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Follicular Lymphoma of the Skin: Different Therapies Similar Outcome
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Volume 90 Number 1S Supplement 2014 group, the 3-year rate for out-of-filed CNS recurrence was 25%.Late neurotoxicity of WBRT was encountered in two 65-year-old patients and in 4 patients less than 60 years of age. Two patients over 60 years old and a 58-year-old patient treated with PBRT developed treatment-related late neurotoxicity. Conclusions: PBRT seems to be a feasible treatment option for solitary PCNSL. Further investigations are needed to evaluate the superiority of PBRT over WBRT. Author Disclosure: M. Iwabuchi: None. C. Sugie: None. S. Ayakawa: None. F. Baba: None. H. Ogino: None. Y. Shibamoto: None.
3177 Definitive Radiation Therapy for Stage I and II Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma: Report of a Prospective Study B. Dabaja,1 C.C. Pinnix,2 N. Fowler,1 P. Allen,3 V. Reed,4 L.K. Ballas,4 P. Horace,3 M. Rodriguez,3 L. Nastoupil,3 L. Kwak,3 L. Medeiros,4 I. Arzu,1 and C.S. Ha5; 1University of Texas MD Anderson Cancer Center, Houston, TX, 2University of Texas MD Anderson Cancer Center, Houston, TX, 3University of Texas MD Anderson Cancer Center, Houston, TX, 4 University of Texas MD Anderson Cancer Center, Houston, TX, 5 University of Texas Health Science Center, San Antonio, TX Purpose/Objective(s): To determine the efficacy and toxicity of radiation therapy alone in treating stage I/II MALT lymphoma either at initial diagnosis or at recurrence after antibiotics or chemotherapy. Materials/Methods: 104 Patients with stage I/II disease (including bilateral orbital and salivary glands) were enrolled from January 2002 until December 2012. Patients had to have measurable disease. Skin lesions had to be encompassed within a radiation port. Pretreatment full staging was required including a bone marrow biopsy, upper and lower endoscopy. Complete remission (CR) was documented by disappearance of disease clinically and by imaging and laboratory studies. All patients were treated with an involved field radiation dose of 30-36 Gy (1.5 Gy per fraction); later protocol was amended to limit the dose to 30 Gy. Results: 104 patients were enrolled with 13 later opting out. The median age was 61 years (range 37-90) and 40 (44%) were male. Sites of presentation are detailed in table 1. Common sites were stomach (43%), orbital (21%), bilateral orbital (8%) and salivary glands (7%). Median follow up was 39 months (range 10-161). CR was achieved in 100 % of patients. Seven patients died, all unrelated to MALT lymphoma. The 10 year-disease specific and overall-survival rates were both 100%. Five patients recurred (1 infield). They were retreated with radiation and are in remission at last follow-up. Acute toxicity included grade 1/2 dermatitis and mucositis. No grade 3 toxicity was seen. Late toxicities were: grade 1 dry eye syndrome in 5/26 patients with orbital, acid reflux in 2/39 patients with gastric, and grade 1 xerostomia in 2/6 patients with salivary gland lymphoma. There was no difference in outcome by site of disease, age or gender. Conclusions: Early stage MALT lymphoma can be effectively and safely treated with radiation therapy alone with acceptable long-term side effects.
Scientific Abstract 3177; Table Site of presentation
Author Disclosure: B. Dabaja: None. C.C. Pinnix: None. N. Fowler: None. P. Allen: None. V. Reed: None. L.K. Ballas: None. P. Horace: None. M. Rodriguez: None. L. Nastoupil: None. L. kwak: None. L. Medeiros: None. I. Arzu: None. C.S. Ha: None.
3178 Follicular Lymphoma of the Skin: Different Therapies Similar Outcome B. Dabaja,1 F. Shihadeh,1 I. Arzu,1 C. Pinnix,1 P. Allen,1 L. Nastoupil,2 Y. Oki,2 L. Medeiros,3 M. Rodriguez,2 and N. Fowler2; 1Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 2University of Texas MD Anderson Cancer Center, Houston, TX, 3Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX Purpose/Objective(s): To investigate the clinical characteristics and outcome of patients presenting with follicular lymphoma involving skin either as primary skin disease or as part of a systemic involvement. Materials/Methods: This is a retrospective chart review of our tumor registry, approved by our institutional board, of 109 patients with follicular lymphoma of the skin. Fifty-five patients had primary skin disease and 52 had skin involvement associated systemic disease, and 2 patients’ details are not available. For the 52 patients with primary skin: 41 (79%) were males, median age is 57 (range 28-85), and 22 (42%) presented with a single skin lesion. Treatment consisted of: chemotherapy in 32 (62%), Rituximab alone in 4 (8%), radiation alone in 16 (31%), and radiation consolidation in 5(10%). With a median follow up of 40 months, 9/52 (17%) patients relapsed. The 5 and 10-years event free survival (EFS) of those with primary skin disease was 84% and 66 %; and Overall survival (OS) was 94% and 94 %, respectively. Patients with multiple skin lesions and compared to those with single lesions had an inferior EFS (53% versus 73%) and inferior OS (88% versus 100%). For the 55 patients with systemic disease there were 28 (51%) were males, median age is 60 (range 3285), and 34 (62%) presented with a single skin lesion. Treatment consisted of: chemotherapy in 41 (75%), Rituximab alone in 7 (13%), radiation given in 3 (1%), With a median follow up of 40 months, 26/55 (47%) patients relapsed. The 5 and 10-years event free survival (EFS) was 53% and 40 %; and overall survival (OS) was 91 % and 66 %, respectively. Conclusions: Patients with primary skin follicular lymphoma seems to carry an excellent outcome independent of the treatment modality.
Scientific Abstract 3178; Table Treated with Treated with Single combined Median Male skin, Treated with radiation modality alone Presentation N age (%) N (%) chemotherapy Primary skin 52 With systemic 55 disease
79 % 42% 51% 62%
62% 75%
31% 1%
10% 1%
Author Disclosure: B. Dabaja: None. F. Shihadeh: None. I. Arzu: None. C. Pinnix: None. P. Allen: None. L. Nastoupil: None. Y. Oki: None. L. Medeiros: None. M. Rodriguez: None. N. Fowler: None.
Sites of presentation and late effects Number (%)
Late toxicity (Number)
Unilateral/bilateral orbits
19 (21%)/7(8%)
Stomach Unilateral/bilateral salivary glands Thyroid Skin Head and neck: larynx/hard palate/tonsil Subcutaneous Lung/Brain Prostate/Breast
39 (43%) 4 (4%)/2(2%)
grade 1 dry eye syndrome (5) acid reflux (2) grade 1 xerostomia (2)
5(6%) 4(4%) 1(1%)/2(2%)/1(1%)
none none none
3(4%) 1(1%)/1(1%) 1(1%)/1(1%)
none none none
3179 The Role of Radiation Therapy in Localized Nongastric and Nonorbital Mucosa-Associated Lymphoid Tissue Lymphoma J. Lee, K. Kim, J. Cho, and C. Suh; Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea, Republic of Korea Purpose/Objective(s): Nongastric and nonorbital (NGNO) mucosaassociated lymphoid tissue (MALT) lymphoma is relatively rare and treatment modalities are diverse according to their original sites. In this study, we tried to elucidate the clinical feature, treatment outcome and the
Volume 90 Number 1S Supplement 2014 group, the 3-year rate for out-of-filed CNS recurrence was 25%.Late neurotoxicity of WBRT was encountered in two 65-year-old patients and in 4 patients less than 60 years of age. Two patients over 60 years old and a 58-year-old patient treated with PBRT developed treatment-related late neurotoxicity. Conclusions: PBRT seems to be a feasible treatment option for solitary PCNSL. Further investigations are needed to evaluate the superiority of PBRT over WBRT. Author Disclosure: M. Iwabuchi: None. C. Sugie: None. S. Ayakawa: None. F. Baba: None. H. Ogino: None. Y. Shibamoto: None.
3177 Definitive Radiation Therapy for Stage I and II Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma: Report of a Prospective Study B. Dabaja,1 C.C. Pinnix,2 N. Fowler,1 P. Allen,3 V. Reed,4 L.K. Ballas,4 P. Horace,3 M. Rodriguez,3 L. Nastoupil,3 L. Kwak,3 L. Medeiros,4 I. Arzu,1 and C.S. Ha5; 1University of Texas MD Anderson Cancer Center, Houston, TX, 2University of Texas MD Anderson Cancer Center, Houston, TX, 3University of Texas MD Anderson Cancer Center, Houston, TX, 4 University of Texas MD Anderson Cancer Center, Houston, TX, 5 University of Texas Health Science Center, San Antonio, TX Purpose/Objective(s): To determine the efficacy and toxicity of radiation therapy alone in treating stage I/II MALT lymphoma either at initial diagnosis or at recurrence after antibiotics or chemotherapy. Materials/Methods: 104 Patients with stage I/II disease (including bilateral orbital and salivary glands) were enrolled from January 2002 until December 2012. Patients had to have measurable disease. Skin lesions had to be encompassed within a radiation port. Pretreatment full staging was required including a bone marrow biopsy, upper and lower endoscopy. Complete remission (CR) was documented by disappearance of disease clinically and by imaging and laboratory studies. All patients were treated with an involved field radiation dose of 30-36 Gy (1.5 Gy per fraction); later protocol was amended to limit the dose to 30 Gy. Results: 104 patients were enrolled with 13 later opting out. The median age was 61 years (range 37-90) and 40 (44%) were male. Sites of presentation are detailed in table 1. Common sites were stomach (43%), orbital (21%), bilateral orbital (8%) and salivary glands (7%). Median follow up was 39 months (range 10-161). CR was achieved in 100 % of patients. Seven patients died, all unrelated to MALT lymphoma. The 10 year-disease specific and overall-survival rates were both 100%. Five patients recurred (1 infield). They were retreated with radiation and are in remission at last follow-up. Acute toxicity included grade 1/2 dermatitis and mucositis. No grade 3 toxicity was seen. Late toxicities were: grade 1 dry eye syndrome in 5/26 patients with orbital, acid reflux in 2/39 patients with gastric, and grade 1 xerostomia in 2/6 patients with salivary gland lymphoma. There was no difference in outcome by site of disease, age or gender. Conclusions: Early stage MALT lymphoma can be effectively and safely treated with radiation therapy alone with acceptable long-term side effects.
Scientific Abstract 3177; Table Site of presentation
Author Disclosure: B. Dabaja: None. C.C. Pinnix: None. N. Fowler: None. P. Allen: None. V. Reed: None. L.K. Ballas: None. P. Horace: None. M. Rodriguez: None. L. Nastoupil: None. L. kwak: None. L. Medeiros: None. I. Arzu: None. C.S. Ha: None.
3178 Follicular Lymphoma of the Skin: Different Therapies Similar Outcome B. Dabaja,1 F. Shihadeh,1 I. Arzu,1 C. Pinnix,1 P. Allen,1 L. Nastoupil,2 Y. Oki,2 L. Medeiros,3 M. Rodriguez,2 and N. Fowler2; 1Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 2University of Texas MD Anderson Cancer Center, Houston, TX, 3Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX Purpose/Objective(s): To investigate the clinical characteristics and outcome of patients presenting with follicular lymphoma involving skin either as primary skin disease or as part of a systemic involvement. Materials/Methods: This is a retrospective chart review of our tumor registry, approved by our institutional board, of 109 patients with follicular lymphoma of the skin. Fifty-five patients had primary skin disease and 52 had skin involvement associated systemic disease, and 2 patients’ details are not available. For the 52 patients with primary skin: 41 (79%) were males, median age is 57 (range 28-85), and 22 (42%) presented with a single skin lesion. Treatment consisted of: chemotherapy in 32 (62%), Rituximab alone in 4 (8%), radiation alone in 16 (31%), and radiation consolidation in 5(10%). With a median follow up of 40 months, 9/52 (17%) patients relapsed. The 5 and 10-years event free survival (EFS) of those with primary skin disease was 84% and 66 %; and Overall survival (OS) was 94% and 94 %, respectively. Patients with multiple skin lesions and compared to those with single lesions had an inferior EFS (53% versus 73%) and inferior OS (88% versus 100%). For the 55 patients with systemic disease there were 28 (51%) were males, median age is 60 (range 3285), and 34 (62%) presented with a single skin lesion. Treatment consisted of: chemotherapy in 41 (75%), Rituximab alone in 7 (13%), radiation given in 3 (1%), With a median follow up of 40 months, 26/55 (47%) patients relapsed. The 5 and 10-years event free survival (EFS) was 53% and 40 %; and overall survival (OS) was 91 % and 66 %, respectively. Conclusions: Patients with primary skin follicular lymphoma seems to carry an excellent outcome independent of the treatment modality.
Scientific Abstract 3178; Table Treated with Treated with Single combined Median Male skin, Treated with radiation modality alone Presentation N age (%) N (%) chemotherapy Primary skin 52 With systemic 55 disease
79 % 42% 51% 62%
62% 75%
31% 1%
10% 1%
Author Disclosure: B. Dabaja: None. F. Shihadeh: None. I. Arzu: None. C. Pinnix: None. P. Allen: None. L. Nastoupil: None. Y. Oki: None. L. Medeiros: None. M. Rodriguez: None. N. Fowler: None.
Sites of presentation and late effects Number (%)
Late toxicity (Number)
Unilateral/bilateral orbits
19 (21%)/7(8%)
Stomach Unilateral/bilateral salivary glands Thyroid Skin Head and neck: larynx/hard palate/tonsil Subcutaneous Lung/Brain Prostate/Breast
39 (43%) 4 (4%)/2(2%)
grade 1 dry eye syndrome (5) acid reflux (2) grade 1 xerostomia (2)
5(6%) 4(4%) 1(1%)/2(2%)/1(1%)
none none none
3(4%) 1(1%)/1(1%) 1(1%)/1(1%)
none none none
3179 The Role of Radiation Therapy in Localized Nongastric and Nonorbital Mucosa-Associated Lymphoid Tissue Lymphoma J. Lee, K. Kim, J. Cho, and C. Suh; Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea, Republic of Korea Purpose/Objective(s): Nongastric and nonorbital (NGNO) mucosaassociated lymphoid tissue (MALT) lymphoma is relatively rare and treatment modalities are diverse according to their original sites. In this study, we tried to elucidate the clinical feature, treatment outcome and the