Abstract
Purpose :
Evaluating a new, comprehensive orbital lymphoma service. A prospective case series was carried out to evaluate the pathway and to identify common themes in orbital lymphoma
Methods :
20 patients (mean age 67 SD14.4; M:F 1:1). presented to ophthalmology over 2 years, were managed on a pathway involving MDT care across ophthalmology, haematology, pathology, oncology and radiotherapy. Baseline investigations included MRI orbits, half-body PET-CT scan, FBC, U&E, Calcium, LDH LFT, ESR, HIV, Hepatitis B&C, open orbital biopsy and bone marrow biopsy. Patients were recorded under AJCC v8 TNM for ocular adnexal lymphoma and Ann-Arbor (AA) staging systems. All patients were discussed at the weekly haematology-oncology MDT on confirmation of histological diagnosis. Those undergoing radiotherapy have an imaging response assessment at 3 months with subsequent long-term follow-up under joint haematology-ophthalmic care
Results :
The pathway was completed by 16 cases, 1 case was palliated prior to biopsy, 1 had a diagnostic pancreatic biopsy, 2 followed up elsewhere. Commonest presentation was ptosis (5), palpable mass (4), proptosis (3), conjunctival lesion (2) and epiphora (2). Two had contiguous, bilateral orbital disease. Histology: 11 EMZL, 4 DLBCL, 1 SLL. Bone marrow involvement in 1 EMZL and 1 DLBCL. Doxycycline had no effect on 2 conjunctival lesions. Mean time from biopsy to treatment (radiotherapy or chemotherapy) 61 days. Radiotherapy was given to 11 (4-30Gy). DBCL received 3 cycles of R-CHOP. 15 had radiologic remission with 1 contracted lesion considered remission
Conclusions :
A multi-disciplinary approach is essential in managing orbital lymphoma. Doxyxycline had no effect and higher doses of radiotherapy was required in some EMZL. Bone marrow biopsy is essential for staging. Having expertise within each area provides a comprehensive patient experience, however coordination between multiple sites and locations can pose difficulties in running a smooth and timely pathway
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.