Salvage Irradiation for Ocular Adnexal Mucosa Associated Lymphoid Tissue Lymphoma Refractory to Chlamydia psittaci Eradication

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology Pub Date : 2025-06-06 DOI:10.1016/j.adro.2025.101822

Elena Flospergher MD , Marianna Sassone MD , Anna Chiara MD , Fabrizio Marino MD , Antonio Giordano Resti MD , Maurilio Ponzoni MD , Maria Giulia Cangi MD , Lucia Bongiovanni MD , Gilda Magliacane MD , Giulio Modorati MD , Elisabetta Miserocchi MD , Teresa Calimeri MD, PhD , Piera Angelillo MD , Federico Erbella MD , Andrés J.M. Ferreri MD

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引用次数: 0

Abstract

Purpose

Prospective trials show that Chlamydia psittaci (Cp) eradication with doxycycline is followed by lymphoma regression in 2-thirds of patients with ocular adnexal marginal zone lymphoma (OAMZL). Postponing orbit irradiation, a standard treatment for OAMZL, while waiting for the tumor response to antibiotic, could raise concern. Herein, we report the safety and efficacy of salvage radiation therapy in patients with OAMZL relapsed after or refractory to Cp eradication.

Methods and Materials

Patients with stage IEA OAMZL diagnosed at our institution between 2005 and 2023 were evaluated for the safety and efficacy of radiation therapy as salvage treatment after doxycycline. Inclusion criteria were as follows: (1) first-line Cp-eradicating therapy with doxycycline; (2) lymphoma relapsed or progressed locally; and (3) orbital irradiation as salvage treatment.

Results

A total of 28 patients (median age 66 years; range, 37-92; 16 males) were assessable; all patients but 2 (relapsing after partial response) experienced progressive disease during or after doxycycline (median 9 months; IQR, 4-40). Radiation therapy (30-36 Gy in 15-18 fractions) was well tolerated, with only 3 cases of grade-2 cataract and 3 cases of grade-1 blepharitis; all irradiated patients achieved a lymphoma regression (overall response rate = 100%), with a complete response rate of 89% (95% CI, 80%-97%). At a median follow-up of 60 months (range, 12-166) from radiation therapy, 8 patients experienced relapse, within the irradiated volume only in 2 (7%), with a 4-year progression-free survival of 74% (95% CI, 72%-75%). All patients but one are alive at a median follow-up from initial lymphoma diagnosis of 96 (IQR, 47-128) months; 22 (79%) patients are disease free.

Conclusions

The postponing of orbit irradiation until relapse/progression after Cp-eradicating antibiotic therapy is a safe and effective strategy in patients with limited-stage OAMZL. The vast majority of patients with OAMZL can be safely managed without chemotherapeutic agents, and radiation therapy can be delayed until relapse without affecting patients’ survival.

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眼附件黏膜相关淋巴组织淋巴瘤对鹦鹉热衣原体根除难治的补救性放射治疗

目的前瞻性研究表明，2 / 3的眼附件边缘区淋巴瘤（OAMZL）患者用强力霉素根除舌热衣原体（Cp）后淋巴瘤消退。眼窝照射是治疗OAMZL的一种标准治疗方法，在等待肿瘤对抗生素反应的同时，可能会引起人们的关注。在此，我们报告了在Cp根除后复发或难治性OAMZL患者中补救性放射治疗的安全性和有效性。方法与材料对我院2005年至2023年间诊断为IEA期OAMZL的患者进行放射治疗作为强力霉素后补救性治疗的安全性和有效性评价。纳入标准如下：(1)采用强力霉素一线灭cp治疗；(2)淋巴瘤局部复发或进展；(3)眼眶照射作为救助治疗。结果共28例患者(中位年龄66岁；范围内,37 - 92;16名男性)可评估；除2例患者（部分缓解后复发）外，所有患者在强力霉素治疗期间或之后病情进展(中位9个月；差,4-40)。放射治疗（30- 36gy， 15-18次）耐受良好，仅3例2级白内障和3例1级睑炎；所有接受放疗的患者均实现淋巴瘤消退（总缓解率为100%），完全缓解率为89% （95% CI, 80%-97%）。在放射治疗后中位随访60个月（范围12-166），8例患者复发，仅2例（7%）在放疗体积内复发，4年无进展生存率为74% （95% CI, 72%-75%）。除1例患者外，所有患者在初始淋巴瘤诊断后的中位随访时间为96个月（IQR, 47-128）；22例（79%）患者无病。结论对于有限期OAMZL患者，抗生素根除cp治疗后延迟眼眶照射至复发/进展是一种安全有效的治疗策略。绝大多数OAMZL患者可以在没有化疗药物的情况下安全管理，并且可以延迟放射治疗直到复发而不影响患者的生存。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.