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Ocular adnexal marginal zone B-cell lymphoma: the low-dose dilemma
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  • Published on: 12 November 2019
    Dilemma of Ultra-low dose vs Low-dose Radiation Therapy for Ocular Adnexal Lymphomas: The prospective trial has been underway
    • Bita Esmaeli, MD, FACS Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, M. D. Anderson Cancer Center, Houston, Texas, USA
    • Other Contributors:
      • Chelsea Pinnix, MD
      • Tine Gadegaard Hindso, MD
      • Steffen Heegaard, MD, DMSci

    To the Editor:
    We herein respond to the letter written by Camus et al raising the issue of “ultra-low” dose radiation therapy (4 Gy) vs. the “standard low-dose” radiation therapy (24-30 Gy) for lymphomas of the orbit, eyelid, and conjunctiva, also referred to as “ocular adnexal lymphoma” (OAL). First off, it is important to point out that the goals of the retrospective multicenter general review of marginal zone lymphoma coordinated by Professor Steffen Heegaard in Denmark which also included some of our patients from M. D. Anderson was not to compare the efficacy of various treatment strategies.(1) Indeed it is challenging to draw practice altering conclusions from a retrospective multi-center study given the usual limitations, most notably the variation in staging and treatment approaches across various continents as noted by Camus et al.

    However, we agree with Camus et al that our encouraging preliminary observations in 22 patients with OAL treated with ultra-low dose radiation therapy (4Gy) suggested a very good response rate (100% ORR:86% CR, 14%% PR) for B-cell orbital and ocular adnexal lymphomas;(2) as such we started a prospective trial of ultra-low dose radiation for ocular adnexal lymphoma patients at MD Anderson Cancer Center soon thereafter (Clinicaltrials.gov identifier NCT02494700)The study aims to evaluate the efficacy of response adapted radiation therapy for this patient population, whereby all patients are treated to an initial 4 Gy in...

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    Conflict of Interest:
    None declared.