Clinical stage IEA-IIEA orbital lymphomas: outcomes in the era of modern staging and treatment

Background and purpose: The present study examines outcomes in patients wit h primary orbital lymphomas who underwent complete staging. Materials and methods: From 1978 to 1997, 21 adult patients at the M.D. And erson Cancer Center had stage IEA-IIEA orbital non-Hodgkin's lymphomas base d on staging that included computed tomography scans. Sixteen (76%) patient s had working formulation low-grade lymphomas, and five (24%) had aggressiv e lymphomas. Fourteen of 16 (88%) patients with low-grade lymphomas were tr eated with radiotherapy alone, and four of five (80%) patients with aggress ive lymphomas were treated using combination chemotherapy with or without r adiotherapy. Total radiotherapy doses ranged from 30.0 to 40.0 Gy using dai ly 1.5-2.0 Gy fractions. Results: The median follow-up was 84 months. For the low-grade lymphomas, t he 5-year local control, progression-free survival, and overall survival ra tes were 100, 100, and 92%, respectively. For the seven low-grade lymphomas treated with radiotherapy alone to 30.0 Gy in 20 fractions, the 5-year loc al control, progression-free, and overall survival rates were 100, 100, and 75%, respectively. The 5-year incidence of complications, which were typic ally mild, in eyes irradiated to 30 Gy in 20 fractions versus higher biolog ically effective doses were 25 and 38%, respectively (P = 0.62). Of the fiv e patients with aggressive lymphomas, none of the four who underwent chemot herapy with or without radiotherapy relapsed (all four remain alive), where as the one treated with radiotherapy alone for stage IEA disease experience d a distant relapse. Conclusions: In patients with low-grade lymphomas, a good therapeutic ratio was obtained with low-dose radiotherapy alone. In patients with aggressive lymphomas, chemotherapy with or without radiotherapy resulted in excellent local control, progression-free survival, and overall survival; however, t he statistical power was limited. (C) 2001 Elsevier Science Ireland Ltd. Al l rights reserved.