Long-term follow-up results of observation or radiation for conjunctival malignant lymphoma

Purpose To elucidate the long-term prognosis of biopsy-proven malignant lymphoma of conjunctival origin after a treatment option of observation or radiation. Design Prospective noncomparative interventional case series. Participants Thirteen patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) of conjunctival origin. Methods In the 11-year period from 1992 to 2002, 13 consecutive patients (7 female and 6 male) with ages ranging from 32 to 68 years (mean, 57) who showed malignant lymphoma of conjunctival origin were enrolled in the study. Histopathological and immunohistochemical studies of biopsy specimens of the conjunctival lesions proved extranodal marginal zone B-cell lymphoma of MALT in all patients. At the initial visit, magnetic resonance imaging (MRI) showed no orbital tumors, and gallium scintigraphy demonstrated no systemic involvement. The patients chose observation or radiation after the biopsy. Main outcome measures Clinical disappearance of the conjunctival lymphoma lesions. Results Five patients chose 30-Gy radiation to the remaining conjunctival lesions after the biopsy, whereas the other 8 patients were simply observed without administration of any medication. During the follow-up, ranging from 1 to 11 years (mean, 5.4), 7 of these 8 patients without radiation showed spontaneous regression of the conjunctival lesions 1 to 5 years after the biopsy. Yearly MRI of the orbit and gallium scintigraphy disclosed no lesions in any of the patients. Conclusions A large fraction of patients with MALT lymphoma of conjunctival origin had spontaneous regression after the biopsy. Follow-up without radiation is an option for patients with MALT lymphoma of conjunctival origin after the pathologic diagnosis by biopsy.