Radiotherapy in the management of orbital lymphoma

Purpose: This retrospective study reviews the treatment technique, disease outcome, and complications of radiotherapy used in the management of lympho ma 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 biops y-proven orbital lymphoma. Twenty patients who had limited disease were tre ated with curative intent, and 18 patients who had known systemic disease w ere treated with palliative intent. Of the 20 patients treated with curativ e intent, 14 had low-grade and 6 had intermediate- or high-grade disease. N one received chemotherapy. Most patients received treatment with 250 kVP or Co-60 radiation, using either an en face anterior field or wedged anterior and lateral fields. Median treatment dose was 25 Gy. Lens shielding was pe rformed if possible. For patients treated for cure, cause-specific survival and freedom from distant relapse were calculated using the Kaplan-Meier me thod. 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 t umor and was salvaged with further radiotherapy. In the patients treated cu ratively, 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 di sease (p = 0.08). Cause-specific survival at 5 years was 89% for patients w ith low-grade and 33% for those with intermediate/high-grade disease (p = 0 .005). Two patients with low-grade disease had contralateral orbital failur es; both were salvaged with further irradiation. Acute toxicity was minimal . Cataracts developed in 7 of 21 patients treated without lens shielding an d 0 of 17 patients treated with lens shielding. No patient developed signif icant late lacrimal toxicity. Conclusion: Radiotherapy is a safe and effective local treatment in the man agement of orbital lymphoma. (C) 1999 Elsevier Science Inc.