Grujić Miloš, Volchenkov Stanislav, Akhmetali Aidos, Živković Radojević Marija, Milosavljević Neda, Janković Katarina, Krasić Katarina, Mihajlović Milica, Shelan Mohamed, Nicosia Luca, Marinković Mladen
Center for Radiation Oncology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia.
Department of Clinical Oncology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia.
Cancers (Basel). 2025 Aug 29;17(17):2845. doi: 10.3390/cancers17172845.
: Ultra-low-dose radiotherapy (ULD-RT), an ultra-low-dose regimen delivering 4 Gy in two fractions, has emerged as a promising treatment for indolent ocular adnexal lymphoma (OAL), offering disease control with minimal toxicity. However, the clinical outcomes and safety profile of ULD-RT remain inconsistently reported across studies. : We conducted a systematic review of peer-reviewed studies evaluating ULD-RT in patients with OAL, including prospective, retrospective, and comparative cohorts published between 2000 and 2025. A comprehensive search was performed in PubMed, Embase, and Scopus. Eligible studies reported clinical outcomes (e.g., response rates, local control, progression-free survival) and safety data (acute and late toxicities). Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). : Ten studies comprising 591 patients met the inclusion criteria. The overall response rate to ULD-RT ranged from 88% to 100%, with complete response rates of 50% to 95%. Local control rates ranged from 63% to 100%, and 2-year progression-free survival exceeded 85% in most studies. Importantly, no grade ≥ 3 toxicities were observed following the regimen of 4 Gy in two fractions. Acute toxicities occurred in up to 42% of patients, typically grade 1 dry eye or conjunctivitis. Late toxicities were uncommon (16-33%), with cataracts rarely requiring surgery. All included studies were rated as good quality (NOS score ≥ 7), indicating low risk of bias. : ULD-RT is a highly effective and safe treatment modality for OAL, providing excellent local control with a favorable toxicity profile. These findings support the adoption of ULD-RT as a first-line radiotherapy strategy for indolent OAL. Future prospective trials with longer follow-up and standardized toxicity reporting are warranted to confirm and refine its clinical role.
超低剂量放疗（ULD-RT）是一种超低剂量方案，分两次给予4 Gy，已成为惰性眼附属器淋巴瘤（OAL）的一种有前景的治疗方法，能在毒性最小的情况下实现疾病控制。然而，各研究对ULD-RT的临床结果和安全性的报道并不一致。
我们对评估OAL患者ULD-RT的同行评审研究进行了系统评价，包括2000年至2025年间发表的前瞻性、回顾性和比较队列研究。在PubMed、Embase和Scopus上进行了全面检索。符合条件的研究报告了临床结果（如缓解率、局部控制率、无进展生存期）和安全性数据（急性和晚期毒性）。使用纽卡斯尔-渥太华量表（NOS）评估方法学质量。
十项研究共591例患者符合纳入标准。ULD-RT的总体缓解率为88%至100%，完全缓解率为50%至95%。局部控制率为63%至100%，大多数研究中2年无进展生存期超过85%。重要的是，在分两次给予4 Gy的方案后，未观察到≥3级毒性反应。高达42%的患者出现急性毒性反应，通常为1级干眼症或结膜炎。晚期毒性反应不常见（16% - 33%），白内障很少需要手术。所有纳入研究均被评为高质量（NOS评分≥7），表明偏倚风险低。
ULD-RT是OAL的一种高效且安全的治疗方式，能提供良好的局部控制且毒性特征良好。这些发现支持将ULD-RT作为惰性OAL的一线放疗策略。未来需要进行更长随访时间和标准化毒性报告的前瞻性试验，以确认并完善其临床作用。
