- Email: [email protected]
Treatment of Primary Central Nervous System Lymphoma (PCNSL): Comparison Between Whole-Brain Radiation Therapy and Partial-Brain Radiation Therapy
S674
International Journal of Radiation Oncology Biology Physics
examining the difference in the cause specific survival between patients who received RT and those who did not in stage III classical HL in the Surveillance, Epidemiology, and End Results (SEER) database, which represents approximately 26% of the United States population. Materials/Methods: The SEER database was queried to identify patients with stage III classical HL between 2004 and 2010 when AJCC 6th and 7th edition were coded. We queried the following data: sex, age, subtype of lymphoma, presence of B symptoms, and treatment with RT. We also queried data on outcomes including duration of survival and cause of death. We separately analyzed adult patients between 18 - 75 years old, patients less than 18, and those greater than 75 years old, due to the unique treatment requirements of the pediatric and geriatric populations. A Kaplan-Meier analysis and the log-rank test were used to assess the statistical significance for survival. Results: A total of 3184 patients with classical Hodgkin lymphoma were identified from 2004 - 2010. The median age of diagnosis was 42 years, range (4 - 94 years). The median duration of follow-up was 30 months. In the adult non-geriatric population (18-75 years, median 42) 407 (16%) patients received RT and 2095 (82%) did not receive RT. In the pediatric population (4 - 17 years, median 15), 182 (60%) patients received RT and 117 (39%) did not receive RT. In the geriatric population (76-94 years, median 81), 20 (6%) received radiation therapy while 305 (92%) did not receive radiation therapy. The 5-year cause specific survival (CSS) for the adult non-geriatric population was 93.7% (92.3% - 95.1%) for patients who received RT and 87.5% (86.6% - 88.4%) for patients who did not receive RT (P Z 0.001). The 5-year CSS for the pediatric population was 100% for patients receiving RT and 93.1% (90.0% - 96.2%) for patients not receiving RT (P Z 0.003). The 5-year CSS for the geriatric population was 53.8% but only 6% received RT, precluding meaningful comparison between groups. Conclusions: Acknowledging the limitations of population-based studies in terms of selection bias, risk factors that lead to treatment decisions, and reporting accuracy, RT is associated with a significantly improved cause specific survival in patients with stage III classical HL based on the SEER database. This supports a cautionary approach to designing trials that intend to eliminate radiation therapy from treatment strategies for stage III classical Hodgkin lymphoma. Author Disclosure: A. Mazloom: None. D. Sughosh: None. L.S. Constine: None.
therapy. At a median follow-up of 25 months (3-88 months), 4 deaths and 32 disease relapses were observed within the entire cohort for a 5-year overall survival (OS) and disease-free survival (DFS) of 90% and 45% respectively. A significant difference was observed in the DFS between the two groups with the patients who received consolidative radiation therapy displaying an improved 5-year DFS of 66% versus 31% for the non-radiation therapy cohort (p Z 0.03). There was also a non-significant trend towards improved 5-year OS (100% vs 83%, p Z 0.11). Subgroup analysis revealed that the 5-year DFS was most improved among patients with B-symptoms (47% vs 0%, p Z 0.09), patients with primary refractory disease (46% vs 27%, p Z 0.06) and those with a complete response to pre-transplant therapy (83% vs 41%, p Z 0.06) although these did not reach statistical significance. Conclusions: Patients who underwent consolidative radiation therapy following high-dose chemotherapy and autologous stem cell transplantation had a significantly improved DFS compared to patients who did not receive post-transplant radiation therapy. Additional prospective studies would help to more fully define the role of consolidation radiation therapy in this group of patients. Author Disclosure: C.T. Wilke: None. J. Yuan: None. Q. Cao: None. A. Lazaryan: None. C. Lee: None. K. Dusenbery: None.
3175 Role of Consolidative Radiation Therapy Following Autologous Stem Cell Transplantation for Relapsed or Refractory Hodgkin Lymphoma C.T. Wilke, J. Yuan, Q. Cao, A. Lazaryan, C. Lee, and K. Dusenbery; University of Minnesota, Minneapolis, MN Purpose/Objective(s): In this study, we present results from our institution examining the role of consolidative radiation therapy in patients undergoing high-dose chemotherapy and autologous stem cell transplantation for relapsed or refractory Hodgkin lymphoma treated on a single protocol. Materials/Methods: A total of 68 patients underwent autologous stem cell transplantation for refractory or relapsed Hodgkin lymphoma between 11/ 2005 and 12/2012. Transplant conditioning consisted of CBV or BEAM chemotherapy. Consolidative radiation therapy was delivered to patients with persistent nodal masses of 2 cm on CT imaging day +28 following transplantation or at the discretion of the treating radiation oncologist. Of the 68 patients included in the current study, 25 received consolidation radiation. Results: The median age of the patients in the selected cohort was 30 years (5-71 years). Patients who underwent consolidation radiation were more likely to have had bulky disease on initial presentation (p Z 0.02), otherwise there was no statistical difference among the two groups in terms of initial stage of disease, presence of B-symptoms, previous IFRT or response to pre-transplant therapy. The median radiation therapy dose was 36 Gy (22.4-39.6 Gy) among the patients receiving consolidative radiation
3176 Treatment of Primary Central Nervous System Lymphoma (PCNSL): Comparison Between Whole-Brain Radiation Therapy and PartialBrain Radiation Therapy M. Iwabuchi,1 C. Sugie,1 S. Ayakawa,2 F. Baba,3 H. Ogino,4 and Y. Shibamoto1; 1Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 2Social Insurance Chukyo Hospital, Nagoya, Japan, 3Nagoya City West Medical Center, Nagoya, Japan, 4Nagoya Proton Therapy Center, Nagoya, Japan Purpose/Objective(s): High-dose methotrexate (MTX)-based chemotherapy and whole-brain radiation therapy (WBRT) is considered to be a treatment option to cure PCNSL patients younger than 60 years old. Elimination of WBRT is associated with a higher rate of relapse, but unacceptable delayed neurotoxicity after WBRT is a matter of concern. Before 2004, our group exclusively used WBRT in the treatment of PCNSL, but thereafter we have employed partial-brain radiation therapy (PBRT) with wide margins in patients with solitary PCNSL. Previously, we reported the feasibility of PBRT, and in the present study, we further evaluated the results of treatment for PCNSL patients, with special reference to WBRT versus PBRT. Materials/Methods: Between 1993 and 2013, 76 patients (median age, 63 years; range, 25-90) with histologically-confirmed PCNSL were treated with radiation therapy with or without chemotherapy. Sixty-one patients were treated with WBRT with or without a focal boost and 15 were treated by PBRT with approximately 4-cm margins from a tumor mass. Daily doses of 1.8-2 Gy were used for both WBRT and PBRT. Even when PBRT was employed, the radiation field was reduced after 3040 Gy to give a focal boost. The median patient age was 62 years (range, 25-90) in the WBRT group and 67 years (range, 49-78) in the PBRT group. Multiple tumors were seen in 30 of the 61 patients (49%) in the WBRT group and in 2 of the 15 patients (13%) in the PBRT group. Median maximum tumor diameter was 35 mm (range, 12-80) in the WBRT group and 37 mm (range, 12-60) in the PBRT group. Median dose was 50 Gy (range, 20-60) in the WBRT group and 50 Gy (range, 30.6-54) in the PBRT group. MTX-based chemotherapy was used in 15 of the 61 patients (25%) in the WBRT group and in 13 of the 15 patients (87%) in the PBRT group. Results: The response rate was 75% in the WBRT group and 93% in the PBRT group (P Z 0.11). The median survival time was 21 and 37 months, respectively, and the 3-year overall survival rate was 44% versus 38% (P Z 0.35). The 3-year CNS-recurrence rate was 48% in both groups (P Z 0.62). When only patients with a single lesion were analyzed, the rate was 57% and 51%,respectively (P Z 0.80). The 3-year extra-CNS-recurrence rate was 15% versus 10% (P Z 0.45).In the PBRT
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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
International Journal of Radiation Oncology Biology Physics
examining the difference in the cause specific survival between patients who received RT and those who did not in stage III classical HL in the Surveillance, Epidemiology, and End Results (SEER) database, which represents approximately 26% of the United States population. Materials/Methods: The SEER database was queried to identify patients with stage III classical HL between 2004 and 2010 when AJCC 6th and 7th edition were coded. We queried the following data: sex, age, subtype of lymphoma, presence of B symptoms, and treatment with RT. We also queried data on outcomes including duration of survival and cause of death. We separately analyzed adult patients between 18 - 75 years old, patients less than 18, and those greater than 75 years old, due to the unique treatment requirements of the pediatric and geriatric populations. A Kaplan-Meier analysis and the log-rank test were used to assess the statistical significance for survival. Results: A total of 3184 patients with classical Hodgkin lymphoma were identified from 2004 - 2010. The median age of diagnosis was 42 years, range (4 - 94 years). The median duration of follow-up was 30 months. In the adult non-geriatric population (18-75 years, median 42) 407 (16%) patients received RT and 2095 (82%) did not receive RT. In the pediatric population (4 - 17 years, median 15), 182 (60%) patients received RT and 117 (39%) did not receive RT. In the geriatric population (76-94 years, median 81), 20 (6%) received radiation therapy while 305 (92%) did not receive radiation therapy. The 5-year cause specific survival (CSS) for the adult non-geriatric population was 93.7% (92.3% - 95.1%) for patients who received RT and 87.5% (86.6% - 88.4%) for patients who did not receive RT (P Z 0.001). The 5-year CSS for the pediatric population was 100% for patients receiving RT and 93.1% (90.0% - 96.2%) for patients not receiving RT (P Z 0.003). The 5-year CSS for the geriatric population was 53.8% but only 6% received RT, precluding meaningful comparison between groups. Conclusions: Acknowledging the limitations of population-based studies in terms of selection bias, risk factors that lead to treatment decisions, and reporting accuracy, RT is associated with a significantly improved cause specific survival in patients with stage III classical HL based on the SEER database. This supports a cautionary approach to designing trials that intend to eliminate radiation therapy from treatment strategies for stage III classical Hodgkin lymphoma. Author Disclosure: A. Mazloom: None. D. Sughosh: None. L.S. Constine: None.
therapy. At a median follow-up of 25 months (3-88 months), 4 deaths and 32 disease relapses were observed within the entire cohort for a 5-year overall survival (OS) and disease-free survival (DFS) of 90% and 45% respectively. A significant difference was observed in the DFS between the two groups with the patients who received consolidative radiation therapy displaying an improved 5-year DFS of 66% versus 31% for the non-radiation therapy cohort (p Z 0.03). There was also a non-significant trend towards improved 5-year OS (100% vs 83%, p Z 0.11). Subgroup analysis revealed that the 5-year DFS was most improved among patients with B-symptoms (47% vs 0%, p Z 0.09), patients with primary refractory disease (46% vs 27%, p Z 0.06) and those with a complete response to pre-transplant therapy (83% vs 41%, p Z 0.06) although these did not reach statistical significance. Conclusions: Patients who underwent consolidative radiation therapy following high-dose chemotherapy and autologous stem cell transplantation had a significantly improved DFS compared to patients who did not receive post-transplant radiation therapy. Additional prospective studies would help to more fully define the role of consolidation radiation therapy in this group of patients. Author Disclosure: C.T. Wilke: None. J. Yuan: None. Q. Cao: None. A. Lazaryan: None. C. Lee: None. K. Dusenbery: None.
3175 Role of Consolidative Radiation Therapy Following Autologous Stem Cell Transplantation for Relapsed or Refractory Hodgkin Lymphoma C.T. Wilke, J. Yuan, Q. Cao, A. Lazaryan, C. Lee, and K. Dusenbery; University of Minnesota, Minneapolis, MN Purpose/Objective(s): In this study, we present results from our institution examining the role of consolidative radiation therapy in patients undergoing high-dose chemotherapy and autologous stem cell transplantation for relapsed or refractory Hodgkin lymphoma treated on a single protocol. Materials/Methods: A total of 68 patients underwent autologous stem cell transplantation for refractory or relapsed Hodgkin lymphoma between 11/ 2005 and 12/2012. Transplant conditioning consisted of CBV or BEAM chemotherapy. Consolidative radiation therapy was delivered to patients with persistent nodal masses of 2 cm on CT imaging day +28 following transplantation or at the discretion of the treating radiation oncologist. Of the 68 patients included in the current study, 25 received consolidation radiation. Results: The median age of the patients in the selected cohort was 30 years (5-71 years). Patients who underwent consolidation radiation were more likely to have had bulky disease on initial presentation (p Z 0.02), otherwise there was no statistical difference among the two groups in terms of initial stage of disease, presence of B-symptoms, previous IFRT or response to pre-transplant therapy. The median radiation therapy dose was 36 Gy (22.4-39.6 Gy) among the patients receiving consolidative radiation
3176 Treatment of Primary Central Nervous System Lymphoma (PCNSL): Comparison Between Whole-Brain Radiation Therapy and PartialBrain Radiation Therapy M. Iwabuchi,1 C. Sugie,1 S. Ayakawa,2 F. Baba,3 H. Ogino,4 and Y. Shibamoto1; 1Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 2Social Insurance Chukyo Hospital, Nagoya, Japan, 3Nagoya City West Medical Center, Nagoya, Japan, 4Nagoya Proton Therapy Center, Nagoya, Japan Purpose/Objective(s): High-dose methotrexate (MTX)-based chemotherapy and whole-brain radiation therapy (WBRT) is considered to be a treatment option to cure PCNSL patients younger than 60 years old. Elimination of WBRT is associated with a higher rate of relapse, but unacceptable delayed neurotoxicity after WBRT is a matter of concern. Before 2004, our group exclusively used WBRT in the treatment of PCNSL, but thereafter we have employed partial-brain radiation therapy (PBRT) with wide margins in patients with solitary PCNSL. Previously, we reported the feasibility of PBRT, and in the present study, we further evaluated the results of treatment for PCNSL patients, with special reference to WBRT versus PBRT. Materials/Methods: Between 1993 and 2013, 76 patients (median age, 63 years; range, 25-90) with histologically-confirmed PCNSL were treated with radiation therapy with or without chemotherapy. Sixty-one patients were treated with WBRT with or without a focal boost and 15 were treated by PBRT with approximately 4-cm margins from a tumor mass. Daily doses of 1.8-2 Gy were used for both WBRT and PBRT. Even when PBRT was employed, the radiation field was reduced after 3040 Gy to give a focal boost. The median patient age was 62 years (range, 25-90) in the WBRT group and 67 years (range, 49-78) in the PBRT group. Multiple tumors were seen in 30 of the 61 patients (49%) in the WBRT group and in 2 of the 15 patients (13%) in the PBRT group. Median maximum tumor diameter was 35 mm (range, 12-80) in the WBRT group and 37 mm (range, 12-60) in the PBRT group. Median dose was 50 Gy (range, 20-60) in the WBRT group and 50 Gy (range, 30.6-54) in the PBRT group. MTX-based chemotherapy was used in 15 of the 61 patients (25%) in the WBRT group and in 13 of the 15 patients (87%) in the PBRT group. Results: The response rate was 75% in the WBRT group and 93% in the PBRT group (P Z 0.11). The median survival time was 21 and 37 months, respectively, and the 3-year overall survival rate was 44% versus 38% (P Z 0.35). The 3-year CNS-recurrence rate was 48% in both groups (P Z 0.62). When only patients with a single lesion were analyzed, the rate was 57% and 51%,respectively (P Z 0.80). The 3-year extra-CNS-recurrence rate was 15% versus 10% (P Z 0.45).In the PBRT
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Poster Viewing Abstracts S675
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