20 fractions is an efficacious and safe primary treatment option for POOAL lymphoma, with excellent local control and low incidence of late manageable ocular toxicities.
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Affiliation(s)
- Maria Valeria Pereira-Da Silva
- Ocular Oncology Service Princess Margaret Cancer Center/University Health Network, Canada,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Maria Laura Di Nicola
- Ocular Oncology Service Princess Margaret Cancer Center/University Health Network, Canada,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Filiberto Altomare
- Ocular Oncology Service Princess Margaret Cancer Center/University Health Network, Canada,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Center/University Health Network, Canada
| | - Richard Tsang
- Radiation Oncology Department, Princess Margaret Cancer Center/University Health Network, Canada
| | - Normand Laperriere
- Radiation Oncology Department, Princess Margaret Cancer Center/University Health Network, Canada
| | - Hatem Krema
- Ocular Oncology Service Princess Margaret Cancer Center/University Health Network, Canada,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada,Corresponding author at: Ocular Oncology, Princess Margaret Cancer Centre/UHN, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
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8
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Panda G, Kalra B, Rishi A, Khanna N, Kakoti S, Sridhar E, Shet T, Sengar M, Nayak L, Bagal B, Jain H, Laskar SS, Goda JS. Long-Term Clinical Outcomes and Sequelae of Therapy in Early-Stage Orbital Mucosa-Associated Lymphoid Tissue Lymphoma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:513-522. [PMID: 35027338 DOI: 10.1016/j.clml.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/26/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Orbital mucosa-associated lymphoid tissue (MALT) lymphoma, which are rare and indolent, often present at an early stage. We report the efficacy and safety outcomes of treatment in these patients. METHODS We analyzed adult patients with stage IE or IIE orbital MALT lymphoma between 1999 and 2017 treated at our institute. We assessed local control (LC) rates, overall survival (OS), relapse-free survival (RFS) using Kaplan Meier method and the incidence of late toxicities. RESULTS Seventy patients were analyzed for clinical outcomes. The median age at diagnosis was 52 years (IQR-45-62 years). Radiotherapy was offered to 97% of patients and the dose ranged from 36 to 45 Gy. Chemotherapy was administered in 5(7.1%) patients. Relapse occurred in 8 patients (local: 2, distant: 6). At a median follow-up of 101 months (IQR-47-146 months), the median OS and RFS was not reached. 8-year OS, RFS and LC rates were 96.5%, 88.5%, 96.7% respectively. Univariate analysis showed age ≤60 years and lacrimal involvement significantly correlated with better OS (P = .01 and .04, respectively). Cataract was the most common sequelae observed in 31 patients (44.3%). CONCLUSION Moderate doses of radiotherapy are curative in early-stage orbital MALT lymphoma with favorable clinical outcomes. Lower doses of radiation can reduce the toxicity further, without compromising efficacy.
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Affiliation(s)
- Goutam Panda
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Babusha Kalra
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Anupam Rishi
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Nehal Khanna
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Sangeeta Kakoti
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Epari Sridhar
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Tanuja Shet
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Lingaraj Nayak
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Bahusaheb Bagal
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Hasmukh Jain
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Siddartha S Laskar
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India
| | - Jayant S Goda
- Adult Haematolymphoid Disease Management Group, Tata Memorial Centre & HomiBhaba National Institute, Mumbai, Maharashtra, India.
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Kaddu-Mulindwa D, Thurner L, Christofyllakis K, Bewarder M, Kos IA. Management of Extranodal Marginal Zone Lymphoma: Present and Upcoming Perspectives. Cancers (Basel) 2022; 14:cancers14123019. [PMID: 35740684 PMCID: PMC9220961 DOI: 10.3390/cancers14123019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/04/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Extranodal marginal zone lymphoma distinguishes itself from other indolent lymphomas due to its unique pathophysiology and natural history. This is reflected in its management, where next to traditional treatment strategies such as observation, radiotherapy or chemotherapy, eradication of the causal agent and even surgery represent important aspects of therapy. This review focuses on the particular aspects of this indolent lymphoma that affect management and summarizes the current evidence and different guidelines. Abstract Extranodal marginal zone lymphoma (EMZL) encompasses a subgroup of non-Hodgkin lymphomas that often present with localized involvement and may manifest in a diversity of organs and tissues. EMZL pathogenesis is in some cases linked to chronic inflammation/infection, which may impose additional diagnostic and clinical challenges. The most studied and established connection is the presence of Helicobacter pylori in gastric EMZL. Due to its heterogeneity of presentation and intricate pathological features, treatment can be complex, and staging systems are decisive for the choice of therapy. Nevertheless, there is no consensus regarding the most suitable staging system, and recommendations vary among different countries. As a rule of thumb, in limited stages, a local therapy with surgery or radiation is the preferred option, and it is potentially curative. Of note, eradicating the causal agent may be an important step of treatment, especially in gastric EMZL, in which Helicobacter pylori eradication remains the first-line therapy for the majority of patients. In patients with more advanced stages, watch-and-wait is a valuable option, especially amongst those without clear indications for systemic therapy, and it may be carried on for several years. If watch-and-wait is not an option, systemic therapy may be needed. Even though several agents have been tested as monotherapy or in combination in recent years, there is no consensus regarding the first-line therapy, and decisions can vary depending on individual factors, such as age, clinical performance and stage. This review aims to discuss the several aspects of EMZL, including genetic milieu, pathogenesis and staging systems, that may influence the choice of therapy. In addition, we present a summary of evidence of several systemic therapies, compare different recommendations worldwide and discuss future perspectives and novelties in its therapy.
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Choi S, Seo M, Park SH, Jo JC, Chae SW, Lee JH, Cha HJ. Clinicopathologic Characteristics Associated with Prognosis in Ocular Extranodal Marginal Zone B Cell Lymphoma. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:818. [PMID: 35744081 PMCID: PMC9229471 DOI: 10.3390/medicina58060818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
Background and Objectives: Extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT) type is the most common subtype of the ocular adnexal lymphoma. Despite its excellent prognosis, some patients experience partial remission or progressive disease. We aimed to evaluate clinicopathologic differences in the treatment responder group by comparing complete remission (CR) and non-complete remission (non-CR). Materials and Methods: This study retrospectively reviewed 48 patients who were diagnosed with ocular adnexal MALT lymphoma at Ulsan University Hospital between March 2002 and August 2018. Patients who were followed up for less than 6 months were excluded. Histologic and clinical features were analyzed. The patients were divided into two groups: CR and non-CR. Results: Among the 48 patients, 33 achieved CR and 15 achieved non-CR during the median follow-up period of 40.00 months (range, 7-109 months). In univariable analysis, more patients tend to undergo treatment in the CR group, and post-radiotherapy (post-RT) SUVmax, PET and serum lactate dehydrogenase (LDH) levels were higher in the non-CR group (p = 0.043, p = 0.016, and p = 0.042, respectively). In a multivariable analysis, only application of treatment, including radiotherapy or chemotherapy with immunotherapy, was related to CR (odd ratio 7.301, 95% confidence interval 1.273-41.862, p = 0.026). In subgroup analysis according to the site of involvement, none of the variables were significant except for the post-RT SUVmax of PET and level of serum LDH in the non-conjunctiva group (p = 0.026, and p = 0.037, respectively). Seven (14.6%) patients had a recurrence, and those with a recurring site other than the primary site had a higher Ki-67 labeling index, although it was not statistically significant (9.56% vs. 18.00%, p = 0.095). Conclusions: Although belonging to the early stages, the non-CR rate was high in patients with high serum LDH levels, and recurred patients had higher Ki-67. Thus, considering active treatment is recommended in this group of patients.
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Affiliation(s)
- Soyeon Choi
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Korea;
| | - Minjung Seo
- Department of Nuclear Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Korea; (M.S.); (S.H.P.)
| | - Seol Hoon Park
- Department of Nuclear Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Korea; (M.S.); (S.H.P.)
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Korea;
| | - Seoung Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea;
| | - Ju-Hyang Lee
- Department of Ophthalmology, Ajou University Medical Center, Suwon 16499, Korea
| | - Hee Jeong Cha
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Korea;
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Peng F, Su W, Zhang A, Huo B, Song T, Wei Z, Geng Z, Wang L. Investigation of epidemiological characteristics and development of a nomogram to predict survival in primary ocular adnexal lymphoma. Clin Exp Ophthalmol 2022; 50:615-631. [PMID: 35656846 DOI: 10.1111/ceo.14122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/09/2022] [Accepted: 05/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies on the epidemiology and prognosis of primary ocular adnexal lymphoma (POAL) are scarce for its low occurrence. The goal of our research was to assess the epidemiologic characteristics, prognostic variables and survival of POAL patients. METHODS The Surveillance, Epidemiology and End Results (SEER) database was used to collect data on patients identified with POAL from 1975 to 2011 and the incidence rate of POAL from 1975 to 2017. To discover independent predictive markers for overall survival (OS) and disease-specific survival (DSS), multivariable Cox regression analysis was utilised. The independent prognostic factors found by multivariate Cox regression analysis were used to generate a nomogram. RESULTS A total of 2839 patients were diagnosed with POAL, with an average age of 64.1 years. The total incidence of POAL was 2.51/1000000 (according to the overall adjustment of the 2000 American standard) from 1975 to 2017, and the annual percentage change (APC) was 2.47 (95% confidence interval 1.64-3.32, p < 0.05), showing a sharp upward trend. After multivariate Cox regression analysis, age, gender, year of diagnosis, marital status, primary site, laterality, pathological type and treatment strategy were evaluated as independent prognostic factors of OS or DSS (p < 0.05). A nomogram was constructed to forecast the DSS of 1, 3, 5 and 10 years. The concordance index (C-index) and the calibration plots demonstrated the robustness and accuracy of the nomogram. CONCLUSIONS Although POAL is sporadic, the incidence has generally increased in the past 36 years. In recent years, survival rates have risen, and radiotherapy can render better OS and DSS. The nomogram specially made for POAL is robust and precise in predicting the DSS of 1, 3, 5 and 10 years.
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Affiliation(s)
- Fei Peng
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Su
- Trauma Center/Department of Emergency and Trauma Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Anqi Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingyue Huo
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianyu Song
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Wei
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenxi Geng
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Wang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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12
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Lo AC, Holloway CL, Savage KJ, Sehn LH, Worsley DF, Connors JM, Pickles T. Radioimmunotherapy for orbital marginal zone lymphoma: a retrospective review. Leuk Lymphoma 2022; 63:1242-1245. [DOI: 10.1080/10428194.2022.2060505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Andrea C. Lo
- Department of Radiation Oncology, British Columbia Cancer Vancouver, Vancouver, Canada
- Department of Surgery, University of British Columbia (UBC), Vancouver, Canada
- BC Cancer Centre for Lymphoid Cancer, Vancouver, Canada
| | - Caroline L. Holloway
- Department of Surgery, University of British Columbia (UBC), Vancouver, Canada
- BC Cancer Centre for Lymphoid Cancer, Vancouver, Canada
- Department of Radiation Oncology, British Columbia Cancer Victoria, Victoria, Canada
| | - Kerry J. Savage
- BC Cancer Centre for Lymphoid Cancer, Vancouver, Canada
- Department of Medical Oncology, British Columbia Cancer, Vancouver, Canada
- Department of Medicine, University of British Columbia (UBC), Vancouver, Canada
| | - Laurie H. Sehn
- BC Cancer Centre for Lymphoid Cancer, Vancouver, Canada
- Department of Medical Oncology, British Columbia Cancer, Vancouver, Canada
- Department of Medicine, University of British Columbia (UBC), Vancouver, Canada
| | - Daniel F. Worsley
- Department of Nuclear Medicine, Vancouver General Hospital, Vancouver, Canada
| | - Joseph M. Connors
- BC Cancer Centre for Lymphoid Cancer, Vancouver, Canada
- Department of Medical Oncology, British Columbia Cancer, Vancouver, Canada
- Department of Medicine, University of British Columbia (UBC), Vancouver, Canada
| | - Tom Pickles
- Department of Radiation Oncology, British Columbia Cancer Vancouver, Vancouver, Canada
- Department of Surgery, University of British Columbia (UBC), Vancouver, Canada
- BC Cancer Centre for Lymphoid Cancer, Vancouver, Canada
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13
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Chung HU, Son JH. Ocular adnexal mucosa-associated lymphoid tissue lymphoma: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2022; 39:3-11. [PMID: 34521183 PMCID: PMC8895963 DOI: 10.12701/yujm.2021.01263] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/01/2021] [Accepted: 08/12/2021] [Indexed: 12/02/2022]
Abstract
Lymphoma is the most common primary tumor of the orbit, accounting for 55% of all orbital malignancies. When divided into histopathological subtypes, extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) comprises the largest proportion. Clinical manifestations are unspecific, but in patients with slow-growing painless orbital mass, or red conjunctival lesion suggestive of 'salmon patch', ocular adnexa lymphoma (OAL) should be suspected. Although the pathogenetic mechanism of ocular adnexal MALT lymphoma (OAML) is not yet fully understood, the relationship between OAML and Chlamydia psittaci has been hypothesized recently, similar to that between gastric MALT lymphoma and Helicobacter pylori. This suggests a new treatment option for OAML; bacterial eradication therapy with systemic antibiotics. Several other treatment methods for OAML have been introduced, but no treatment guidelines have been established yet. In this article, we summarize the current knowledge on the clinical features, pathogenesis, diagnostic methods, therapeutic strategies, and prognosis of OAML.
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Affiliation(s)
- Hyun Uk Chung
- Yeungnam Eye Center, Yeungnam University Hospital, Daegu, Korea
| | - Jun Hyuk Son
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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14
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Leeson S, Jayamohan J, Vu H, Sundaresan P. Examining the utility of lower dose radiotherapy for localised primary ocular adnexal MALT lymphoma. J Med Radiat Sci 2021; 68:269-273. [PMID: 33675287 PMCID: PMC8424308 DOI: 10.1002/jmrs.464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/05/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Most primary ocular adnexal lymphomas are those involving mucosa-associated lymphoid tissue (MALT). Radiotherapy (RT) dose regimens in the literature vary from the historically used high doses (up to 56 Gy) to lower dose RT. We aimed to examine our institution's experience with the use of orbital RT for treating early-stage primary ocular adnexal MALT lymphoma (POAML). METHODS Patients treated for stage I or II POAML over a 12-year period (July 2006 to June 2018) were identified through institutional databases. Data were retrospectively collated through review of patient records. Descriptive statistical methods were employed to analyse the data. RESULTS Eighteen patients (median age of 67; range 44-87yrs) with localised POAML (3 cases of bilateral disease) were identified, resulting in a total of 21 evaluable orbits. Eight (44%) patients were female, and all were documented to be of good performance status (ECOG 0-1). The median follow-up was 34 months (range 8-75 months). The commonest dose fractionation used was 20 Gy in 10 fractions (n = 13 orbits) and a 3D conformal or volumetric modulated arc therapy (VMAT) technique was used in the majority of cases. None of the patients experienced an in-field recurrence. One patient had experienced a contralateral orbital recurrence two years post-unilateral orbital RT for orbital MALT lymphoma. Three patients experienced distant relapse. CONCLUSION The use of lower dose orbital RT such as 20 Gy in 10 fractions (or radio biologically equivalent) yields excellent local disease control in the management of ocular adnexal MALT lymphoma. The durability of the response appears to be favourable. Given the indolent nature of the disease and the low levels of toxicity associated with lower dose orbital RT, this regimen remains our favoured approach to the management of localised POAML.
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Affiliation(s)
- Sarah Leeson
- Radiation Oncology Network, Western Sydney Local Health DistrictSydneyNSWAustralia
| | - Jayasingham Jayamohan
- Radiation Oncology Network, Western Sydney Local Health DistrictSydneyNSWAustralia
- Sydney Medical SchoolUniversity of SydneySydneyNSWAustralia
| | - Hanh Vu
- Radiation Oncology Network, Western Sydney Local Health DistrictSydneyNSWAustralia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health DistrictSydneyNSWAustralia
- Sydney Medical SchoolUniversity of SydneySydneyNSWAustralia
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15
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Lee MJ, Lee MY, Choe JY, Choi SH, Kim HJ. Ultra-low-dose radiation treatment for early-stage ocular adnexal MALT lymphoma. Eur J Ophthalmol 2021; 32:3092-3096. [PMID: 34318737 DOI: 10.1177/11206721211035622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the long-term outcomes of ultra-low-dose (4 Gy) radiation treatment (RT) in patients with early-stage ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS This retrospective case series includes eight patients with ocular adnexal MALT lymphoma who received ultra-low-dose RT at a single tertiary referral center between March 2016 and February 2018. Response to treatment and the time taken to respond were analyzed. RESULTS Of the eight patients (three men, five women), seven patients had conjunctival lymphoma (T1N0M0), and one patient had orbital lymphoma (T2N0M0). Six patients with T1 disease showed complete response (CR), and the median time to CR was 4.5 months (range 2-5). Partial response was achieved in the remaining two patients (one each with T1 and T2). During the median follow-up period of 44 months (range 30-54), none of the patients had a relapse or needed additional treatment. RT was well-tolerated in all patients with no ocular complications, including cataracts and dry eye. CONCLUSION This case series suggests that ultra-low-dose RT is effective and well-tolerated in patients with early-stage ocular adnexal MALT lymphoma. Further studies with a larger sample size and long-term follow-up are needed to evaluate the local control rate and disease-free survival precisely.
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Affiliation(s)
- Min Joung Lee
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Me Yeon Lee
- Department of Radiation Oncology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji-Young Choe
- Department of Pathology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Se Hyun Choi
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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16
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Marques MDO, Manso PG, Araujo RLC, Brito FDN, Herculani JEDCC, Lemos GGD, Rodrigues MA, Teixeira LF, Espirito Santo KSD, Menezes YD, Cecyn KZ, Colleoni GWB, Baiocchi OCG. Long-term outcomes of ocular adnexal lymphomas: case series from two lymphoma centers in Brazil. Leuk Lymphoma 2021; 62:1013-1015. [PMID: 33461351 DOI: 10.1080/10428194.2020.1855348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Paulo Goes Manso
- Ophthalmology Department, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Raphael L C Araujo
- Clinical and Experimental Oncology Department, Universidade Federal de São Paulo, São Paulo, Brasil
| | | | | | | | | | | | | | - Yara de Menezes
- Pathology Department, Hospital Alemão Oswaldo Cruz, São Paulo, Brasil
| | - Karin Zattar Cecyn
- Clinical and Experimental Oncology Department, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Gisele W Braga Colleoni
- Clinical and Experimental Oncology Department, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Otavio C G Baiocchi
- Clinical and Experimental Oncology Department, Universidade Federal de São Paulo, São Paulo, Brasil.,Hematology Department, Hospital Alemão Oswaldo Cruz, São Paulo, Brasil
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17
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Ocular adnexal lymphoma: long-term outcome, patterns of failure and prognostic factors in 174 patients. J Hematop 2020. [DOI: 10.1007/s12308-020-00424-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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18
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Yu H, Du YX, Sun ZC, Fu XR, Tan N, Gong WF, Zhang MZ. Clinical features and treatment outcomes of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma: a single center retrospective analysis of 64 patients in China. Int J Ophthalmol 2019; 12:1731-1736. [PMID: 31741862 DOI: 10.18240/ijo.2019.11.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/25/2019] [Indexed: 12/31/2022] Open
Abstract
AIM To investigate the clinical features, treatment and prognosis of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (POAML). METHODS A retrospective analysis was performed on 64 patients with POAML who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2006 to December 2018. RESULTS With a median follow-up of 61mo (range, 2-156mo), estimated overall survival (OS) rate and progression-free survival (PFS) rate at 10y reached 94.5% and 61.5%, respectively. Median OS time and PFS time were not reached. During this period, only 3 patients died, but none of them died directly due to disease progression. One patient (1.6%) developed transformation to diffuse large B-cell lymphoma (DLBCL). Of the 56 patients achieved complete remission after first-line treatment, 5 (8.9%) developed local and/or systemic relapse eventually. Patients ≥60y had significantly shorter PFS than younger patients (P=0.01). For patients with early stages (Ann Arbor stage I and stage II), univariate analysis confirmed that radiotherapy dose lower than 32 Gy were independently associated with shorter PFS (P=0.04). Other factors including gender, bone marrow involvement, the initial location of the disease, and the laterality were not associated with PFS. CONCLUSION The data from our center indicate that POAML has a slow clinical progression and has an excellent clinical outcome. Patients with POAML harbor a continual risk of relaps and transformation to aggressive subtype of lymphoma.
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Affiliation(s)
- Hui Yu
- Department of Oncology, Zhengzhou University First Affiliated Hospital; Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou 450052, Henan Province, China
| | - Yu-Xin Du
- Department of Oncology, Zhengzhou University First Affiliated Hospital; Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou 450052, Henan Province, China
| | - Zhen-Chang Sun
- Department of Oncology, Zhengzhou University First Affiliated Hospital; Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou 450052, Henan Province, China
| | - Xiao-Rui Fu
- Department of Oncology, Zhengzhou University First Affiliated Hospital; Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou 450052, Henan Province, China
| | - Nan Tan
- Department of Ophthalmology, Zhengzhou University First Affiliated Hospital, Zhengzhou 450052, Henan Province, China
| | - Wei-Feng Gong
- Department of Ophthalmology, Zhengzhou University First Affiliated Hospital, Zhengzhou 450052, Henan Province, China
| | - Ming-Zhi Zhang
- Department of Oncology, Zhengzhou University First Affiliated Hospital; Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou 450052, Henan Province, China
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Santambrogio E, Nicolosi M, Vassallo F, Castellino A, Novo M, Chiappella A, Vitolo U. Aggressive Non-Hodgkin lymphomas: risk factors and treatment of central nervous system recurrence. Expert Rev Hematol 2019; 12:787-796. [DOI: 10.1080/17474086.2019.1643232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Elisa Santambrogio
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Maura Nicolosi
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Francesco Vassallo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Alessia Castellino
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Mattia Novo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Annalisa Chiappella
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Umberto Vitolo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
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20
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Tanenbaum RE, Galor A, Dubovy SR, Karp CL. Classification, diagnosis, and management of conjunctival lymphoma. EYE AND VISION 2019; 6:22. [PMID: 31372366 PMCID: PMC6660942 DOI: 10.1186/s40662-019-0146-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/15/2019] [Indexed: 02/06/2023]
Abstract
Lymphoma is a malignant lymphoproliferative tumor that can involve the conjunctiva. Approximately 5-15% of all extranodal lymphomas are found in the ocular adnexal region, with approximately 25% of those involving the conjunctiva. Ninety-eight percent of conjunctival lymphomas arise from B-lymphocytes. The most common subtype of conjunctival lymphoma is extranodal marginal zone lymphoma (80%), followed by follicular lymphoma (8%), diffuse large B-cell lymphoma (3%) and mantle cell lymphoma (3%). Natural killer and T cells (NK/T) are rare causes of lymphoma. While most conjunctival lymphomas are localized to the ocular adnexa at the time of presentation, systemic examination and management are of key importance in the long-term care of the patient. This review outlines the classification, etiology, presentation, diagnosis, and management of conjunctival lymphoma. The novel use of high resolution optical coherence tomography, both as a diagnostic tool and as a means for ongoing evaluation during treatment, is illustrated. Treatment options discussed include external beam radiation, chemotherapy, immunotherapy, antibiotic therapy, and combination regimens. Future investigation of the etiology and pathogenesis of conjunctival lymphoma is expected to reveal opportunities for innovative and individualized therapeutic agents. Collaboration between multiple disciplines is key in the advancement of the field.
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Affiliation(s)
- Rebecca E Tanenbaum
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, Miami, FL 33136 USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, Miami, FL 33136 USA
| | - Sander R Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, Miami, FL 33136 USA
| | - Carol L Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, Miami, FL 33136 USA
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Seresirikachorn K, Norasetthada L, Ausayakhun S, Apivatthakakul A, Tangchittam S, Pruksakorn V, Wudhikarn K, Wiwatwongwana D. Clinical presentation and treatment outcomes of primary ocular adnexal MALT lymphoma in Thailand. Blood Res 2018; 53:307-313. [PMID: 30588468 PMCID: PMC6300677 DOI: 10.5045/br.2018.53.4.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/13/2018] [Accepted: 08/27/2018] [Indexed: 01/26/2023] Open
Abstract
Background Primary ocular adnexal extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (POML) is the most common subtype of lymphoma involving the eyes in Thailand. We sought to assess the characteristics and treatment outcomes of patients with POML in Thailand. Methods We retrospectively reviewed patient data and included patients diagnosed with POML between January 2004 and December 2016 at Chiang Mai University Hospital and King Chulalongkorn Memorial Hospital, Thailand. We collected and analyzed patients' clinical characteristics and treatment outcomes. Results Among 146 patients with lymphoma involving the eyes, 121 (82%) were diagnosed with POML. Sixty-four (52.9%) were women with median age 58 (range, 22–86) years. The most common presenting symptom was orbital mass (71.1%). Common sites of origin were the orbit (46.3%) and lacrimal gland (34.7%). At presentation, 22.3% of patients had bilateral eye involvement. About half of patients had stage I disease (N=59, 56.2%) and 20% had stage IV. Most patients (73.3%) had a low-risk International Prognostic Index. Radiotherapy was the main treatment for patients with limited-stage disease (66.7% in stage I and 56.5% in stage II). The overall response rate was 100% with complete response rates 80%, 77.3%, and 64.7% for stages I, II, and IV, respectively. Five-year progression-free survival (PFS) and overall survival were 66.1% and 94.0%, respectively. For patients with limited-stage disease, radiotherapy significantly improved PFS compared with treatment not involving radiotherapy (5-year PFS 89.9% vs. 37.3%, P=0.01). Conclusion We revealed that POML has good response to treatment, especially radiotherapy, with excellent long-term outcome.
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Affiliation(s)
- Kasem Seresirikachorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sakarin Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Atitaya Apivatthakakul
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirima Tangchittam
- Department of Ophthalmology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Vannakorn Pruksakorn
- Department of Ophthalmology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kitsada Wudhikarn
- Division of Hematology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Damrong Wiwatwongwana
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Jeon YW, Yang HJ, Choi BO, Jung SE, Park KS, O JH, Yang SW, Cho SG. Comparison of Selection and Long-term Clinical Outcomes Between Chemotherapy and Radiotherapy as Primary Therapeutic Modality for Ocular Adnexal MALT Lymphoma. EClinicalMedicine 2018; 4-5:32-42. [PMID: 31193655 PMCID: PMC6537565 DOI: 10.1016/j.eclinm.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/25/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The choice of a primary treatment for ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML) depends on the extent of tumor spread. However, radiotherapy is commonly used as a first-line therapy despite ophthalmic complications, because most OAMLs are in a limited stage of progression. However, the initial therapeutic modality, including chemotherapy and treatment of the advanced stage, has not been fully established for OAML. Therefore, we evaluated the optimal therapeutic options and survival outcome-related parameters for patients with primary OAML. METHODS We evaluated 208 consecutive patients with primary OAML who were diagnosed at the Catholic University Lymphoma Group between January 2004 and April 2015. FINDINGS During a median follow-up of 70.0 months (range, 3.2-182.0 months) in 208 patients with primary OAML, most patients were female and the median age was 46 years old. Overall survival (OS) and progression-free survival (PFS) at 13 years were excellent (92.7% and 69.7%, respectively). Of the 117 patients who received the first-line radiotherapy, 92% achieved complete remission (CR), usually by being treated with less than 30 Gy. Radiation-related ophthalmic complications including dry eye syndrome (59%) and cataract (22%) caused a decline in the quality of life (QoL). Chemotherapy alone was used to treat 86 OAML patients, with 84.9% achieving CR and 12.8% achieving partial remission with tolerable toxicities. There were no differences in survival outcomes between patients treated with radiotherapy versus those treated with rituximab-containing chemotherapy, although the latter group had more advanced stages of OAML (OS, p = 0.057; PFS, p = 0.075). INTERPRETATION OAML patients were predominantly female and relatively young, and radiotherapy as a primary therapeutic option was more likely to lead to radiation-related complications, resulting in lower QoL. On the other hand, frontline chemotherapy showed consistent therapeutic outcomes with tolerable toxicities compared to radiotherapy, and there were no long-term or delayed adverse events. Therefore, when considering therapeutic efficacy and therapy-related QoL, chemotherapy is recommended for younger patients, and radiotherapy is recommended for older and chemotherapy-ineligible patients. FUNDING A National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP) (No. NRF-2016R1A2B4007282).
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Affiliation(s)
- Young-Woo Jeon
- Department of Hematology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Jung Yang
- Department of Ophthalmology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Ock Choi
- Department of Radiation Oncology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Eun Jung
- Department of Radiology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Sin Park
- Department of Pathology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-Hyun O
- Department of Nuclear Medicine, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suk-Woo Yang
- Department of Ophthalmology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence to: S.-W. Yang, Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #505 Banpo-Dong, Seocho-Ku, Seoul 06591, Republic of Korea.
| | - Seok-Goo Cho
- Department of Hematology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence to: S.-G. Cho, Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #505, Banpo-Dong, Seocho-Ku, Seoul 06591, Republic of Korea.
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Yen MT, Bilyk JR, Wladis EJ, Bradley EA, Mawn LA. Treatments for Ocular Adnexal Lymphoma. Ophthalmology 2018; 125:127-136. [DOI: 10.1016/j.ophtha.2017.05.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 12/31/2022] Open
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Characteristics of primary extranodal marginal zone B-cell lymphoma in Korea: conjunctiva versus other ocular adnexa. Br J Ophthalmol 2017; 102:502-508. [DOI: 10.1136/bjophthalmol-2017-310741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/27/2017] [Accepted: 07/25/2017] [Indexed: 12/12/2022]
Abstract
AimsTo compare the clinical characteristics and prognosis of primary conjunctival versus other ocular adnexal extranodal marginal zone B-cell lymphoma (EMZL).MethodsRetrospective review of clinical records for all consecutive patients with primary ocular adnexal EMZL treated from March 1995 to December 2015.Results198 patients were evaluated including 81 with primary conjunctival and 117 with other ocular adnexal EMZL. Conjunctival EMZL was found at a younger age (40.3±10.3vs 54.3±13.4 years, p<0.0001) with a female predilection (75.3%vs35.9%, p<0.0001) and had a higher rate of bilaterality (40.7%vs11.1%, p<0.0001) and a lower rate of systemic involvement (1.2%vs9.4%, p=0.030) compared with other ocular adnexal EMZLs. Conjunctival EMZL also showed a higher rate of complete response to primary treatment (98.8%vs89.5%, p=0.016) than other ocular adnexal EMZLs; however, recurrence and lymphoma-related death rates were not different between the two groups (p>0.05). Kaplan-Meier estimates for disease-specific survival at 5 and 10 years were 98.2% and 98.2% in conjunctival and 98.6%, respectively, and 95.2% in other ocular adnexal EMZLs. Univariate analysis showed that systemic involvement was negatively associated with conjunctival tumour location and positively associated with age (OR=0.35 and OR=1.05, p=0.045 and p=0.012, respectively), and treatment response was positively associated with conjunctival tumour location and negatively associated with age (OR=3.02 and OR=0.95, p=0.035 and p=0.009, respectively).ConclusionsConjunctival EMZL shows unique demographic characteristic compared with other ocular adnexal EMZLs. Long-term follow-up is required due to late recurrence in ocular adnexal EMZL.
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Lee GI, Oh D, Kim WS, Kim SJ, Ko YH, Woo KI, Kim YD, Ahn YC. Low-Dose Radiation Therapy for Primary Conjunctival Marginal Zone B-Cell Lymphoma. Cancer Res Treat 2017; 50:575-581. [PMID: 28618774 PMCID: PMC5912130 DOI: 10.4143/crt.2017.182] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/05/2017] [Indexed: 12/29/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the clinical features and the long-term outcomes of primary conjunctival marginal zone B-cell lymphoma (MZBCL) patients who were treated with radiation therapy (RT). Materials and Methods Retrospective data of 79 patients with 121 primary conjunctival MZBCL lesions were collected from January 1, 2001 till June 30, 2014. All lesions were treated by local RT (26 Gy) with patient-specific customized lens-shielding device. Results The current Korean patients’ cohort showed younger median age at diagnosis (38 years), great female preponderance (78.5%) and more frequent bilateral involvement (53.2%) than the previous studies. Following 26 Gy’s RT, excellent clinical outcomes were achieved: 5-year rates of overall survival, local relapse-free survival, and contralateral relapse-free survival were 100%, 98.1%, and 91.5%, respectively. Two patients (2.5%) developed local relapse and five (6.3%) developed relapse at initially uninvolved contralateral conjunctiva with median interval of 52.9 months, and late adverse events of grade 2 and 3 occurred in seven (8.8%) and two (2.5%) patients, respectively. Conclusion 26 Gy’s RT was highly effective and safe, with the use of lens-shielding device, in treating patients with primary conjunctival MZBCL.
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Affiliation(s)
- Ga-In Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shirota N, Nakayama H, Shiraishi S, Usui Y, Kimura K, Sanada T, Kennoki N, Okubo M, Goto H, Tokuuye K. Target volume dose and clinical outcome in radiotherapy for primary marginal zone lymphoma of the ocular adnexa. Mol Clin Oncol 2017; 6:833-838. [PMID: 28588773 PMCID: PMC5451851 DOI: 10.3892/mco.2017.1241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 03/17/2017] [Indexed: 01/15/2023] Open
Abstract
The aim of the present study was to determine the optimal dose and optimal target volume for marginal zone lymphoma of the ocular adnexa. Between January, 2008 and December, 2013, 40 patients with histologically proven primary marginal zone lymphoma of the ocular adnexa who underwent radiotherapy at the Tokyo Medical University were evaluated. The prescribed dose was 30 Gy in 15 fractions to the iso-center. Doses to the gross tumor volume (GTV), conjunctiva, bulbus oculi, retina and retrobulbar space were investigated, and the association between dose-volume factors and clinical outcome was analyzed. The overall and local progression-free survival rates at 3 and 5 years were 100% during a median observation period of 32 months. Two patients relapsed in the contralateral ocular adnexa. The progression-free survival rates at 3 and 5 years were 100 and 93.3%, respectively. The mean dose was 2.0 and 1.9 Gy for targets receiving 95% of the GTV dose (D95). The minimum dose was 0.9–2.0 Gy (median, 1.8 Gy). Thus, primary marginal zone lymphoma of the ocular adnexa favorably responded to lower doses of radiation, compared with prescribed doses to the iso-center. A radiation dose of 27 Gy in 15 fractions at D95 of GTV appeared to be optimal.
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Affiliation(s)
- Natuhiko Shirota
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Hidetsugu Nakayama
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Sachica Shiraishi
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Keisuke Kimura
- Department of Ophthalmology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Tomohide Sanada
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Norifumi Kennoki
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Mitsuru Okubo
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Koichi Tokuuye
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
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Qi D, Lin H, Gao Y, Lin J, Hu LT, Zhao GQ. The expressions of metadherin and LEF-1 in mucosa-associated lymphoid tissue lymphoma of ocular adnexal. Int J Ophthalmol 2017; 10:705-710. [PMID: 28546924 DOI: 10.18240/ijo.2017.05.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/23/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the expressions of metadherin (astrocyte elevated gene-1, AEG-1) and lymphoid enhancer-binding factor-1 (LEF-1) in ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS The expressions of AEG-1 and LEF-1 were detected on specimens harvested from patients suffering from MALT lymphoma and lymphadenosis of ocular adnexal in Ophthalmology Department, Affiliated Hospital of Qingdao University from 2000 to 2015 by immunohistochemical and polymerase chain reaction (PCR) analysis. RESULTS AEG-1 and LEF-1 expressions in MALT lymphoma was respectively higher than that in lymphadenosis, both by immunohistochemical and PCR analysis (P<0.05). Diversity of AEG-1 and LEF-1 expressions in different Ann Arbor clinical stages showed a statistically significant result (P<0.05). A positive relevance between AEG-1 and LEF-1 was observed in MALT ocular adnexal lymphoma (r=0.435, P=0.016). CONCLUSION The over expressions of AEG-1 and LEF-1 at the level of protein and mRNA participates in the tumorigenesis of ocular adnexal MALT lymphoma. They should act as a new biological marker for pathological diagnosis in the future.
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Affiliation(s)
- Dan Qi
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Hong Lin
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Yan Gao
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Jing Lin
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Li-Ting Hu
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Gui-Qiu Zhao
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
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Local Disease Control in Ocular Adnexal Lymphoproliferative Disorders: Comparative Outcomes of MALT Versus Non-MALT Histologies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:305-311.e2. [DOI: 10.1016/j.clml.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/04/2017] [Accepted: 02/07/2017] [Indexed: 12/22/2022]
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Platt S, Al Zahrani Y, Singh N, Hill B, Cherian S, Singh AD. Extranodal Marginal Zone Lymphoma of Ocular Adnexa: Outcomes following Radiation Therapy. Ocul Oncol Pathol 2017; 3:181-187. [PMID: 29134184 DOI: 10.1159/000453615] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/15/2016] [Indexed: 12/16/2022] Open
Abstract
Aim The aim of this study was to report outcomes following radiation therapy in patients with biopsy-proven extranodal marginal zone lymphoma of the ocular adnexa and uvea. Methods Records from a single institution were retrospectively reviewed from January 1997 to December 2015. The mean follow-up duration was 38 months (range 0-194). Radiation therapy was administered to 77 eyes (60 patients); 57 of the 77 eyes (74%) were treated with radiation only (range 20-36 Gy, median 15 fractions). Radiation cataract, radiation retinopathy, and optic neuropathy assessments were performed on all eyes treated with radiation. Results 100% of the 47 patients treated with radiation therapy only had local control with an average dose of 26.5 Gy (median 25.2 [range 20-36] Gy; 150-200 cGy per fraction). Four patients lost 2 lines or more of vision after radiation. The most common complication of radiation therapy was cataract formation/progression in 19 eyes (25%). Radiation retinopathy was observed only in 1 patient (1%). Conclusion Our results confirm that radiation therapy (median 25 Gy) for extranodal marginal zone lymphoma of the ocular adnexa is associated with high local control and low risk of visually significant complications.
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Affiliation(s)
- Sean Platt
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, Ohio, USA
| | - Yahya Al Zahrani
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, Ohio, USA
| | - Nakul Singh
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Brian Hill
- Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Sheen Cherian
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arun D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, Ohio, USA
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Richards H, Ramsden C, Naidoo R, Yvon C, Jacob E, Mohamedbhai S. Ocular adnexal lymphomas: a review. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1280394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Huw Richards
- North Middlesex University Hospital NHS Trust, London, UK
| | - Conor Ramsden
- Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Camille Yvon
- Institute of Ophthalmology, University College London, London, UK
- Frimley Park Hospital, Portsmouth Road, Frimley, Surrey, UK
| | | | - Sajir Mohamedbhai
- North Middlesex University Hospital NHS Trust, London, UK
- University College Hospital NHS Foundation Trust, London, UK
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Long-term course of patients with primary ocular adnexal MALT lymphoma: a large single-institution cohort study. Blood 2017; 129:324-332. [DOI: 10.1182/blood-2016-05-714584] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/20/2016] [Indexed: 12/19/2022] Open
Abstract
Key Points
POAML (specifically Ann Arbor stage I disease) has an excellent clinical outcome, with only a few patients succumbing to lymphoma. POAML patients face a continuous risk of distant relapse, including in the central nervous system, and transformation to aggressive lymphoma.
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Park Y, Park BB, Jeong JY, Kim WY, Jang S, Shin BK, Lee DS, Han JH, Park CJ, Suh C, Kim I, Chi HS. Assessment of bone marrow involvement in patients with lymphoma: report on a consensus meeting of the Korean Society of Hematology Lymphoma Working Party. Korean J Intern Med 2016; 31:1030-1041. [PMID: 27809449 PMCID: PMC5094919 DOI: 10.3904/kjim.2015.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 10/14/2016] [Indexed: 02/01/2023] Open
Abstract
In September 2011, the Korean Society of Hematology Lymphoma Working Party held a nationwide conference to establish a consensus for assessing bone marrow (BM) involvement in patients with lymphoma. At this conference, many clinicians, hematopathologists, and diagnostic hematologists discussed various topics for a uniform consensus in the evaluation process to determine whether the BM is involved. Now that the discussion has matured sufficiently to be published, we herein describe the consensus reached and limitations in current methods for assessing BM involvement in patients with lymphoma.
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Affiliation(s)
- Yong Park
- Department of Internal Medicine, Korea University School of Medicine, Seoul, Korea
| | - Byung Bae Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji Yun Jeong
- Department of Pathology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Wook Youn Kim
- Department of Pathology, Konkuk University Medical Center, Seoul, Korea
| | - Seongsoo Jang
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Bong Kyung Shin
- Department of Pathology, Korea University School of Medicine, Seoul, Korea
| | - Dong Soon Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Ho Han
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Chan-Jeoung Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Cheolwon Suh, M.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3209 Fax: +82-2-3010-6961 E-mail:
| | - Insun Kim
- Department of Pathology, Korea University School of Medicine, Seoul, Korea
| | - Hyun-Sook Chi
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Seoul, Korea
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de la Fuente MI, Haggiagi A, Moul A, Young RJ, Sidani C, Markoe A, Vega F, DeAngelis LM, Lossos IS. Marginal zone dural lymphoma: the Memorial Sloan Kettering Cancer Center and University of Miami experiences. Leuk Lymphoma 2016; 58:882-888. [PMID: 27649904 DOI: 10.1080/10428194.2016.1218006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Dural lymphoma (DL) is a rare type of primary CNS lymphoma arising from the dura mater. The optimal treatment is uncertain. A retrospective review was performed on 26 DL patients. Seventeen patients underwent resection and nine had a biopsy. Twenty three patients could be assessed for a response to treatment after surgery. Thirteen received focal radiotherapy (RT), six whole brain RT (WBRT), three chemotherapy alone and one chemotherapy followed by WBRT. Twenty two achieved complete response (CR) and one a partial response (PR). Four patients relapsed (two local and two systemic). Median follow up was 64 months, with median progression free survival (PFS) and OS not reached. Three year PFS was 89% (95% CI 0.64-0.97). All patients are alive at last follow-up, demonstrating that DL is an indolent tumor with long survival. CR is achievable with focal therapy in the majority of cases, but there is a risk for relapses and long-term follow-up is recommended.
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Affiliation(s)
- Macarena I de la Fuente
- a Departments of Neurology and Sylvester Comprehensive Cancer Center , University of Miami , Miami , FL , USA
| | - Aya Haggiagi
- b Department of Neurology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Adrienne Moul
- c Department of Hematopathology, Pathology and Laboratory Medicine , University of Miami/Sylvester Comprehensive Cancer Center , Miami , FL , USA.,g Division of Hematology-Oncology, Department of Medicine , Sylvester Comprehensive Cancer Center, University of Miami , Miami , FL , USA
| | - Robert J Young
- d Department of Radiology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Charif Sidani
- e Department of Radiology , University of Miami , Miami , FL , USA
| | - Arnold Markoe
- f Department of Radiation Oncology , University of Miami , FL , USA
| | - Francisco Vega
- c Department of Hematopathology, Pathology and Laboratory Medicine , University of Miami/Sylvester Comprehensive Cancer Center , Miami , FL , USA
| | - Lisa M DeAngelis
- b Department of Neurology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Izidore S Lossos
- g Division of Hematology-Oncology, Department of Medicine , Sylvester Comprehensive Cancer Center, University of Miami , Miami , FL , USA.,h Department of Molecular and Cellular Pharmacology , Sylvester Comprehensive Cancer Center, University of Miami , Miami , FL , USA
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Review article: Mucosa-associated lymphoid tissue (MALT)-type lymphoma of ocular adnexa. Biology and treatment. Crit Rev Oncol Hematol 2016; 100:37-45. [DOI: 10.1016/j.critrevonc.2016.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 12/08/2015] [Accepted: 01/14/2016] [Indexed: 12/27/2022] Open
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Starr AG, Caimi PF, Fu P, Massoud MR, Meyerson H, Hsi ED, Mansur DB, Cherian S, Singh AD, Cooper BW, De Lima MJ, Lazarus HM, Gerson SL, Jagadeesh D, Smith MR, Dean RM, Pohlman BL, Hill BT, William BM. Dual institution experience of extranodal marginal zone lymphoma reveals excellent long-term outcomes. Br J Haematol 2016; 173:404-12. [DOI: 10.1111/bjh.13975] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/21/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Adam G. Starr
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
| | - Paolo F. Caimi
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
| | - PingFu Fu
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
| | - Mira R. Massoud
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
| | - Howard Meyerson
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
| | - Eric D. Hsi
- Cleveland Clinic Foundation; Case Comprehensive Cancer Center; Cleveland OH USA
| | - David B. Mansur
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
| | - Sheen Cherian
- Cleveland Clinic Foundation; Case Comprehensive Cancer Center; Cleveland OH USA
| | - Arun D. Singh
- Cleveland Clinic Foundation; Case Comprehensive Cancer Center; Cleveland OH USA
| | - Brenda W. Cooper
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
| | - Marcos J.G. De Lima
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
| | - Hillard M. Lazarus
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
| | - Stanton L. Gerson
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
| | - Deepa Jagadeesh
- Cleveland Clinic Foundation; Case Comprehensive Cancer Center; Cleveland OH USA
| | - Mitchell R. Smith
- Cleveland Clinic Foundation; Case Comprehensive Cancer Center; Cleveland OH USA
| | - Robert M. Dean
- Cleveland Clinic Foundation; Case Comprehensive Cancer Center; Cleveland OH USA
| | - Brad L. Pohlman
- Cleveland Clinic Foundation; Case Comprehensive Cancer Center; Cleveland OH USA
| | - Brian T. Hill
- Cleveland Clinic Foundation; Case Comprehensive Cancer Center; Cleveland OH USA
| | - Basem M. William
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
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Rituximab as Single Agent in Primary MALT Lymphoma of the Ocular Adnexa. BIOMED RESEARCH INTERNATIONAL 2015; 2015:895105. [PMID: 26425558 PMCID: PMC4575717 DOI: 10.1155/2015/895105] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/06/2015] [Accepted: 07/14/2015] [Indexed: 12/22/2022]
Abstract
Ocular Adnexal Lymphomas are the first cause of primary ocular malignancies, and among them the most common are MALT Ocular Adnexal Lymphomas. Recently systemic immunotherapy with anti-CD20 monoclonal antibody has been investigated as first-line treatment; however, the optimal management for MALT Ocular Adnexal Lymphomas is still unknown. The present study evaluated retrospectively the outcome of seven consecutive patients with primary MALT Ocular Adnexal Lymphomas, of whom six were treated with single agent Rituximab. All patients received 6 cycles of Rituximab 375 mg/mq every 3 weeks intravenously. The overall response rate was 100%; four patients (67%) achieved a Complete Remission, and two (33%) achieved a partial response. In four patients an additional Rituximab maintenance every 2-3 months was given for two years. After a median follow-up of 29 months (range 8-34), no recurrences were observed, without of therapy- or disease-related severe adverse events. None of the patients needed additional radiotherapy or other treatments. Rituximab as a single agent is highly effective and tolerable in first-line treatment of primary MALT Ocular adnexal Lymphomas. Furthermore, durable responses are achievable with the same-agent maintenance. Rituximab can be considered the agent of choice in the management of an indolent disease in whom the "quality of life" matter is of primary importance.
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Extranodal Marginal Zone Lymphoma From Ocular Adnexae With Subcutaneous Involvement. Am J Dermatopathol 2014; 36:e189-93. [DOI: 10.1097/dad.0000000000000050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Outcomes of primary lymphoma of the ocular adnexa (orbital lymphoma) treated with radiotherapy. Clin Oncol (R Coll Radiol) 2014; 27:153-9. [PMID: 25455843 DOI: 10.1016/j.clon.2014.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 09/16/2014] [Accepted: 09/24/2014] [Indexed: 12/27/2022]
Abstract
AIMS Low-grade ocular adnexal lymphoma is a rare disease and often treated with local radiotherapy to varying doses. Most previously reported studies have a very heterogeneous patient population and treatments. We report the outcomes from a 10 year cohort of patients at our institution treated with primary radiation therapy. MATERIALS AND METHODS We analysed a retrospective case series of patients with stage IE low-grade ocular adnexal lymphoma including a review of case notes, histological reports and radiotherapy charts. We assessed local and distant tumour control and relapse rates in addition to toxicity. Disease-free survival was estimated using the Kaplan-Meier method. RESULTS In total, 81 patients and 85 orbits were treated with primary radiotherapy to a median dose of 30 Gy in 15 fractions over 3 weeks. Seventy-nine per cent were treated with standard MV external beam radiotherapy to the whole orbit and 21% with a lens-sparing technique. The median follow-up was 4.4 years (range 0.2-10.4). Local control rates were 100%, with 5% of patients experiencing disease relapse elsewhere. No patients died from lymphoma. Cumulative acute toxicity rates were 51% (mainly erythema and conjunctivitis) and late toxicity rates were 8% (mainly cataract). The lens-sparing technique was associated with a significant reduction in cataract rate (P = 0.013) and an increase in acute toxicity (P < 0.001). CONCLUSIONS This study has shown excellent local control rates and acceptable toxicity from the treatment of stage IE low-grade ocular adnexal lymphoma with localised radiotherapy to a median dose of 30 Gy in 15 fractions over 3 weeks.
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Plazola Hernández SI, Pérez Terán SA, Moreno Ferreyra LG. Linfoma B de zona marginal extranodal tipo MALT de conjuntiva bilateral tratado con radioterapia y anticuerpo monoclonal en un paciente con orbitopatía distiroidea. REVISTA MEXICANA DE OFTALMOLOGÍA 2014. [DOI: 10.1016/j.mexoft.2013.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Clinical characteristics of 95 patients with ocular adnexal and uveal lymphoma: treatment outcomes in extranodal marginal zone subtype. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 14:203-10. [PMID: 24417911 DOI: 10.1016/j.clml.2013.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/07/2013] [Accepted: 10/21/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lymphoma rarely presents in the ocular adnexa but is usually extranodal marginal zone (ENMZ) lymphoma when it does. Involved-field radiotherapy (IFRT) is the standard of care for unilateral disease, but the optimal management of more extensive disease is unclear. PATIENTS AND METHODS We retrospectively evaluated the clinical characteristics and outcomes of 95 patients with ocular adnexal lymphoma (OAL) or uveal lymphoma treated or diagnosed at our institution. All patients identified were included in the risk factor analysis for progression-free survival (PFS). The initial treatment-related outcomes were assessed for ENMZ OAL only (n = 62). RESULTS With a median follow-up of 32 months, significant risk factors for PFS after initial treatment were age (hazard ratio, 1.33; 95% confidence interval, 1.02-1.74), female gender (hazard ratio, 2.04; 95% confidence interval, 1.04-4.00), and a history of lymphoma (hazard ratio, 2.31; 95% confidence interval, 1.12-4.78). In ENMZ, IFRT was associated with improved PFS (median, 5.4 years; P < .001). Progression occurred in 7 of 39 (23%), with 6 of the 7 (86%) at systemic sites. Single-agent rituximab was typically used for bilateral ocular or systemic presentations of ENMZ OAL. Progression occurred in 7 of 11 (64%), with no progression at systemic sites. All progression events in those initially treated with rituximab occurred in the ocular adnexa. CONCLUSION The results of the present study have confirmed IFRT as the standard for unilateral ENMZ OAL. Single-agent rituximab was an effective agent for bilateral ocular or systemic ENMZ OAL, particularly for systemic control, but ocular progression should be closely monitored. Combined modality therapy should be studied further in bilateral and systemic ENMZ OAL.
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Rath S, Connors JM, Dolman PJ, Rootman J, Rootman DB, White VA. Comparison of American Joint Committee on Cancer TNM-based staging system (7th edition) and Ann Arbor classification for predicting outcome in ocular adnexal lymphoma. Orbit 2013; 33:23-8. [PMID: 24180616 DOI: 10.3109/01676830.2013.842257] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the TNM and Ann Arbor staging systems in predicting outcome in ocular adnexal lymphoma (OAL). METHODS Retrospective review of the clinical, imaging and histopathologic records of OALs between 1986 and 2009. Outcome measures included local recurrence and progression. RESULTS One hundred and sixty patients of OAL were included. Mean age was 65 ± 15 years (range 20-97) and 68 (43%) were male. The median follow-up of all OAL patients was 65 months (range 2.5-238). Histopathology identified low-grade, indolent B-cell lymphomas in 140 patients (87.5%) and rest had aggressive grades. Of 134 indolent OAL patients, those with unilateral disease had a 10-year progression free survival of 72% versus 48% in their bilateral counterparts (p = 0.001). Amongst unilateral OAL patients staged within the T1-2 group, a significantly better outcome was noted for patients without nodal or metastatic involvement compared to those with such involvement (p = 0.0001). The above observations helped to formulate a simple scoring system to prognosticate OALs based on their laterality and node/metastatic status. Amongst the 3 groups identified, group 1 with a score of 0 (unilateral OALs with no nodes or metastasis) had a 10-year progression free survival of 75%; group 2 with score 1 (either bilateral or positive nodes/metastasis) 50% and group 3 with score 2 (both bilateral OAL with positive nodes/metastasis) zero at 10 years (p < 0.00001). CONCLUSIONS The TNM-based staging system better predicts outcome in OAL than the Ann Arbor system primarily by delineation of bilateral disease and nodal/metastatic involvement at presentation.
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Affiliation(s)
- Suryasnata Rath
- Department of Ophthalmology and Visual Sciences , University of British Columbia, Vancouver, Canada
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Gandolfi L, Stefani G, Narducci R, Argnani L, Polito E, Zinzani PL. Primary ocular adnexal lymphomas: a retrospective study of 25 patients. Leuk Lymphoma 2013; 54:2076-8. [DOI: 10.3109/10428194.2013.765567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ocular adnexal lymphoma staging and treatment: American Joint Committee on Cancer versus Ann Arbor. Eur J Ophthalmol 2013; 23:344-55. [PMID: 23397158 DOI: 10.5301/ejo.5000224] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the prognostic utility of the American Joint Committee on Cancer (AJCC) staging system for ocular adnexal lymphoma (OAL).
METHODS A multicenter, consecutive case series of patients with biopsy-proven conjunctival, orbit, eyelid, or lacrimal gland/sac lymphoma was performed. The electronic pathology and clinical records were reviewed for new or recurrent cases of ocular adnexal lymphoma. The main outcome measures included pathology and clinical staging (AJCC and Ann Arbor systems), treatment, and recurrence (local and systemic). Statistical analysis included demographic evaluations and the Kaplan-Meier survival probability method.
RESULTS Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue were the most common (n=60/83, 72%). The most common Ann Arbor clinical stages were IE (76%) followed by IIE (17%) and IIIE (7%). Pathology identified 13 cases (15%) that were upstaged to group IV (p=0.017). Similarly, AJCC clinical stages were cT1NOMO (21.7%), cT2NOMO (44.6%), cT3N0M0 (5%), and cT4NOMO (2.4%). Local control was achieved in 75% of treated patients. There were 19 local recurrences from which 14 (74%) belonged to the non-radiation treatment groups. Lower-risk groups (T1 and T2 without lymph node involvement or metastatic disease of AJCC and IE of Ann Arbor) had longer disease-free survival than the higher-risk groups (AJCC T1, T2 with nodal involvement or metastatic disease, T3, and T4 as well as Ann Arbor II, III, and IV). The overall mean follow-up was 43.3 months (range 6-274).
CONCLUSIONS Regardless of stage, recurrence and disease-free survival were more closely related to treatment and histopathology rather than tumor size or site-specific location.
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Huang HC, Cheng AL, Lin CW, Kuo SH. Primary central nervous system diffuse large B cell lymphoma transformed from orbital mucosa-associated lymphoid tissue lymphoma: complete response to combined intrathecal and systemic rituximab. Ann Hematol 2012; 92:989-92. [DOI: 10.1007/s00277-012-1651-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 12/01/2012] [Indexed: 10/27/2022]
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Tran KH, Campbell BA, Fua T, MacManus M, Ryan G, Chesson B, Wirth A. Efficacy of low dose radiotherapy for primary orbital marginal zone lymphoma. Leuk Lymphoma 2012; 54:491-6. [DOI: 10.3109/10428194.2012.717279] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Orbital lymphoma: imaging features and differential diagnosis. Insights Imaging 2012; 3:337-44. [PMID: 22695946 PMCID: PMC3481074 DOI: 10.1007/s13244-012-0156-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/07/2012] [Accepted: 02/21/2012] [Indexed: 11/15/2022] Open
Abstract
Purpose Patterns of orbital lymphoma at diagnosis and follow-up are described. We also discuss differential diagnosis of orbital masses. Materials and methods This pictorial review contains 19 cases of orbital lymphoma before and after treatment. Superior-lateral quadrant and extra-conal location were observed predominantly. Effective response after treatment was presented on follow-up imaging, although few local relapses were found. Further follow-up showed no changes of residual images. Discussion Location of orbital masses can help in the differential diagnosis. Moreover, imaging features of lymphoma at diagnosis can be useful in planning surgical biopsy. Pattern of follow-up described may be relevant on monitoring imaging. Teaching points • Orbital lymphoma involves mainly superior-lateral quadrant and the orbital structures inside. • Location of retrobulbar mass-like lesions are useful information in the differential diagnosis. • Satisfactory response is detected after treatment, however relapse is noted, so follow-up is needed.
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Bibliography. Lymphoma. Current world literature. Curr Opin Oncol 2011; 23:537-41. [PMID: 21836468 DOI: 10.1097/cco.0b013e32834b18ec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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