What stage is bilateral orbital/conjunctival NHL (limited only to the bilateral orbit/conjunctiva)?

By the Ann Arbor staging system, this is stage IV disease because more than one extranodal site is involved at initial presentation. However, NCCN and other guidelines acknowledge that MALT lymphoma involving both paired organs (e.g., bilateral orbital/conjunctiva) is often best treated with RT alon...

By Ann Arbor staging IE (PMID 19653722) and would still favor definitive management with RT (PMID 24521680).