Orbital lymphoma: diagnostic approach and treatment outcome

Tumori Journal, 1997

Aims and Background The orbit is an uncommon primary site for non-Hodgkin's lymphomas (NHL), and it accounts for less than 1% of all sites of primary presentations. We report the experience of the Department of Radiation Oncology at Ankara University Faculty of Medicine with radiation therapy in treatment of patients with stage I primary orbital NHL. Methods From February 1978 through August 1993, 14 patients with stage I primary orbital NHL were treated with radiation therapy. According to the Working Formulation classification, 8 patients had low-grade and 6 had intermediate-grade lymphomas. The most commonly used radiation therapy technique was a single anterior field with a Cobalt-60 unit, delivering 40 Gy in 2 Gy daily fractions. Two patients with intermediate-grade lymphomas received the CHOP regimen following radiation therapy. Results Follow-up ranged from 0.8 to 18.3 years (median, 10.3 years). Local control was achieved in all patients. Two patients with low-grade lymp...

Acta Medica Bulgarica, 2020

Background and purpose: The occurrence of primary orbital lymphoma comprises approximately 1% of non-Hodgkin’s lymphoma and 8% of extranodal lymphoma. The vast majority of orbital lymphomas are of B-cell origin, of which extranodal marginal zone B-cell lymphoma is the most common subtype. The purpose of this paper was to present the diagnostic challenges in a case of orbital lymphoma. Case presentation: An 84-year -old woman with orbital tumour was operated on after a long period of inappropriate treatment. It was later diagnosed as B-cell lymphoma. Conclusion: Orbital lymphoma can be easily mistaken for another ocular disease due to the slowly progressing non-specific complaints of the patients. We should be alert to the possibility of this ocular diagnosis when we are presented with an elderly patient with proptosis.

Lymphoma of the orbit is a rare presentation of non- Hodgkin's lymphoma (NHL). According to the data from the literature, orbital lymphoma represents 8% of all extranodal NHL and about 1% of all NHL [1-3]. Symptoms which are usually caused by orbital lymphoma are proptosis, periorbital swelling, conjunctival (salmonpink) swelling, diplopia, and conjunctival redness and irritation [4]. Radiotherapy is widely used as the primary treatment for orbital lymphoma. Radiation in those cases is often technically challenging, because special effort is made to preserve the integrity of the orbit without compromising local control [1]. The studies have shown that a local control rate is 95-98% for low grade orbital lymphomas [1,5]. The localized primary orbital lymphomas respond well to radiotherapy. The advantages of the radiotherapy treatment are a high-local control rate and durable disease-free status. Carefully planned orbital radiotherapy is well tolerated by patients and obligatory use of a lens shield contributes to greatly reducing the incidence of complications.

Journal of the Egyptian National Cancer Institute, 2015

To analyze the clinical outcome of primary orbital lymphoma (POL) patients treated with a combined modality approach with local radiotherapy after induction chemotherapy. Methodology: We retrospectively retrieved demographic, treatment and outcome data of patients treated for POL from 2000 to 2010. The charts were reviewed and the data were tabulated in a predesigned pro-forma. Results: 23 patients of POL were found evaluable. Median age was 55 years (range 24-70 years). Of 23 patients, 15 were male and 8 female, making the male:female ratio approximately 1.9:1. Patients were thoroughly evaluated and staged. All but one patient received multi agent chemotherapy. Radiotherapy was delivered for all cases. Radiation was delivered by 3DCRT technique. Median dose of radiation was 45 Gy (range 20-45 Gy). Median follow up was 26.8 months. None of the patients had any evidence of local failure or systemic progression. Conclusion: A combined modality therapy with a combination of CHOP/COP based chemotherapy and moderate dose of radiotherapy imparts excellent long term local and systemic disease control.

International Journal of Radiation Oncology Biology Physics, 1999

Purpose: This retrospective study reviews the treatment technique, disease outcome, and complications of radiotherapy used in the management of lymphoma involving the orbits. Patients & Methods: Thirty-eight patients were treated between May 1969 and January 1995, with a median follow-up of 8.3 years. All patients had biopsy-proven orbital lymphoma. Twenty patients who had limited disease were treated with curative intent, and 18 patients who had known systemic disease were treated with palliative intent. Of the 20 patients treated with curative intent, 14 had low-grade and 6 had intermediate-or high-grade disease. None received chemotherapy. Most patients received treatment with 250 kVP or 60 Co radiation, using either an en face anterior field or wedged anterior and lateral fields. Median treatment dose was 25 Gy. Lens shielding was performed if possible. For patients treated for cure, cause-specific survival and freedom from distant relapse were calculated using the Kaplan-Meier method. Results: Control of disease in the orbit was achieved in all but 1 patient, who developed an out-of-field recurrence after irradiation of a lacrimal tumor and was salvaged with further radiotherapy. In the patients treated curatively, the 5-year rate of actuarial freedom from distant relapse was 61% for those with low-grade and 33% for those with intermediate/high-grade disease (p ‫؍‬ 0.08). Cause-specific survival at 5 years was 89% for patients with low-grade and 33% for those with intermediate/high-grade disease (p ‫؍‬ 0.005). Two patients with low-grade disease had contralateral orbital failures; both were salvaged with further irradiation. Acute toxicity was minimal. Cataracts developed in 7 of 21 patients treated without lens shielding and 0 of 17 patients treated with lens shielding. No patient developed significant late lacrimal toxicity. Conclusion: Radiotherapy is a safe and effective local treatment in the management of orbital lymphoma.

International Journal of Research Publications

Orbital lymphoma represents a small fraction of all systemic lymphomas that has been accounted for approximately in 1-2% of non-Hodgkin lymphomas (NHL). Some diagnostic delays might be occurred due to the fact that there are non-specific clinical signs. Furthermore, an orbital CT scan can determine the location of the orbital mass and assist in ophthalmological surgery as well as to obtain an optimal sample for an accurate diagnosis. CT scan was performed and revealed the pattern of orbital lymphoma in order to pursue the proper diagnosis. In accordance to the imaging result, immunohistochemical studies were performed from biopsy specimens of all three patients. It showed that there were a non-Hodgkin's lymphomas originating in the orbit, lids, and oculi adnexa.

International Journal of Approximate Reasoning, 2020

We report the case of a fifty-two year old lady with a primary large Bcell Non-Hodgkin lymphoma, NHL, of the orbit which is a rare presentation of NHL. The tumour was amenable to chemotherapy and radiotherapy. Lymphomas are malignant neoplasm arising from the lymphoid cells (Kumar et al 2005). They are broadly classified into two groups namely the Hodgkin Lymphoma, HL and NHL. Lymphomas are not rare in occurrence; they are considered as the eighth and ninth leading cause of death due to cancers in women and men respectively in the United State in 2017 (Longo et al 2012). NHL occurs 10 times more frequently than the HL and in general has a poorer prognosis as compared to the latter (Cancer treatment center of America, 2017).

Reports of Practical Oncology and Radiotherapy

Background: The extranodal marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) is the most common orbital and adnexal lymphomas. Radiotherapy is one of the most preferred treatment options for orbital lymphomas since they are localized and radiation sensitive. The objective of this study is to evaluate how radiation therapy affected the outcome of orbital MALT lymphoma. Materials and ethods: PRISMA guideline was used to conduct this systematic review of electronic databases (PubMed, EMBASE and Cochrane Library), then we assessed the quality of evidence of each paper. Results: Twenty-five studies were finally included. 94% studies were intended for definitive therapy and almost all of the studies used external radiation sources. The total doses given to the tumor bed ranged from 4 Gy to 55 Gy and were divided into three groups: ultra-low dose (4-6 Gy), standard-dose (24-30.6 Gy), and high-dose (> 30.6 Gy). 75-90% patients showed CR and local relapse was only reported at 3.5-5%. Higher 5-year PFS was reported in the patients group with lens shielding (90.1% vs. 82.1%) and an increase in Meiboscore after RT courses. Toxicities, including dry eye and cataract, were reported in several patients. Acute toxicities subsided gradually over a few months with artificial tears. The risk of early cataract formation increases in patients who received > 30 Gy and lower in the IMRT group. Conclusion: RT is a successful primary definitive therapy for low-grade orbital MALT lymphoma, with a high survival rate, low recurrence rate, and typically acceptable toxicity.

Primary Non-Hodgkin's lymphoma of the orbit is a rare presentation and the diffuse large B-cell lymphoma (DLCL) type of histology is much less commoner than the mucosa associated lymphoid tissue (MALT) and follicular lymphoma. A 70 years female patient presented with palpable mass arising from right orbit and proptosis of the right eye. CT scan suggested homogenous enhancing soft tissue mass affecting right lacrimal region without any bony destruction. Biopsy confirmed it to be a case of Primary non-Hodgkin's lymphoma of diffuse large B-cell type with strongly positive CD 20. She was given 6 cycles of chemotherapy with R-CHOP after surgery. The patient is now asymptomatic one year after the last cycle of the chemotherapy.

International Journal of Radiation Oncology*Biology*Physics, 1984

Lymphoreticular tumors in tbe orbit are uncommon. Only 42 patients were identified from over 2000 patients with tumors of lymphoid tisue seen between 1958 and 1979. The patients were divided into 3 groups: primary malignant, secondary malignant, and benign lymphoma. In the primary malignant lymphoma groups, there were 24 patients with a median age of 64 (40 to 87) years and a 2.4:1 female to male ratio: 2 cases were bilateral. In I9 (79%) patients with the lymphoma limited to one orbit the tumor was controlled in every case with doses from 25 to 45 Gy. There were no serious complications. Subsequently lymphoma developed at other sites in 7 (37%) patients. The 5 and 10 year cause specific actuarial survival rates were 70 and 62%. In the 8 patients with secondary malignant lymphoma, the orbital disease was controlled by irradiation, although all patients required further treatment and died of their disease. Radiotherapy controlled all 7 patients with benign lymphoma without any complictitions.