Treatment/Prognosis

Question 1

What is the Tx paradigm for orbital lymphoma?

Answer 1

Orbital lymphoma Tx paradigm: RT alone (low grade) or CRT (if intermediate/high grade)

Question 2

What RT doses are used for orbital lymphoma?

Answer 2

19.5–24 Gy at 1.5 or 2 Gy (MALT, low grade) or even 4 Gy in 2 fx (“boom-boom”) can be used as a palliative dose, and 30–36 Gy (high grade, based on chemo response).

Question 3

Does RT alone offer high rates of LC for low-grade orbital lymphoma? What rates have been reported?

Answer 3

Yes. A retrospective series of 31 orbital MALT lymphoma pts at Stanford treated with 30–40 Gy achieved a 10-yr LC of 100% and freedom from relapse of 71%; no dose response was observed as there was no difference in pts treated with >34 Gy vs. ≤34 Gy. (Le Q et al., IJROBP 2002)

Question 4

What is the Tx paradigm for intraocular lymphoma?

Answer 4

Intraocular lymphoma Tx paradigm: chemo +/- RT. These are treated more like primary CNS lymphomas.

Question 5

What area is irradiated in intraocular lymphoma?

Answer 5

The orbits (+/- whole brain) are irradiated in intraocular lymphoma.

Question 6

Which chemo agent is typically used for intraocular lymphomas?

Answer 6

High-dose methotrexate (Mtx). Intraocular/intravitreal Mtx and rituximab (Rituxan) are usually employed.

Question 7

What chemo regimens are typically used for high-grade orbital/ocular adnexa lymphomas?

Answer 7

Cyclophosphamide HCl/doxorubicin/Oncovin/prednisone + Rituxan (R-CHOP) or cyclophosphamide/vincristine/Adr/dexamethasone (CVAD) are typically used for high-grade orbital lymphomas.

Question 8

What is 1 additional option for refractory/relapsed Dz?

Answer 8

Radioimmunotherapy with I-131 or yttrium-90 is another option for refractory/relapsed Dz. (Esmaelli et al., Ann Oncol 2009)

Question 9

What RT technique can be utilized for ant (eyelid, conjunctival) lesions?

Answer 9

Ant orthovoltage or electron fields can be employed for ant eye lesions.

Question 10

How is lens shielding accomplished with an ant orthovoltage field?

Answer 10

A lead shield is suspended in the beam to shield the lens (limits lens dose to 5%–10%).

Question 11

What are some poor prognostic factors for ocular/orbital lymphomas?

Answer 11

High-grade Dz, advanced Dz (stage IVE), elevated LDH, age > 60, lacrimal gland involvement, and symptomatic Dz