International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationPrimary Radiation Therapy in Patients With Localized Orbital Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT Lymphoma)
Introduction
Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) was first described in 1983 by Isaacson and Wright (1). This tumor has generally been considered to have an indolent natural history and a favorable prognosis, and it usually responds well to local radiotherapy (RT) alone 2, 3, 4, 5, 6, 7. However, the data on the clinical behavior of orbital MALT lymphoma is limited, inconsistent, and still unclear because the literature includes variable histologies from benign to malignant entities.
The use of immunophenotypic analysis, in addition to hematoxylin/eosin-stained microscopic examination, could make possible a more exact diagnosis of orbital MALT lymphoma. These procedures can distinguish MALT lymphoma from the other types of Non-Hodgkin's lymphoma (NHL), such as small lymphocytic lymphoma, mantle cell lymphoma, and reactive lymphoid infiltration.
Several groups have recently published valuable treatment results for this tumor 2, 3, 4, 5, 6, and these studies included patients with orbital MALT lymphoma confirmed by immunophenotypic studies. Their data could be compared with each other, and the characteristics of MALT lymphoma arising in the orbit are now better understood.
In this study, we retrospectively reviewed the results of primary RT in 46 patients with localized orbital MALT lymphoma and evaluated the clinical features and treatment outcomes.
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Patient characteristics
Between May 1999 and July 2008, 46 patients with pathologically confirmed localized orbital MALT lymphoma were treated with primary RT at Kangnam St. Mary's Hospital and St. Mary's Hospital, which are affiliated hospitals of a single institution.
All the patients were diagnosed according to the World Health Organization histologic diagnostic criteria. In addition to a hematoxylin/eosin-stained microscopic examination, immunohistochemical staining for CD20, CD3, CD5, and cyclinD1 was performed to
Local control, RFS, and OS
The 5-year local control, RFS, and OS rates were 93%, 93%, and 100%, respectively (Fig. 2). Among the 46 patients, 43 (93%) achieved CR, of whom 18 had residual or suspicious lesions at their initial response evaluation. However, their lesions gradually regressed 3–13 months after the completion of RT. The median duration for achieving CR was 2 months (range, 0.1–25 months). Three patients (7%) who achieved PR had lymphoma lesions of the retro-orbit arising in the rectus muscles and optic
Discussion
MALT lymphoma was initially described by Isaacson and Wright (1), and it is known to be a rare disease. However, its incidence in Korea is relatively high, comprising 17.3% of all NHL cases in Korea (8). Diffuse large B-cell lymphoma (DLBL) is usually the most common pathologic NHL subtype. However, MALT lymphoma constitutes 76%–100% of orbital NHL cases in Far Eastern countries, including Korea and Japan 3, 4, 8, 9.
Many studies in the literature have shown that excellent local control can be
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Cited by (57)
Long-Term Clinical Outcomes and Sequelae of Therapy in Early-Stage Orbital Mucosa-Associated Lymphoid Tissue Lymphoma
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2019, Radiotherapy and OncologyTreatments for Ocular Adnexal Lymphoma: A Report by the American Academy of Ophthalmology
2018, OphthalmologyCitation Excerpt :Two studies reported results of using oral doxycycline as the primary treatment method. The clinical outcomes and complications of the included studies are presented in Table 2.1,3,7,12,13,18–39 The outcomes reported from studies involving radiotherapy for MALT lymphomas universally are very good, both for radiotherapy used as a stand-alone treatment or in combination with chemotherapy.
Local Disease Control in Ocular Adnexal Lymphoproliferative Disorders: Comparative Outcomes of MALT Versus Non-MALT Histologies
2017, Clinical Lymphoma, Myeloma and LeukemiaLong-term course of patients with primary ocular adnexal MALT lymphoma: A large single-institution cohort study
2017, BloodCitation Excerpt :Only 1 of our patients received treatment with doxycycline with no response. RT was reported to achieve an excellent local control (86% to 100%) in all previous studies of patients with Ann Arbor stage I POAML.14,25,34,43,44 Similarly, RT achieved local control in 97% of our Ann Arbor stage I POAML patients.
Conflict of interest: none.
- 1
S. H. Son and B. O. Choi contributed equally to this work.