Orbital Lymphoma

[142348]

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Quick question on orbital lymphoma (low grade);

1) Lacrimal gland- My thought is to treat just the gland to 30 Gy with a margin (wedge pair)

2) Conjunctiva- I had been told that this was usually the indication to treat the whole orbit but I know some people treat just the lesion. What are you all doing and whats your technique in terms of beam arrangement (SO and IO is one I have seen); do you use a lens shield?

 

[Gfunk6]

1. If it is a MALT then I would treat with wedge pair to 30 Gy

2. If MALT, then test for Clamydia psitacci. If positive, consider doxycycline x2 weeks. For XRT I use an enface 6 MeV electron beam with bolus based on CT. During treatment I place a contact lens shield on the eye w/o block the tumor. I go 1.8 Gy per fraction to 24 Gy.

 

[ShirleyT]

for malt of the lacrimal gland, i would treat lacrimal gland only with a margin using either imrt or skin collimation electron (with sharp pneumbra) to spare cornea as much as possible. i would do 24-25.5 Gy at 1.5 Gy per frx. NCCN says 24-30 for non gastric malts, so 30 is perfectly acceptable and is what i used to do, but i was on chart rounds recently with Prosnitz from duke and he said most of the lymphoma folks are dropping their orbital malt doses to mid to upper twenties to dry to avoid permanent dry eye.

 

[Palex80]

Bearing in mind the recent data from the UK dose finding trial in low grade lymphomas, I think that restricting dose to 24 Gy for orbital lymphomas should be safe.