S507
Clinical - Haemotology
ESTRO 2026
Digital Poster Highlight 1671 Ultra-low-dose radiotherapy for ocular adnexal lymphoma: a systematic review of clinical outcomes and safety Milos Grujic 1,2 , Stanislav Volchenkov 3 , Aidos Akhmetali 4 , Marija Zivkovic Radojevic 1,2 , Neda Milosavljevic 1,2 , Katarina Jankovic 2 , Katarina Krasic 2 , Milica Mihajlovic 5,6 , Mohamed Shelan 7 , Luca Nicosia 8 , Mladen Marinkovic 9,10 1 Department of Clinical Oncology, Faculty of Medical Sciences, Kragujevac, Serbia. 2 Center for Radiation Oncology, University Clinical Center Kragujevac, Kragujevac, Serbia. 3 Department of Hematology, National Medical Research Center of Oncology N.N. Petrov, St. Petersburg, Russian Federation. 4 Outpatient Care Department, Hematology Center LLP, Karaganda Medical University, Karaganda, Kazakhstan. 5 Faculty of Medicine, University of Nis, Nis, Serbia. 6 Clinic for Oncology, University Clinical Center Nis, Nis, Serbia. 7 Department of Radiation Oncology, Inselspital Bern, University of Bern, Bern, Switzerland. 8 Advanced Radiation Oncology Department, RCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Verona, Italy. 9 Faculty of Medicine, University of Belgrade, Belgrade, Serbia. 10 Clinic for Radiation Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia Purpose/Objective: Ocular adnexal lymphoma (OAL) represents a rare but radiosensitive malignancy in which local control must be achieved with minimal toxicity to critical visual structures. Conventional doses of 20–30 Gy provide excellent control but carry late ocular morbidity such as cataracts and dry eye [1,2]. Ultra-low-dose radiotherapy (ULD-RT, 4 Gy in two fractions) has emerged as a de-escalation approach demonstrating high responses in indolent lymphomas [3,4,5].We performed a systematic review and critical evidence synthesis to evaluate clinical outcomes, safety, and methodological quality of studies applying ULD-RT for OAL and to assess whether this regimen can be considered a new standard of care. Material/Methods: Following PRISMA guidelines, PubMed, Embase, and Scopus were searched (2000–2025) for prospective, retrospective, or comparative cohorts evaluating ULD- RT (4 Gy/2 fractions) in OAL. Extracted outcomes included response rates, local control (LC), progression-free survival (PFS), and acute/late toxicities (Common Terminology Criteria for Adverse Events, CTCAE v5.0). Study quality was assessed using the Newcastle–Ottawa Scale (NOS). This review was prospectively registered on Open Science Framework, OSF (osf.io/djxfb). Results:
evaluation is the gold standard for determining disease extent. Due to the superficial nature of the conjunctiva and its three distinct regions, radiologic imaging is often insufficient for accurate target volume delineation. Although several techniques advocating irradiation of the entire conjunctiva with lens shielding have been reported, no guideline exists for defining the optimal target volume. This study evaluated treatment outcomes and toxicity profiles in patients with CALT treated with radiotherapy (RT) following CTV delineation based on ophthalmologic mapping. Material/Methods: Twenty patients diagnosed between 2009 and 2024 were included in this study. All patients underwent ophthalmologic examination, biopsy, and ophthalmologic mapping performed by the same ophthalmologist, followed by staging and radiotherapy. Staging was based on the AJCC 7th edition system and included systemic evaluation with PET-CT, orbital MRI for intraorbital extension, and bone marrow biopsy. After digital photographic documentation at 1:1 magnification, the lesion location was mapped, and the CTV and personalized blocks were defined according to the lesion extent (see Figure). Radiotherapy was delivered using 6 MeV electrons at a dose of 1.8 Gy per fraction, to a total dose of 30 Gy. A custom-made electron block designed according to the ophthalmologic mapping was used for daily setup verification and treatment delivery. Results: Median patient age was 54.7 years (range, 10–82); all cases were marginal zone lymphoma. Ten (50%) were male. Stages were T1a (5%), T1b (55%), T1c (30%), and T2c (10%). Two patients (10%) had bilateral and 18 (90%) unilateral disease (13 right, 5 left). All achieved complete response. With a median follow-up of 58 months (range, 6–158), no local recurrences occurred, yielding a 5-year local control rate of 100%. Contralateral recurrences developed in two patients at 12 and 22 months, successfully re-treated with the same technique. One systemic relapse (pararenal mass) responded completely to chemotherapy. During RT, 12 patients developed grade 1–2 conjunctivitis and 8 had grade 1 radiodermatitis, all managed conservatively. Cataract occurred in 5 patients (25%) during follow-up. No keratitis or chronic dry eye was observed. At last follow-up, 18 patients were alive without disease; two had died of unrelated causes. Conclusion: CALT is a rare lymphoma subtype for which RT ensures excellent local control. Ophthalmologic mapping enables precise CTV delineation, achieving high efficacy and minimal toxicity. This approach represents a safe and effective strategy for conjunctival lymphomas. Keywords: electron, mapping, delineation
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