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Costa PA, Tse DT, Benedetto P. Neoadjuvant Intra-arterial Cytoreductive Chemotherapy Improves Outcomes in Lacrimal Gland Adenoid Cystic Carcinoma. Oncologist 2024; 29:263-269. [PMID: 38227581 PMCID: PMC10911902 DOI: 10.1093/oncolo/oyad346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/19/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Lacrimal gland adenoid cystic carcinoma (LGACC) has historically been associated with a poor prognosis even with localized disease, with a survival of 56% at 5 years. In 1988, we treated the first patient with neoadjuvant intra-arterial cytoreductive chemotherapy (IACC). Since then, we have used this protocol as the standard approach. We aim to analyze the outcomes of patients with LGACC treated with the protocol and compare them to a population-based cohort to assess if IACC can improve survival. METHODS We prospectively assessed all non-metastatic patients with LGACC treated with IACC at a single institution between 1988 and 2021. For a comparison group, we identified all non-metastatic patients with LGACC treated with excision from the Surveillance, Epidemiology, and End Results (SEER) registry. We calculated disease-specific survival using the Kaplan-Meier and Cox proportional-hazards modeling methods. RESULTS Thirty-five non-metastatic patients with LGACC treated with IACC were identified at a single institution, and 64 patients with non-metastatic LGACC treated with excision were identified in the SEER database. The 5- and 10-year disease-specific survival rates for patients treated with IACC were 84% (95%CI 71-97) and 76% (95%CI 60-92), respectively. While the 5- and 10-year disease-specific survival rates for the population-based cohort were 72% (95%CI 62-82) and 46% (95%CI 32-60). The survival analysis favored IACC, with a 60% lower risk of death (HR: 0.4; 95%CI 0.2-0.9). CONCLUSION IACC improves disease-specific survival in comparison to a population-based cohort treated with excision. Additional patients treated with IACC at multiple institutions are required to provide further external validity.
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Affiliation(s)
| | - David T Tse
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pasquale Benedetto
- Department of Medicine, Division of Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Shoji MK, Moeyersoms AHM, Wang Q, Gonzalez Hernandez L, Tang VD, Khzam RA, Dubovy SR, Pelaez D, Tse DT. Apoptotic Marker Expression of Resected Lacrimal Gland Adenoid Cystic Carcinoma Tumor Margins After Intra-arterial Chemotherapy and Globe-Sparing Excision. Ophthalmic Plast Reconstr Surg 2024; 40:206-211. [PMID: 37972978 DOI: 10.1097/iop.0000000000002548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE Lacrimal gland adenoid cystic carcinoma (LGACC) is a rare orbital malignancy with devastating lethality. Neoadjuvant intra-arterial chemotherapy (IACC) has demonstrated cytoreductive effects on LGACC macroscopically, but limited studies have examined cellular and molecular determinants of the cytoreductive effect. This post hoc study assessed apoptotic marker expression on excised tumor specimens after neoadjuvant IACC and globe-sparing resection, emphasizing the examination of tumor margins. METHODS This retrospective study identified LGACC specimens resected in a globe-sparing technique after neoadjuvant IACC by reviewing the Florida Lions Ocular Pathology database at Bascom Palmer Eye Institute. Histopathology slides of the specimens were re-examined to confirm the diagnosis and identify the tumor margin. Immunofluorescent staining was performed for apoptotic markers, including P53, cleaved caspase-3, cleaved PARP-1, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL). Positive expression was determined by comparison to the negative control. RESULTS Tumor specimens from 5 patients met inclusion criteria. All 5 cases were positive at the center and the margin for TUNEL, p53, and cleaved caspase-3. One case did not show positive expression of cleaved PARP-1 at the margin but was positive for the other apoptotic markers. CONCLUSIONS This post hoc study demonstrated positive staining for multiple apoptotic markers in post-IACC tumor specimens at the tumor center and margin. Apoptotic marker expression along the margins of post-treatment specimens is important, as it may offer surrogate information to speculate on the state of residual cancer cells adjacent to the excision margin inadvertently remaining in the orbit.
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Affiliation(s)
- Marissa K Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
- Department of Oculofacial Plastic and Orbital Surgery, Shiley Eye Institute, University of California San Diego, San Diego, California
| | - Acadia H M Moeyersoms
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Qikai Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | | | - Vincent D Tang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Rayan Abou Khzam
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Sander R Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Daniel Pelaez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - David T Tse
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
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Zhao Z, Frank SJ, Ning J, Zhao J, Jiang X, Wang XA, Schefler AC, Hanna E, Moreno A, Gunn B, Ferrarotto R, Esmaeli B. Visual outcome and ocular complications in patients with lacrimal gland carcinoma after eye-sparing surgery and adjuvant radiation therapy. Br J Ophthalmol 2023; 107:1914-1919. [PMID: 36229179 PMCID: PMC10097836 DOI: 10.1136/bjo-2022-321889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND We report visual outcomes and ocular complications in patients with lacrimal gland carcinoma who had eye-sparing surgery followed by radiotherapy. METHODS This review included consecutive patients with lacrimal gland carcinoma who underwent eye-sparing surgery and adjuvant radiotherapy or concurrent chemoradiation therapy between 2007 and 2018. Clinical data, including details of ophthalmological examinations and radiation treatment were reviewed. RESULTS The study included 23 patients, 15 males and 8 females, with median age 51 years. Twenty patients (87%) received intensity-modulated proton therapy; 3 (13%) received intensity-modulated radiotherapy. Nineteen patients (83%) received concurrent chemotherapy. After a median follow-up time of 37 months (range: 8-83), 13 patients (57%) had best-corrected visual acuity 20/40 or better, 3 (13%) had moderate vision loss (between 20/40 and 20/200) and 7 (30%) had severe vision loss (20/200 or worse). The most common ocular complications were dry eye disease (21 patients; 91%), radiation retinopathy (16; 70%) and cataract progression (11; 49%). Tumour crossing the orbital midline (p=0.014) and Hispanic ethnicity (p=0.014) were associated with increased risk of severe vision loss. The risk of radiation retinopathy was significantly different among the three racial groups; Hispanic patients (n=3) had the highest rate of retinopathy (p<0.001). Tumour size, initial T category and total prescribed radiation dose were not significantly associated with severe vision loss. CONCLUSION Eye-sparing surgery followed by adjuvant radiotherapy in patients with lacrimal gland carcinoma has a reasonable overall visual prognosis. Patients with tumours crossing the orbital midline and Hispanic patients have a higher risk of severe vision loss.
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Affiliation(s)
- Zhenyang Zhao
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven Jay Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jiawei Zhao
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xinyang Jiang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xin A Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Ehab Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy Moreno
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brandon Gunn
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bita Esmaeli
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Moeyersoms AHM, Gallo RA, Zhang MG, Stathias V, Maeng MM, Owens D, Abou Khzam R, Sayegh Y, Maza C, Dubovy SR, Tse DT, Pelaez D. Spatial Transcriptomics Identifies Expression Signatures Specific to Lacrimal Gland Adenoid Cystic Carcinoma Cells. Cancers (Basel) 2023; 15:3211. [PMID: 37370820 PMCID: PMC10296284 DOI: 10.3390/cancers15123211] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Although primary tumors of the lacrimal gland are rare, adenoid cystic carcinoma (ACC) is the most common and lethal epithelial lacrimal gland malignancy. Traditional management of lacrimal gland adenoid cystic carcinoma (LGACC) involves the removal of the eye and surrounding socket contents, followed by chemoradiation. Even with this radical treatment, the 10-year survival rate for LGACC is 20% given the propensity for recurrence and metastasis. Due to the rarity of LGACC, its pathobiology is not well-understood, leading to difficulties in diagnosis, treatment, and effective management. Here, we integrate bulk RNA sequencing (RNA-seq) and spatial transcriptomics to identify a specific LGACC gene signature that can inform novel targeted therapies. Of the 3499 differentially expressed genes identified by bulk RNA-seq, the results of our spatial transcriptomic analysis reveal 15 upregulated and 12 downregulated genes that specifically arise from LGACC cells, whereas fibroblasts, reactive fibrotic tissue, and nervous and skeletal muscle account for the remaining bulk RNA-seq signature. In light of the analysis, we identified a transitional state cell or stem cell cluster. The results of the pathway analysis identified the upregulation of PI3K-Akt signaling, IL-17 signaling, and multiple other cancer pathways. This study provides insights into the molecular and cellular landscape of LGACC, which can inform new, targeted therapies to improve patient outcomes.
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Affiliation(s)
- Acadia H M Moeyersoms
- Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Ryan A Gallo
- Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Michelle G Zhang
- Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Vasileios Stathias
- Department of Pharmacology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Michelle M Maeng
- Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT 06437, USA
| | - Dawn Owens
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL 33314, USA
| | - Rayan Abou Khzam
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Yoseph Sayegh
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Cynthia Maza
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Sander R Dubovy
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - David T Tse
- Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Daniel Pelaez
- Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, University of Miami, Miami, FL 33136, USA
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Liu R, Li J, Zhang X, Ge X, Ma J. Differences in clinical features and prognosis between orbit adenoid cystic carcinoma and adenocarcinoma: a study from the SEER 18 database. Tumori 2023; 109:61-70. [PMID: 35114870 DOI: 10.1177/03008916211070328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To analyze the differences in clinical features, treatment methods, prognosis, and etiological factors between lacrimal gland, adenoid cystic carcinoma (LGACC), and orbit adenocarcinoma. MATERIAL AND METHODS All cases of LGACC and orbit adenocarcinoma between 1975 and 2016 were obtained from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. RESULTS The 3-, 5-, and 10-year overall survival (OS) rates for 118 LGACC cases were 82.2%, 70.2%, and 51.7%, respectively. The 3-, 5-, and 10-year OS rates for 29 orbit adenocarcinoma cases were 76.3%, 51.2%, and 51.2%, respectively. There was no statistically significant difference in the overall survival rate between LGACC and adenocarcinoma (P=0.566). Univariate analysis showed that the proportion of deaths was higher with increased age and year of diagnosis in LGACC (P=0.010 and P=0.000), while the death rate was higher for poorly differentiated adenocarcinoma (P=0.020). The survival rate for LGACC was lower in patients ⩾60 years of age than in those <60 years of age (P=0.035). There was no significant difference in survival rate between adenocarcinoma patients ⩾60 years and <60 years old (P=0.102). There was no significant correlation between the degree of tumor differentiation and the survival rate for LGACC or adenocarcinoma (P=0.401 or P=0.098, respectively). CONCLUSION There is no significant difference in prognosis between LGACC and adenocarcinoma. The degree of tumor differentiation is not associated with prognosis for either LGACC or adenocarcinoma.
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Affiliation(s)
- Rui Liu
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xuan Zhang
- Department of Ophthalmology, Tai'an City Central Hospital, Shandong, China
| | - Xin Ge
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jianmin Ma
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Shah SA, Parikh L, Solanki R, Bhojani J, Gohil R. Lacrimal Gland Adenoid Cystic Carcinoma with High Grade Transformation: A Case Report and Current Concepts in Multi Modality Management. Indian J Otolaryngol Head Neck Surg 2022; 74:2599-2606. [PMID: 36452811 PMCID: PMC9702296 DOI: 10.1007/s12070-020-02277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 11/26/2022] Open
Abstract
Lacrimal gland adenoid cystic carcinoma (AdCC) is associated with an aggressive clinical course and grave prognosis. A high grade transformation within adenoid cystic carcinoma of lacrimal gland is a rare condition which is even more locally aggressive with frequent neck and distant metastasis. We present a case of left lacrimal gland adenoid cystic carcinoma with high grade transformation to adenocarcinoma NOS type presenting with orbital pain and proptosis. After thorough evaluation for locoregional and distant spread of the disease, the patient underwent left orbital exenteration with orbitectomy and neck dissection with free flap reconstruction. Patient received adjuvant radiation therapy and is presently disease free for last 6 months. A multi-modality management protocol involving surgery, radiotherapy and chemotherapy has been proposed for management of lacrimal gland AdCC with high grade transformation. We report the 4th case in the literature of lacrimal gland adenoid cystic carcinoma with high grade transformation.
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Affiliation(s)
- Siddharth A. Shah
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
| | - Loma Parikh
- Department of Histo-Pathology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat India
| | - Raghuvir Solanki
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
| | - Jatin Bhojani
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
| | - Raviraj Gohil
- Department of Surgical Oncology, Zydus Cancer Centre, Zydus Hospital, Ahmedabad, Gujarat 380054 India
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Ashok Kumar P, Wang D, Huang D, Paulraj S, Sivapiragasam A. Current Trends in the Management of Epithelial Lacrimal Gland Tumors: A Retrospective National Cancer Database Analysis. Cureus 2022; 14:e27109. [PMID: 36000118 PMCID: PMC9391612 DOI: 10.7759/cureus.27109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Lacrimal gland tumors are rare with data limited to very few large studies. Contemporary strategies like orbit sparing surgeries and neoadjuvant intraarterial chemotherapy remain controversial. Methods: This is a retrospective cohort analysis of epithelial lacrimal gland tumors from the 2004-2016 National Cancer Database. Patients were stratified based on the type of surgery (limited vs destructive) and various treatment modalities employed. Results: Squamous cell carcinoma (33.48%) and adenoid cystic carcinoma (29.45%) were the commonest histologies (N=669). Comparison of limited (46.33%) vs destructive procedures (53.11%) among 482 patients did not show any survival difference, nor the comparison between surgery vs ± chemotherapy vs ± radiotherapy among 472 patients. Conclusion: Squamous cell carcinoma and adenoid cystic carcinoma are the commonest types of lacrimal gland tumors seen in our study. Tumor spread from adjacent sites may have contributed to the higher percentage of squamous cell carcinomas seen. The type of surgery or chemoradiation use did not alter survival.
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Rose GE. Re: “Does Multimodal Treatment Improve Eye and Life Salvage in Adenoid Cystic Carcinoma of the Lacrimal Gland?”. Ophthalmic Plast Reconstr Surg 2022; 38:406-406. [DOI: 10.1097/iop.0000000000002211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tse DT, Benedetto PW, Tse BC, Feuer WJ. Neoadjuvant Intra-Arterial Cytoreductive Chemotherapy for Lacrimal Gland Adenoid Cystic Carcinoma: A Long-Term Follow-up Study of a Trimodal Strategy. Am J Ophthalmol 2022; 240:239-251. [PMID: 35381201 PMCID: PMC9396917 DOI: 10.1016/j.ajo.2022.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the therapeutic efficacy of integrating neoadjuvant chemotherapy with conventional bimodal therapies for lacrimal gland adenoid cystic carcinoma by providing an additional 8 years of follow-up data on the same cohort of patients whose cumulative 10-year disease-free survival outcomes were reported in 2013. DESIGN Non-randomized, retrospective, interventional case series. METHODS Nineteen consecutive patients treated with neoadjuvant intra-arterial cytoreductive chemotherapy (IACC), orbital exenteration, chemoradiotherapy, and adjuvant intravenous chemotherapy at a single institution were included. Analyses were undertaken of locoregional recurrences and distant metastases, disease-free survival time, TNM tumor stage at presentation, response to IACC, and prognostic impact of positive resection margins. The main outcome measures were overall survival, disease-free survival, disease relapse, positive tumor resection margins, and tumor stage at presentation. RESULTS Eight patients with an intact lacrimal artery (group 1), 7 with AJCC stage T4a-c, had significantly better overall survival (87.5% versus 14.3% at 15 years), disease-specific mortality, and recurrences (all < .001, log-rank test) than prior conventionally treated patients from the Bascom Palmer Eye Institute. Group 1 was superior to group 2, patients lacking an intact lacrimal artery, concerning overall survival (P = .042) and recurrence (P = .017), but with no significant difference in disease-specific mortality (P = .23). Group 2 was associated with a significantly lower cause-specific mortality than the institutional comparator group (P = .039). Prior tumor resection with lateral wall osteotomy and failure to adhere to all protocol elements were adverse prognostic factors for suboptimal outcomes. Positive tumor margins increased the risk of all-cause mortality 4.1 times (P = .036, stratified Cox proportional hazards regression) and disease-specific mortality 8.0 times (P = .043, stratified Cox proportional hazards regression) than a patient with negative margins. CONCLUSIONS Extended follow-up supplemented with AJCC staging data supports neoadjuvant IACC as an integral component of a trimodal treatment strategy in patients with an intact lacrimal artery. Protocol elements implemented as designed appear to have improved overall survival and decreased disease relapse in this cohort. This extended long-term IACC dataset suggests that a critical bar of at least 15 years of follow-up is appropriate for assessing the efficacy of current conventional and future globe-sparing bimodal therapies.
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Yu MD, Men CJ, Do H, Colevas AD, Lin JH, Egbert PR, Tse DT, Kossler AL. Genome Sequencing and Apoptotic Markers to Assess Treatment Response of Lacrimal Gland Adenoid Cystic Carcinoma to Intra-Arterial Cytoreductive Chemotherapy. Ophthalmic Plast Reconstr Surg 2022; 38:e44-e47. [PMID: 34798653 PMCID: PMC10838401 DOI: 10.1097/iop.0000000000002079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Adenoid cystic carcinoma of the lacrimal gland is an aggressive, malignant epithelial neoplasm. We report the case of a 30-year-old male with lacrimal gland adenoid cystic carcinoma treated with neoadjuvant intra-arterial chemotherapy through the internal carotid artery, followed by orbital exenteration and chemoradiation. Treatment response was evaluated using a novel combination of pre- and posttreatment genome sequencing coupled with immunohistochemical evaluation, which showed diffuse tumor apoptosis. A posttreatment decrease in variant allele frequency of the NOTCH1 mutation, and robust tumor cytoreduction on imaging, supports exploration of NOTCH1 analysis as a potential marker of cisplatin sensitivity. The use of genome sequencing and immunohistochemical evaluation could provide a more targeted therapeutic assessment of neoadjuvant intra-arterial chemotherapy in the management of lacrimal gland adenoid cystic carcinoma.
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Affiliation(s)
- Michael D. Yu
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, U.S.A
| | - Clara J. Men
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, U.S.A
| | - Huy Do
- Department of Interventional Neuroradiology, Stanford University, Stanford, California, U.S.A
| | - A. Dimitrios Colevas
- Department of Medicine (Oncology), Stanford University, Stanford, California, U.S.A
| | - Jonathan H. Lin
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, U.S.A
- Department of Pathology, Stanford University, Stanford, California, U.S.A
| | - Peter R. Egbert
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, U.S.A
- Department of Pathology, Stanford University, Stanford, California, U.S.A
| | - David T. Tse
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, U.S.A
| | - Andrea L. Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, U.S.A
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Maniar A, Saqi A, Troob SH, Belinsky I, Charles NC, Gobin YP, Marr BP. Targeted Neoadjuvant Intra-arterial Chemotherapy in Lacrimal Gland Adenoid Cystic Carcinoma: A Histological Correlation Using Apoptotic Tumor Markers. Ophthalmic Plast Reconstr Surg 2022; 38:e28-e33. [PMID: 34652309 DOI: 10.1097/iop.0000000000002071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neoadjuvant intra-arterial cytoreductive chemotherapy is used for the treatment of lacrimal gland adenoid cystic carcinomas (ACC) to improve outcomes in this condition with an otherwise dismal prognosis. We share our experience in the management of an advanced case of ACC using a novel, highly targeted intra-arterial cytoreductive chemotherapy delivery technique involving both the internal and external carotid circulation, with an attempt to correlate the effect histologically. Refinement of the chemotherapy delivery using the tumor's vascular anatomy and appropriate blood vessel selection may lead to future globe sparing procedures without compromising survival.
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Affiliation(s)
- Arpita Maniar
- Department of Ocular Oncology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
| | - Anjali Saqi
- Department of Pathology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
| | - Scott H Troob
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
| | - Irina Belinsky
- Department of Ophthalmology, New York University Langone Medical Center, New York, NY
| | - Norman C Charles
- Department of Pathology, New York University Langone Medical Center, New York, NY
| | - Y Pierre Gobin
- Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY
| | - Brian P Marr
- Department of Ocular Oncology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
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Manjandavida FP, Honavar SG, Murthy R, Das S, Vemuganti GK, Mulay K, Reddy VAP. Does Multimodal Treatment Improve Eye and Life Salvage in Adenoid Cystic Carcinoma of the Lacrimal Gland? Ophthalmic Plast Reconstr Surg 2021. [PMID: 34873122 DOI: 10.1097/IOP.0000000000002108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the efficacy of multimodal treatment in adenoid cystic carcinoma (ACC) of the lacrimal gland. METHODS A retrospective comparative case series of 40 consecutive patients with ACC of the lacrimal gland without systemic metastasis at the initial presentation and primarily managed by one of the 3 treatment protocols-surgery + external beam radiotherapy (EBRT) (group 1), surgery + EBRT + adjuvant chemotherapy (group 2), and neoadjuvant chemotherapy + surgery + EBRT + adjuvant chemotherapy (multimodal treatment) (group 3) at a tertiary care ocular oncology center. Local tumor control, eye salvage, and systemic metastasis were the primary outcome measures. RESULTS The age ranged from 11 to 72 (mean ± SD, 36 ± 13; median, 36) years with 26 (65%) male and 14 (35%) female patients. Twelve (30%) patients belonged to group 1, 8 (20%) to group 2, and 20 (50%) to group 3. Primary surgery included tumor excision in 36 (90%) and orbital exenteration in 4 (10%). Chemotherapy composed of cisplatin + 5 fluorouracil (5FU) for 6 cycles in 28 (70%) patients. Extended-field stereotactic EBRT with a dose of 5,000-6,000 cGy included the entire pretreatment extent of the tumor with a 10-mm margin all around, superior orbital fissure, inferior orbital fissure, cavernous sinus, and temporal fossa. Mean duration of follow up after completion of treatment was 58 ± 26 (range, 29-180; median, 60) months. In all, local tumor recurrence occurred in 10 (25%) patients at a mean of 38 ± 23 (range, 12-120; median, 24) months. Local tumor recurrence was noted in 5 (42%) patients in group 1, 2 (25%) in group 2, and 3 (15%) in group 3. Overall, eye salvage was possible in 34 (85%) patients, with visual acuity >20/40 in 28 (82%). Systemic metastasis occurred in 10 (25%) patients at a mean of 53 ± 28 (range, 12-120; median, 43) months. Eight (67%) patients in group 1, 1 (13%) in group 2, and 1 (5%) in group 3 developed systemic metastasis. Six (15%) overall, 5 (42%) in group 1 and 1 (13%) in group 2, died with systemic metastasis. CONCLUSIONS Multimodal treatment with sequential neoadjuvant chemotherapy, followed by surgery, extended-field stereotactic EBRT, and adjuvant chemotherapy seems relatively more effective in providing local tumor control and eye salvage and in minimizing the risk of systemic metastasis in ACC of the lacrimal gland.
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Anjum S, Sen S, Pushker N, Bajaj MS, Kashyap S, Bakhshi S, Chosdol K, Meel R, Sharma MC. Prognostic impact of Notch1 receptor and clinicopathological High-Risk Predictors in lacrimal gland adenoid cystic carcinoma. Acta Ophthalmol 2021; 99:e1467-e1473. [PMID: 33675181 DOI: 10.1111/aos.14812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 02/02/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Adenoid Cystic Carcinoma (ACC) is an aggressive malignant lacrimal gland tumour associated with poor prognosis. Aberrant Notch signalling has been investigated in various tumours. However, very few studies on Notch signalling in lacrimal gland ACC are reported. The aim of the present study was to evaluate the status of Notch1 receptor and activated Notch1 (NICD1) in lacrimal gland ACC and to correlate it with high-risk clinicopathological features. METHODS A total of 23 cases of histopathologically proven lacrimal gland ACC, who underwent surgical treatment, were included in this study. Expression of Notch1 receptor and NICD1 was evaluated by immunohistochemistry on formalin fixed paraffin embedded tissues. The results obtained were correlated with clinicopathological high-risk features and survival of the patients. Kaplan-Meier survival and multivariate analysis was performed to determine the prognostic significance. RESULTS Overexpression of Notch1 receptor and NICD1 was observed in 65% and 39% of lacrimal gland ACC cases, respectively. On Kaplan-Meier survival analysis, patients with Notch1 receptor overexpression had reduced disease free survival. On univariate analysis, male gender, bone erosion, perineural invasion, solid histologic pattern, intracranial extension and advanced tumour stage were also indicators of poor prognosis. On multivariate analysis bone erosion was the most significant poor prognostic indicator. CONCLUSION Our study demonstrates that overexpression of Notch1 receptor plays a critical role in the biology and aggressive behaviour of lacrimal gland ACC. Bone erosion, solid histologic pattern, advanced T stage, perineural invasion and intracranial extension are other high-risk clinicopathological predictors of lacrimal gland ACC.
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Affiliation(s)
- Shahzan Anjum
- Department of Ocular Pathology Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Seema Sen
- Department of Ocular Pathology Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Neelam Pushker
- Department of Ophthalmology Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Mandeep Singh Bajaj
- Department of Ophthalmology Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Seema Kashyap
- Department of Ocular Pathology Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Sameer Bakhshi
- Department of Medical Oncology Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital All India Institute of Medical Sciences New Delhi India
| | - Kunzang Chosdol
- Department of Biochemistry All India Institute of Medical Sciences New Delhi India
| | - Rachna Meel
- Department of Ophthalmology Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi India
| | - Mehar Chand Sharma
- Department of Pathology All India Institute of Medical Sciences New Delhi India
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Guo J, Li Z, Qu X, Xian J. Value of MRI-based radiomics analysis for differentiation of benign and malignant epithelial neoplasms in the lacrimal gland: a retrospective study. Acta Radiol 2021; 62:743-751. [PMID: 32660315 DOI: 10.1177/0284185120940258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND It is essential to distinguish malignant from benign epithelial neoplasms in the lacrimal gland for different treatment options and prognosis. PURPOSE To retrospectively assess the performance of magnetic resonance imaging (MRI)-based radiomics features in the differentiation of benign and malignant epithelial neoplasms in the lacrimal gland. MATERIAL AND METHODS Seventy-six consecutive patients with histopathology-proven epithelial neoplasms of the lacrimal gland were enrolled in the study, including 41 benign and 35 malignant neoplasms. Radiomics features were extracted from T2-weighted and post-contrast T1-weighted imaging. The least absolute shrinkage and selection operator method was used to select imaging features and reduce data dimension to discriminate malignant from benign neoplasms in the lacrimal gland. Diagnostic performance of the radiomics model was assessed by receive operation characteristic (ROC) curve and compared with that of radiologists. RESULTS Four quantitative image features including inverse difference moment normalized (IDMN), mean deviation (MD), standard deviation (SD), and long-run emphasis (LRE) were selected to distinguish malignant from benign epithelial neoplasms in the lacrimal gland. Area under the curve (AUC) of these four features were 0.88, 086, 0.88, and 0.86, respectively, with 0.93 for the combination model. The model identified malignant epithelial neoplasms from benign group with 89% sensitivity, 93% specificity, and 89% accuracy. There was a significant difference in the diagnostic performance of radiomics model and the radiologists, with AUC of 0.70 for radiologists. The diagnostic performance of radiomics is superior to that of radiologists. CONCLUSION MRI-based radiomics analysis has potential for differentiation of benign and malignant epithelial neoplasms in the lacrimal gland.
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Affiliation(s)
- Jian Guo
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, PR China
| | - Zheng Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, PR China
| | - Xiaoxia Qu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, PR China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
- Clinical Center for Eye Tumors, Capital Medical University, Beijing, PR China
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Ford JR, Rubin ML, Frank SJ, Ning J, Debnam JM, Bell D, El-Naggar A, Ferrarotto R, Esmaeli B. Prognostic factors for local recurrence and survival and impact of local treatments on survival in lacrimal gland carcinoma. Br J Ophthalmol 2021; 105:768-774. [PMID: 32680839 DOI: 10.1136/bjophthalmol-2020-316142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To identify prognostic factors for local recurrence, distant metastasis and disease-specific survival (DSS) for lacrimal gland carcinoma. METHODS All consecutive patients with lacrimal gland carcinoma treated from January 1998 through December 2018 were included. Log-rank tests and univariate Cox proportional hazards regression models were used to study risk factors and survival. RESULTS Overall, 55 patients were included in this study, and 5 patients were excluded from the survival analysis. Median age was 46 years (range: 10-76). 43 patients (78%) had adenoid cystic carcinoma (ACC). 31 patients (56%) had T2 disease at presentation. 28 patients (51%) underwent orbital exenteration with or without adjuvant radiotherapy or chemoradiation, 26 (47%) underwent eye-sparing surgery with or without adjuvant radiotherapy or chemoradiation, and 1 received palliative chemoradiation. 11 patients (22%) experienced local recurrence; 14 (29%) experienced distant metastasis. Five- and 10-year local-recurrence-free survival rates were 0.71 (95% CI 0.58 to 0.88), and 5- and 10-year distant-metastasis-free survival rates were 0.67 (95% CI 0.53 to 0.85) and 0.49 (95% CI 0.30 to 0.81), respectively. There was no significant difference in risks of local recurrence, distant metastasis or DSS between ACC patients who had orbital exenteration and those who had eye-sparing surgery. Perineural invasion was negatively associated with local-recurrence-free survival (p=0.02). Among patients with ACC, basaloid/solid histologic type was associated with significantly worse DSS than non-basaloid/solid histologic type (p<0.01). CONCLUSIONS For lacrimal gland carcinoma, orbital exenteration with adjuvant therapy and eye-sparing surgery with adjuvant therapy are associated with similar recurrence outcomes. Eye-sparing surgery is associated with better DSS. Perineural invasion is a risk factor for local recurrence. ACC with basaloid/solid subtype correlates with worse DSS.
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Affiliation(s)
- Joshua Richard Ford
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Maria Laura Rubin
- Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Steven Jay Frank
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Ning
- Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Diana Bell
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adel El-Naggar
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bita Esmaeli
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Herranz-torrubiano AM, Berzal-cantalejo MF, Cuenca-gonzález C. TUMOR DE GLÁNDULA LACRIMAL: A PROPÓSITO DE UN CASO. Revista Médica Clínica Las Condes 2021; 32:359-63. [DOI: 10.1016/j.rmclc.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Liao SD, Erickson BP, Kapila N, Dubovy SR, Tse DT. Histopathologic Observations of Eyes in Exenterated Orbits After Neoadjuvant Intra-Arterial Cytoreductive Chemotherapy for Adenoid Cystic Carcinoma of the Lacrimal Gland. Ophthalmic Plast Reconstr Surg 2021; 37:274-279. [PMID: 32890114 PMCID: PMC7904959 DOI: 10.1097/iop.0000000000001808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess whether exenteration specimens obtained after neoadjuvant intra-arterial cytoreductive chemotherapy (IACC) for adenoid cystic carcinoma of the lacrimal gland demonstrate significant ocular histopathologic alterations that might preclude future pursuit of globe-preserving therapy. METHODS Retrospective histopathologic analysis of globes in IACC-treated exenteration specimens among the same cohort of patients whose survival outcomes have been reported. RESULTS Twenty patients had specimens available. Nineteen globes revealed no abnormalities of the iris, ciliary body, lens, retinal pigment epithelium, choroid, or chorioretinal vasculature. Eighteen globes showed no optic nerve abnormalities. One globe from a patient who refused exenteration until adenoid cystic carcinoma recurrence supervened demonstrated optic nerve edema with a peripapillary hemorrhage and cotton wool spot, as well as hemorrhage and necrosis within an extraocular muscle. Eighteen globes showed no retinal abnormalities attributable to intra-arterial chemotherapy. Three globes showed incidental retinal findings: 2 globes contained 1 to 2 small peripheral retinal hemorrhages and 1 had a pigmented retinal hole. Seven demonstrated mild, chronic extraocular muscle inflammation, and 13 had unremarkable musculature. The single patient who received IACC via the internal carotid rather than the external carotid artery developed ophthalmic artery occlusion with orbital apex syndrome prior to exenteration, and diffuse necrosis and hemorrhage were evident histopathologically. CONCLUSIONS Neoadjuvant IACC does not cause significant histopathologic damage to key ocular structures or compromise visual function in patients receiving intra-arterial chemotherapy through the external carotid artery. However, delivering chemotherapy through the internal carotid artery may result in visually significant thrombotic vascular events. The generally benign histopathological findings in these exenteration specimens support the concept of IACC delivery through the external carotid system as the cornerstone of a future globe-preserving strategy for lacrimal gland adenoid cystic carcinoma.
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Affiliation(s)
- Sophie D. Liao
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Colorado School of Medicine
| | - Benjamin P. Erickson
- Division of Oculoplastic Surgery, Department of Ophthalmology, Stanford University
| | - Neha Kapila
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Miami Miller School of Medicine
| | - Sander R. Dubovy
- Florida Lions Ocular Pathology Laboratory, Department of Ophthalmology, University of Miami Miller School of Medicine
| | - David T. Tse
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Miami Miller School of Medicine
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Liu R, Shi JT, Ge X, Yang BT, Zhang H, Zhang JX, Ma JM. Similar therapeutic effects of 125I seed radiotherapy and γ-ray radiotherapy on lacrimal gland adenoid cystic carcinoma. Int J Ophthalmol 2021; 14:547-553. [PMID: 33875946 DOI: 10.18240/ijo.2021.04.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the survival outcomes of patients with lacrimal gland adenoid cystic carcinoma who underwent eye-sparing surgery combined with 125I seed implantation radiotherapy or local external γ-ray radiotherapy. METHODS In this retrospective comparative case series, the clinical records of 27 primary and 8 recurrent patients were reviewed. Univariate and multivariate analyses were used to identify risk factors associated with distant metastasis (DM), and the overall survival (OS) after the initial surgery was analyzed. RESULTS The median follow-up after radiotherapy was 36mo (range 6-120mo). At the last follow-up after radiotherapy, 26 (74.3%) patients had no evidence of disease, 7 (20%) patients had DM, 2 (5.9%) patients died of DM, and 1 patient with DM was lost to follow-up. Univariate analyses showed that duration of symptoms, bone destruction, T stage classification, and wide excision surgery were risk factors influencing DM (P<0.05). The 5-year and 10-year OS rates after the initial surgery were 95.8% and 79.9%, respectively. The 5-year DM-free survival and disease-free survival rates after radiotherapy were 66.4% and 52.7%, respectively. CONCLUSION 125I seed radiotherapy and local external γ-ray radiotherapy may have similar therapeutic effects in preventing DM. Patients with T1/T2 stage disease have a better prognosis than those with T3/T4 stage disease.
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Affiliation(s)
- Rui Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Ji-Tong Shi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Xin Ge
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Ben-Tao Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Hong Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Jing-Xue Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Jian-Min Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
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Abstract
Lacrimal gland lesions account for approximately 9 to 10% of all biopsied orbital masses. Potential causes include nongranulomatous and granulomatous inflammation, autoimmune disease, lymphoproliferative disorders, benign epithelial proliferation, malignant neoplasia, and metastatic disease. Inflammatory lesions and lymphoproliferative disorders are the most common and may be unilateral or bilateral; they may also be localized to the orbit or associated with systemic disease. Both benign and malignant epithelial lacrimal gland masses tend to be unilateral and involve the orbital lobe, but a more rapid onset of symptoms and periorbital pain strongly suggest malignant disease. On orbital imaging, both inflammatory and lymphoproliferative lesions conform to the globe and surrounding structures, without changes in adjacent bone, whereas epithelial lacrimal gland masses often show scalloping of the lacrimal gland fossa. Malignant epithelial lacrimal gland tumors can also have radiographic evidence of bony invasion and destruction. Masses of the lacrimal gland may be due to a broad range of pathologies, and a good working knowledge of common clinical characteristics and radiographic imaging findings is essential for diagnosis and treatment. All patients with inflammatory, lymphoproliferative, and epithelial neoplastic lesions involving the lacrimal gland require long-term surveillance for disease recurrence and progression.
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Affiliation(s)
- Jane S Kim
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
| | - Jason Liss
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
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Wolkow N, Jakobiec FA, Afrogheh AH, Kidd M, Eagle RC, Pai SI, Faquin WC. PD-L1 and PD-L2 Expression Levels Are Low in Primary and Secondary Adenoid Cystic Carcinomas of the Orbit: Therapeutic Implications. Ophthalmic Plast Reconstr Surg 2021; 36:444-450. [PMID: 31990894 PMCID: PMC7423458 DOI: 10.1097/iop.0000000000001585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine if there is a biologic rationale for using checkpoint inhibitor drugs targeting programmed cell death ligand 1 (PD-L1) and PD-L2 in the treatment of adenoid cystic carcinoma of the orbit. METHODS Twenty-three cases of adenoid cystic carcinoma involving the orbit (13 primary lacrimal gland, 5 secondarily extending into the orbit, and 5 unspecified) were examined histopathologically. Immunohistochemistry for PD-L1, PD-L2, and CD8 was performed. Charts were reviewed for clinical correlations. RESULTS Expression of PD-L1 and of PD-L2 was overall low in adenoid cystic carcinoma (mean expression 1.4 ± 0.9 of 5 for PD-L1, mean 0.83 ± 1.1 of 5 for PD-L2), and tumor-infiltrating CD8-positive T-lymphocytes were sparse (mean 1.1 ± 0.51 of 3). Only 13 of the 23 (57%) cases expressed PD-L1 as a combined positive score ≥1 of cells. No associations were found between expression levels of these markers and patient sex, tumor site of origin, Tumor, Node, Metastasis stage, or patient outcome. A significant association was observed between stromal PD-L1 expression and tumor histopathologic subtype (p = 0.05), and between tumor PD-L1 expression and prior exposure to radiation (p = 0.03). CONCLUSIONS Checkpoint inhibitor drugs may have limited impact in the treatment and clinical course of orbital adenoid cystic carcinoma based on the low frequency of CD8 infiltrate and low expression of PD-L1 and PD-L2. Pretreatment with radiation, however, may improve tumor response to checkpoint inhibitor drugs.
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Affiliation(s)
- Natalie Wolkow
- David G. Cogan Ophthalmic Pathology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
- Ophthalmic Plastic and Reconstructive Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Frederick A. Jakobiec
- David G. Cogan Ophthalmic Pathology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Amir H. Afrogheh
- Department of Oral and Maxillofacial Pathology, National Health Laboratory Service, University of the Western Cape, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Department of Statistics and Actuarial Sciences, University of Stellenbosch, Stellenbosch, South Africa
| | - Ralph C. Eagle
- Department of Ophthalmic Pathology, Wills Eye Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Sara I. Pai
- Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - William C. Faquin
- Division of Head and Neck Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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Abstract
Objective Primary orbital malignancy is rare. Awareness of the characteristic clinical and imaging features is imperative for timely identification and management. Surgery remains an important diagnostic and treatment modality for primary orbital malignancy, but determining the optimal surgical approach can be challenging. The purpose of this article is to explore recent advances in the diagnosis, management, and surgical approaches for primary orbital malignancies. Design In this review, the clinical presentation, imaging features, and medical and surgical management of primary orbital malignancies with representative cases will be discussed. Setting Outpatient and inpatient hospital settings. Participants Patients with diagnosed primary orbital malignancies. Main Outcome Measures Descriptive outcomes. Results Advancements in orbital imaging, microsurgical techniques, and multimodal therapy have improved the diagnosis and management of primary orbital malignancies. Special considerations for biopsy or resection are made based on the tumor's location, characteristics, nearby orbital structures, and goals of surgery. Minimally invasive techniques are supplanting traditional approaches to orbital surgery with less morbidity. Conclusions Advances in imaging technologies and surgical techniques have facilitated the diagnosis and management of primary orbital malignancies. Evolution toward less invasive orbital surgery with focus on preservation and restoration of function is underway.
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Affiliation(s)
- Jacquelyn Laplant
- Department of Ophthalmology, Tulane University, New Orleans, Louisiana, United States
| | - Kimberly Cockerham
- Stanford Department of Ophthalmology, Byers Eye Institute, Palo Alto, California, United States
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Martel A, Baillif S, Nahon-Esteve S, Gastaud L, Bertolotto C, Lassalle S, Lagier J, Hamedani M, Poissonnet G. Orbital exenteration: an updated review with perspectives. Surv Ophthalmol 2021; 66:856-876. [PMID: 33524457 DOI: 10.1016/j.survophthal.2021.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 01/15/2023]
Abstract
Orbital exenteration is a radical and disfiguring surgery mainly performed in specialized tertiary care centers. Orbital exenteration has long been considered the treatment of choice for managing periocular tumors invading the orbit or primary orbital malignancies. Over the past decades, attention has been directed toward reducing the perioperative morbidity by developing new surgical devices and new strategies and promoting cosmetic rehabilitation by providing adequate facial prostheses. Despite these advances, several studies have questioned the role of orbital exenteration in improving overall survival. The last decade has been marked by the emergence of a new paradigm: the "eye-sparing" strategies based on conservative surgery with or without adjuvant radiotherapy and/or targeted therapies and immunotherapies. We summarize the data on orbital exenteration, including epidemiology, etiologies, use of surgical ablative and reconstructive techniques, complications, outcomes, and the related controversies.
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Affiliation(s)
- Arnaud Martel
- Université Côte d'Azur, Ophthalmology department, Centre Hospitalier Universitaire de Nice, Nice, France.
| | - Stephanie Baillif
- Université Côte d'Azur, Ophthalmology department, University Hospital of Nice, Nice, France
| | - Sacha Nahon-Esteve
- Université Côte d'Azur, Ophthalmology department, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Lauris Gastaud
- Oncology department, Antoine Lacassagne Cancer Centre, Nice, France
| | | | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology and Biobank BB-0033-00025, Nice, France
| | - Jacques Lagier
- Université Côte d'Azur, Ophthalmology department, University Hospital of Nice, Nice, France
| | - Mehrad Hamedani
- Oculoplastic department, Jules Gonin Eye hospital, Lausanne, Switzerland
| | - Gilles Poissonnet
- Cervico-facial department, Institut Universitaire de la Face et du Cou, Nice, France
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Abstract
Proptosis, the protrusion of the eyeball from the orbit, results from a wide variety of pathologies that can be vision- or life-threatening. Clinical history, associated physical exam findings, and imaging features are all crucial in establishing the underlying etiology. The differential diagnosis is broad, and includes infectious, inflammatory, vascular, and neoplastic entities that range from benign and indolent, to malignant and aggressive. While treatment varies significantly based on the disease process, all are aimed at preserving vision, salvaging the globe, preventing disfigurement, and reducing mortality. Both internists and general ophthalmologists should be familiar with the causes of proptosis in order to initiate the work-up for, and appropriately triage, affected patients.
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Affiliation(s)
- Nicole J Topilow
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Ann Q Tran
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Eubee B Koo
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Chrisfouad R Alabiad
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
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Lesueur P, Rapeaud E, De Marzi L, Goudjil F, Levy C, Galatoire O, Jacomet PV, Dendale R, Calugaru V. Adenoid Cystic Carcinoma of the Lacrimal Gland: High Dose Adjuvant Proton Therapy to Improve Patients Outcomes. Front Oncol 2020; 10:135. [PMID: 32133287 PMCID: PMC7041626 DOI: 10.3389/fonc.2020.00135] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction: Lacrymal cystic adenoid carcinoma is a rare disease for which optimal treatment is still debated. In fact, despite aggressive treatment such as eye sparing surgery or orbital exenteration, following by adjuvant radiotherapy, local recurrence and distant metastatic disease are common. This study aims to describe outcomes of eye surgery associated with high dose exclusive adjuvant proton beam irradiation. Materials and Methods: This is a monocentric institutional retrospective study. We retrospectively reviewed records of patients treated in our institution since 2008 with high dose adjuvant proton irradiation for a lacrymal cystic adenoid carcinoma up to a maximum of 75.6Gy(RBE). Other histologies or patients treated with a mix of photon-proton were excluded. A total of 15 patients were finally included. Results: Fifteen patients (80% women, 100% Performance status 0-1) with locally advanced disease (33% T3-T4, 47% R1-R2) were included. After a median follow-up of 67.4 months [13.4-122] the 3 years Overall Survival, local Progression free survival, and progression free survival rates were 78, 70, and 58%, respectively. Six patients exhibited a local recurrence. All patients with conservative surgery maintained their base-line visual acuity and visual field at last follow up. Four patients developed brain radionecrosis. Conclusion: This is the largest series of patients with ACC treated with high dose adjuvant proton therapy. Proton therapy is a safe and efficient treatment and should be considered as an adjuvant irradiation modality to privilege, for patients with lacrimal ACC after conservative or radical eyeball surgery. Dose delivered to temporal lobe should be limited to avoid brain radionecrosis.
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Affiliation(s)
- Paul Lesueur
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France.,Radiation Oncology Department, Institut Curie, Paris, France.,Radiation Oncology Department, Centre François Baclesse, Caen, France.,Normandy University, Université de Caen Basse Normandie, Caen, France
| | - Etienne Rapeaud
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France.,Radiation Oncology Department, Institut Curie, Paris, France.,Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - Ludovic De Marzi
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France
| | - Farid Goudjil
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France
| | | | - Olivier Galatoire
- Ophtalmology Service, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | - Rémi Dendale
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France.,Radiation Oncology Department, Institut Curie, Paris, France
| | - Valentin Calugaru
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France.,Radiation Oncology Department, Institut Curie, Paris, France
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Bonavolontà P, Esmaeli B, Donna P, Tranfa F, Iuliano A, Abbate V, Fossataro F, Attanasi F, Bonavolontà G. Outcomes after eye‐sparing surgery vs orbital exenteration in patients with lacrimal gland carcinoma. Head Neck 2020; 42:988-993. [DOI: 10.1002/hed.26073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/10/2019] [Accepted: 12/31/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Paola Bonavolontà
- Department of Neuroscience Reproductive Sciences and Odontostomatology, Maxillofacial Surgery Section, Federico II University of Naples Naples Italy
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery The University of Texas MD Anderson Cancer Center Houston Texas
| | - Piero Donna
- Department of Neuroscience Reproductive Sciences and Odontostomatology, Ophthalmology Section, Federico II University of Naples Naples Italy
| | - Fausto Tranfa
- Department of Neuroscience Reproductive Sciences and Odontostomatology, Ophthalmology Section, Federico II University of Naples Naples Italy
| | - Adriana Iuliano
- Department of Neuroscience Reproductive Sciences and Odontostomatology, Ophthalmology Section, Federico II University of Naples Naples Italy
| | - Vincenzo Abbate
- Department of Neuroscience Reproductive Sciences and Odontostomatology, Maxillofacial Surgery Section, Federico II University of Naples Naples Italy
| | - Federica Fossataro
- Department of Neuroscience Reproductive Sciences and Odontostomatology, Ophthalmology Section, Federico II University of Naples Naples Italy
| | - Federica Attanasi
- Statistical Science Department, School of Statistic Science University of Rome “La Sapienza” Rome Italy
| | - Giulio Bonavolontà
- Department of Neuroscience Reproductive Sciences and Odontostomatology, Ophthalmology Section, Federico II University of Naples Naples Italy
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Rose GE, Gore SK, Plowman NP. Cranio-orbital Resection Does Not Appear to Improve Survival of Patients With Lacrimal Gland Carcinoma. Ophthalmic Plast Reconstr Surg 2019; 35:77-84. [PMID: 30130333 DOI: 10.1097/IOP.0000000000001177] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To ascertain long-term outcome of treatment for primary epithelial malignancies of the lacrimal gland and compare outcomes after cranio-orbital resection or after macroscopic tumor resection with radiotherapy. METHODS Comparative case series of 79 patients (49 male; 62%) treated for primary epithelial malignancies of the lacrimal gland at Moorfields Eye Hospital between 1972 and 2014. Patients were identified from clinical and pathological databases and, where available, the clinical, pathological, and imaging records reviewed. The primary outcome measures were overall survival after diagnosis, disease-free survival, and final visual acuity for patients having cranio-orbital resection (exenteration plus local bone removal), compared with macroscopic tumor resection plus radiotherapy. RESULTS The mean age at presentation was 48 years (median: 50 years; range: 13-84 years), with 53 (67%) having adenoid cystic carcinoma, 15 (19%), primary adenocarcinoma, and 11 (14%) carcinoma ex-pleomorphic adenoma (malignant mixed tumor). The overall survival probability of the cohort (79 patients) was 0.59 at 5 years and 0.52 at 10 years, with 36/79 (46%) patients suffering tumor-related deaths; 14 patients died from other causes, and 4 patients were lost to follow up after the minimum follow-up period. The probability of disease-free survival at 5 years for patients with adenoid cystic carcinoma, adenocarcinoma, and malignant mixed tumor was 0.52, 0.4, and 0.64, respectively, with the comparable figures at 10 years being 0.44, 0.40, and 0.64. Most importantly, the 9 patients undergoing cranio-orbital resection and the 44 having solely macroscopic tumor resection plus radiotherapy had similar overall survival (p = 0.59) and disease-free survival (p = 0.89). Subgroup analysis of the 2 treatment modalities for patients with adenoid cystic carcinoma (8 cranio-orbital resection and 32 debulking and radiotherapy) demonstrated similar results for disease-free survival (p = 0.87). Likewise, there were no significant differences between rates of recurrences between the 2 different treatments. For the 50 patients who had eye-preserving surgery and long-term visual acuity data, the final acuity was better or equal to 0.6 logMAR (6/24 Snellen) in 25 (50%). DISCUSSION There is no difference in either survival or tumor recurrence for lacrimal gland carcinoma treated with cranio-orbital resection, or eye-preserving tumor excision and radiotherapy. The authors, therefore, continue to advocate local resection and radiotherapy for almost all patients with primary epithelial malignancies of the lacrimal gland-this treatment having lower morbidity, causing less disfigurement, and, importantly, preserving useful vision in most patients.
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Hung J, Wei Y, Huang C, Chen L, Fuh C, Liao S. Survival outcomes of eye-sparing surgery for adenoid cystic carcinoma of lacrimal gland. Jpn J Ophthalmol 2019; 63:344-351. [DOI: 10.1007/s10384-019-00671-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Yang J, Zhou C, Wang Y, Fan X, Jia R. Multimodal therapy in the management of lacrimal gland adenoid cystic carcinoma. BMC Ophthalmol 2019; 19:125. [PMID: 31176360 PMCID: PMC6556222 DOI: 10.1186/s12886-019-1110-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 04/22/2019] [Indexed: 12/03/2022] Open
Abstract
Background To evaluate the prognosis of Chinese patients with lacrimal gland adenoid cystic carcinoma treated with eye-sparing surgery and adjuvant multimodal therapy. Methods The study included 24 consecutive patients with lacrimal gland adenoid cystic carcinoma treated at the Ninth People’s Hospital of Shanghai from May 2008 to September 2017. All patients underwent eye-sparing surgical tumor resection and 20 (83.3%) of the 24 patients in the cohort received postoperative RT. Eight (41.7%) patients in the cohort received chemotherapy. Each patient’s medical records were reviewed. Results The study included 13 male and 11 female patients. The median follow-up time after surgery was 33.5 months. Fifteen (62.5%) patients experienced local recurrence. The 1-, 3-, and 5-year recurrence rates were 27.9, 60.0, and 80.0%, respectively. Eleven (45.8%) patients developed metastasis. The 1-, 3-, and 5-year metastasis rates were 8.7, 48.5, and 66.9%, respectively. Eight (33.3%) patients died of lacrimal gland adenoid cystic carcinoma, with a median survival duration of 34.0 months. The 1-, 3-, and 5-year tumor-related mortality was 4.5, 28.1, and 58.0%, respectively. More advanced T stage (≥ T3a) was a risk factor for local recurrence (hazard ratio [HR]: 5.374, P = 0.02), distant metastasis (HR: 8.585, P < 0.01), and tumor-related survival (HR: 9.654, P < 0.01). Conclusions Eye-sparing tumor resection protocol followed by adjuvant therapy seems to be associated with high rates of local recurrence, metastases and death. In addition, greater attention should be paid to patients with lacrimal gland adenoid cystic carcinoma with ≥ T3a tumors.
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Affiliation(s)
- Jie Yang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Chuandi Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yefei Wang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
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Hung JY, Wei YH, Huang CH, Chen LW, Fuh CS, Liao SL. Survival outcomes of eye-sparing surgery for adenoid cystic carcinoma of lacrimal gland. Jpn J Ophthalmol 2019; 63:344-351. [PMID: 31134459 DOI: 10.1007/s10384-019-00671-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/23/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To survey adenoid cystic carcinoma of lacrimal glands in Asian population and investigate the predictability in prognosis following the 8th edition American Joint Committee on Cancer (AJCC) staging guideline. STUDY DESIGN Retrospective study. METHODS The clinical entities and surgical outcomes of the patients who were histologically confirmed with a diagnosis of lacrimal adenoid cystic carcinoma in National Taiwan University Hospital between January 1995 and December 2015 were retrospectively reviewed. RESULTS Enrolled were 11 patients. The median follow-up was 7.2 years. Eight patients (72.7%) were diagnosed as T1 or T2 disease, and three patients (27.3%) were diagnosed as T3 or T4 disease according to the AJCC 8th edition guideline. Eye-sparing surgery with radiotherapy was performed in nine patients. Local recurrence was noted in six patients (54.5%) with median disease-free interval of 23.5 months. Six patients (54.5%) developed distant metastases, including lung, bone, and cranial invasions. Overall survival rate during the study period was 54.6%. Five-year overall survival was 81.8% and ten-year overall survival was 68.2%. The Log-rank test for overall survival and disease-free survival between patients with less than T3 disease (p=0.001) and patients with T3 or T4 disease (p=0.006) revealed significant differences. CONCLUSION This study highlighted the aggressive nature of adenoid cystic carcinoma of lacrimal glands. Eye-sparing surgery with adjunctive radiotherapy may achieve relatively optimal disease control in diseases staged T1 or T2, but in advanced disease metastasis and mortality are usually inevitable.
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Affiliation(s)
- Ju-Yi Hung
- Department of Ophthalmology, Taipei Medical University Hospital, No. 252, Wuxing St, Xinyi District, Taipei City, Taiwan.,Department of Computer Science and Information Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei City, Taiwan
| | - Yi-Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zongzheng Dist., Taipei City, Taiwan
| | - Chu-Hsuan Huang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zongzheng Dist., Taipei City, Taiwan
| | - Lily-Wei Chen
- College of Medicine, University of Massachusetts, Boston, USA.,University of Massachusetts, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Chiou-Shann Fuh
- Department of Computer Science and Information Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei City, Taiwan
| | - Shu-Lang Liao
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zongzheng Dist., Taipei City, Taiwan. .,College of Medicine, National Taiwan University, No. 1, Jen Ai Road, Section 1, Taipei City, Taiwan.
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Bowen RC, Ko HC, Avey GD, Hartig GK, Hu R, Harari PM, Lucarelli MJ. Personalized Treatment for Lacrimal Sac Adenoid Cystic Carcinoma: Case Report and Literature Review. Pract Radiat Oncol 2019; 9:136-141. [DOI: 10.1016/j.prro.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/23/2019] [Accepted: 01/27/2019] [Indexed: 11/15/2022]
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Schwartz TM, Rogg JM, Griffith RC, Migliori ME. Adenoid cystic carcinoma presenting with bilateral orbital extension from the soft palate. Digit J Ophthalmol 2019; 24:1-5. [PMID: 30800005 DOI: 10.5693/djo.02.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Adenoid cystic carcinoma (ACC) is a rare neoplasm of secretory epithelium that most commonly occurs in the fifth and sixth decades of life. It is characterized by high recurrence rates and poor response to chemotherapy, In the orbit, ACC usually presents as a lacrimal gland mass. We describe the rare case of a 70-year-old woman who presented with pain during mastication and bilateral facial numbness in the cranial nerve V2 distribution. She was found to have adenoid cystic carcinoma involving the orbits bilaterally without lacrimal gland involvement and without a clear primary tumor. Imaging suggested that the tumor arose from the soft palate by extension along cranial nerves V2 and V3. The patient was treated with radiation therapy with some degree of radiographic improvement 27 months after diagnosis. This case emphasizes the importance of considering adenoid cystic carcinoma when evaluating orbital tumors sparing the lacrimal gland. We also suggest the possibility of an oropharyngeal source with anterograde intracranial extension in cases of putative primary orbital ACC without lacrimal gland involvement.
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Affiliation(s)
- Tayler M Schwartz
- Warren Alpert Medical School of Brown University, Providence Rhode Island
| | - Jeffrey M Rogg
- Department of Radiology, Rhode Island Hospital, Providence, Rhode Island
| | - Rogers C Griffith
- Department of Pathology, Rhode Island Hospital, Providence Rhode Island
| | - Michael E Migliori
- Department of Ophthalmology, Rhode Island Hospital, Providence, Rhode Island
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Doddapaneni R, Tao W, Naranjo A, Nikpoor N, Tse DT, Pelaez D. Fibroblast growth factor receptor 1 (FGFR1) as a therapeutic target in adenoid cystic carcinoma of the lacrimal gland. Oncotarget 2019; 10:480-493. [PMID: 30728899 PMCID: PMC6355187 DOI: 10.18632/oncotarget.26558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/20/2018] [Indexed: 11/25/2022] Open
Abstract
Identification of molecular targets is the first step in developing efficacious therapeutic strategies for tumors. A tumors' biological response to perturbagens yields important information on the molecular determinants for tumor growth. The aim of this study was to characterize the response of adenoid cystic carcinoma of the lacrimal gland (LGACC) to intra-arterial cytoreductive chemotherapy (IACC) in order to identify novel targets to enhance therapy. We performed high-throughput proteomic analysis on paired samples from pre-IACC diagnostic biopsies and post-IACC excised tumor samples from 6 LGACC patients. This proteomic analysis provides a comprehensive landscape of the cellular compartments contained within the excised tumors. Interestingly, we found a strong upregulation across the fibroblast growth factor (FGF) signaling pathway, with FGF receptor 1 (FGFR1) exhibiting a consistent and significant upregulation in all post-IACC samples. We thus evaluated the therapeutic efficacy of a novel FGFR1 selective inhibitor, AZD4547, in combination with cisplatin on LGACC cells in-vitro. The combination index (CI) value (<0.895) demonstrated synergistic effect of AZD4547 and cisplatin in inhibiting cell growth and viability (p<0.02), with a differential response seen in post-IACC cultures when compared to pre-IACC cultures. The combination approach showed synergy of the drugs in the migration assay. Western blot analysis indicated a significant upregulation of cleaved caspase-3 and downregulation the expression of FGFR1 (p<0.05) with the combination treatment as compared to either agent independently. Our findings demonstrate that FGFR1 inhibition potentiates the cytoreductive effects of cisplatin and suggest a potential therapeutic benefit of using AZD4547 in the management of LGACC.
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Affiliation(s)
- Ravi Doddapaneni
- Dr. Nasser Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Wensi Tao
- Dr. Nasser Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Andrea Naranjo
- Dr. Nasser Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Neda Nikpoor
- Dr. Nasser Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - David T Tse
- Dr. Nasser Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Daniel Pelaez
- Dr. Nasser Al-Rashid Orbital Vision Research Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Cell Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Wolkow N, Jakobiec FA, Lee H, Sutula FC. Long-term Outcomes of Globe-Preserving Surgery With Proton Beam Radiation for Adenoid Cystic Carcinoma of the Lacrimal Gland. Am J Ophthalmol 2018; 195:43-62. [PMID: 30071211 DOI: 10.1016/j.ajo.2018.07.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE To describe outcomes of globe-preserving surgery combined with high-dose proton beam radiation (PBR) in treating primary adenoid cystic carcinoma (ACC) of the lacrimal gland. DESIGN Retrospective case series. METHODS Twenty-nine patients with primary ACC of the lacrimal gland were identified in the records of a single institution between 1990 and 2017. Patients with nonorbital primary tumor origins or with inadequate follow-ups were excluded. Eighteen patients met inclusion criteria. Clinical data, imaging studies, histopathology, treatment modality, local recurrences, visual outcomes, metastases, and survivals were assessed. Disease-free survivals for the current patients were measured and compared to those of other studies. RESULTS The eighteen patients (14 female, 4 male) were followed for a median of 12.9 years (range 0.6-22.3 years) after treatment completion. Their median age was 40 years. Four were children (median age 12 years). All were treated with globe-preserving tumor resection and radiation (median dose of 72 cobalt gray equivalents). Three adult patients died of metastatic disease (median of 4.2 years after treatment). Four had local recurrences. Useful vision (20/40 or better) was retained for a median 3 years (range 1-12.9 years). Radiation morbidity included brain injury, retinopathy, optic neuropathy, keratopathy, and cataract. Overall and disease-free survivals were significantly better compared to historical treatments, but did not differ statistically from other modern approaches. CONCLUSIONS Globe-preserving surgery with PBR, although imperfect, has a favorable long-term survival compared to other modern modalities, and offers a variable period of useful vision.
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Affiliation(s)
- Natalie Wolkow
- David Glendenning Cogan Ophthalmic Pathology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and the Harvard Medical School, Boston, Massachusetts, USA
| | - Frederick A Jakobiec
- David Glendenning Cogan Ophthalmic Pathology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and the Harvard Medical School, Boston, Massachusetts, USA.
| | - Hang Lee
- Biostatistics Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Francis C Sutula
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and the Harvard Medical School, Boston, Massachusetts, USA; Sutula Eye Associates, Milton, Massachusetts, USA
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Abstract
PURPOSE OF REVIEW The goal of this article is to review the key clinical and radiological features, treatment strategies, and prognosis of lacrimal gland tumors. RECENT FINDINGS Debulking of the orbital lobe of the lacrimal gland may offer improved control rates in dacryoadenitis without compromise of tear film function. Contrary to previous belief, careful biopsy of the lacrimal gland prior to excision does not appear to increase the risk of recurrence in cases with suspected pleomorphic adenoma. Low-dose radiation (4 Gy) in two 2-Gy fractions appears to be effective and well tolerated in indolent non-Hodgkin lymphoma of the ocular adnexa with high local control rate. Eye-sparing surgery for adenoid cystic carcinoma (ACC) leaving minimal or no tumor residual in the orbit followed by adjuvant radiation therapy or chemoradiotherapy may provide good local control and long-term survival outcomes. Intra-arterial chemotherapy has been found to decrease recurrence and improve survival in ACC and can also be used as part of an eye-sparing treatment strategy. The development of targeted drugs may offer palliation for patients with unresectable or metastatic disease in lacrimal gland carcinoma. SUMMARY This article offers an update on diagnosis, management, and prognosis of the major lacrimal gland lesions.
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Affiliation(s)
- Simon Andreasen
- Department of Otorhinolaryngology and Maxillofacial Surgery; Zealand University Hospital; Køge Denmark
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Noh JM, Lee E, Ahn YC, Oh D, Kim YD, Woo KI, Ko YH, Kim S. Clinical significance of post-surgical residual tumor burden and radiation therapy in treating patients with lacrimal adenoid cystic carcinoma. Oncotarget 2018; 7:60639-60646. [PMID: 27372060 PMCID: PMC5312407 DOI: 10.18632/oncotarget.10259] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/13/2016] [Indexed: 11/25/2022] Open
Abstract
Retrospective analyses were done on 19 lacrimal adenoid cystic carcinoma (ACC) patients who underwent curative treatment between 1997 and 2013. Nine patients (47.4%) had T1-2 disease and ten (52.6%) had T4 disease. Surgical procedures were globe-preserving tumor resection in 11 patients (57.9%), incisional biopsy in five (26.3%), and orbital exenteration was undertaken in three (15.8%). Residual tumor burdens were R0/1 in 12 patients (63.2%) and R2 in seven (36.8%). Radiation therapy (RT) was recommended to all patients, and 16 (84.2%) completed RT (median 60 Gy). After median follow-up of 57.5 months, seven (36.8%) developed progression and three (15.8%) died. Local recurrence occurred in four patients (21.1%), distant metastasis in one (5.3%), and combined local recurrence and distant metastasis in two (10.5%). Progression-free survival and overall survival rates at 5-years were 64.5% and 82.6%, respectively. Among 12 patients following R0/1 resection, two (16.7%) developed local recurrence and none died, while among seven following R2 resection, five (71.4%) developed progression and three (42.9%) died. RT following R0/R1 resection could reduce progression. Globe-preserving surgery and RT seemed optimal strategy for T1-2 disease. Careful attention should to be paid to minimize residual tumor burden at surgery and effort for safe radiation dose escalation would be desired.
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Affiliation(s)
- Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eonju Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seokhwi Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Han J, Kim Y, Woo KI, Sobti D. Long-Term Outcomes of Eye-Sparing Surgery for Adenoid Cystic Carcinoma of Lacrimal Gland. Ophthalmic Plast Reconstr Surg 2018; 34:74-8. [DOI: 10.1097/iop.0000000000000877] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sant DW, Tao W, Field MG, Pelaez D, Jin K, Capobianco A, Dubovy SR, Tse DT, Wang G. Whole Exome Sequencing of Lacrimal Gland Adenoid Cystic Carcinoma. Invest Ophthalmol Vis Sci 2017; 58:BIO240-BIO246. [PMID: 28820917 PMCID: PMC5562266 DOI: 10.1167/iovs.16-21097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose To identify genomic mutations in lacrimal gland adenoid cystic carcinoma (LGACC) samples from patients. Methods Genomic DNA was extracted from LGACC specimens. Whole exome sequencing (exome-seq) was conducted to screen for mutations. Capillary sequencing was performed to verify mutations in genes shared by multiple samples. Luciferase assays were used to evaluate functional consequences of NOTCH1 mutations. Results The mutation profile of LGACC was complicated. The most frequently mutated gene observed (28.6%) was bromodomain PHD finger transcription factor (BPTF). No mutation was identified in common cancer genes such as TP53, KRAS, and BRAF. However, mutations predicted to be functionally severe were accumulated in the Notch signaling pathway including NOTCH1 and NOTCH2, of which mutations have been reported in head/neck adenoid cystic carcinoma (ACC). Of 14 LGACC samples, five samples carry mutations in Notch pathway genes. Capillary sequencing verified all the mutations in the two NOTCH genes identified by exome-seq. Compared to the wild-type NOTCH1, three frame shifting mutations and two missense mutations (C387W and L1600Q) increased luciferase activity approximately 10- to 25-fold. Conclusions Major genomic mutation profiles in LGACC were uncovered by exome-seq. Although preliminary in nature, the Notch pathway could be a potential therapeutic target for LGACC.
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Affiliation(s)
- David W Sant
- John P. Hussman Institute for Human Genomics, Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Wensi Tao
- Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Center, University of Miami Miller School of Medicine, Miami, Florida, United States.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Matthew G Field
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Daniel Pelaez
- Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Center, University of Miami Miller School of Medicine, Miami, Florida, United States.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ke Jin
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Anthony Capobianco
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - David T Tse
- Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Center, University of Miami Miller School of Medicine, Miami, Florida, United States.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Gaofeng Wang
- John P. Hussman Institute for Human Genomics, Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, United States.,Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Center, University of Miami Miller School of Medicine, Miami, Florida, United States.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
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Dorbandt DM, Lundberg AP, Roady PJ, Huey JA, Phillips H, Hamor RE. Surgical excision of a feline orbital lacrimal gland adenocarcinoma with adjunctive cryotherapy and carboplatin-impregnated bead implantation. Vet Ophthalmol 2017; 21:419-425. [DOI: 10.1111/vop.12501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel M. Dorbandt
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
| | - Alycen P. Lundberg
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
| | - Patrick J. Roady
- Veterinary Diagnostic Laboratory; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 2001 S. Lincoln Avenue Urbana IL 61802 USA
| | - Jane A. Huey
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
- Memphis Veterinary Specialists; 555 Trinity Creek Cove Cordova TN 38018 USA
| | - Heidi Phillips
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
| | - Ralph E. Hamor
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
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Abstract
Adenoid cystic carcinoma (ACC) of the lacrimal gland is an aggressive, malignant epithelial neoplasm. This tumor is rarely seen in adults and even less commonly seen in children and adolescents; thus, there have been no large studies to date describing the optimal treatment of this malignancy in the pediatric population. Here, we report a case of lacrimal gland ACC in a 14-year-old male treated with neoadjuvant intra-arterial chemotherapy followed by globe-sparing tumor resection and chemoradiation. At 2-year follow-up, he remains disease free without evidence of tumor recurrence.
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Affiliation(s)
- Michelle M Falcone
- a Bascom Palmer Eye Institute , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Kimberly D Tran
- a Bascom Palmer Eye Institute , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Mehdi Tavakoli
- a Bascom Palmer Eye Institute , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Daniel F Ortiz
- b Pediatric Hematology-Oncology , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Julio C Barredo
- b Pediatric Hematology-Oncology , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Wendy W Lee
- a Bascom Palmer Eye Institute , University of Miami Miller School of Medicine , Miami , Florida , USA
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Andreasen S, Esmaeli B, Holstein SLV, Mikkelsen LH, Rasmussen PK, Heegaard S. An Update on Tumors of the Lacrimal Gland. Asia Pac J Ophthalmol (Phila) 2017; 6:159-172. [PMID: 28399336 DOI: 10.22608/apo.201707] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/06/2017] [Indexed: 02/06/2023] Open
Abstract
Lacrimal gland tumors are rare and constitute a wide spectrum of different entities ranging from benign epithelial and lymphoid lesions to high-grade carcinomas, lymphomas, and sarcomas with large differences in prognosis and clinical management. The symptoms and findings of a lacrimal gland lesion are a growing mass at the site of the lacrimal gland, including displacement of the eyeball, decreased motility, diplopia, and ptosis. Pain is the cardinal symptom of an adenoid cystic carcinoma. Radiological findings characteristically include an oval, well-demarcated mass for benign lesions whereas malignant lesions typically display calcifications, destruction of bone, and invasion of adjacent structures. The diagnosis ultimately relies on histology, as does the choice of treatment and the prognosis. In recent years, the understanding of the biology of numerous types of lacrimal gland neoplasia has improved and the choice of treatment has changed accordingly and holds further promise for future targeted therapies. Treatment of benign epithelial lesions is surgical excision whereas carcinomas often require adjuvant radiotherapy and/or chemotherapy. In contrast, the cornerstone in management of lymphoid lesions is chemotherapy, often including a monoclonal antibody. This article presents an update on the clinical, radiological, histological, and molecular features, along with treatment strategies for tumors of the lacrimal gland.
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Affiliation(s)
- Simon Andreasen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sarah Linéa von Holstein
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
- Department of Pathology, Rigshospitalet, University of Copenhagen, Cophenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Cophenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Peter Kristian Rasmussen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Cophenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Cophenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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Honavar SG, Manjandavida FP. Recent Advances in Orbital Tumors--A Review of Publications from 2014-2016. Asia Pac J Ophthalmol (Phila) 2017; 6:153-158. [PMID: 28399335 DOI: 10.22608/apo.201736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/08/2017] [Indexed: 11/08/2022] Open
Abstract
The aim of this review article is to provide an update of the current literature on orbital tumors. The authors conducted a PubMed literature search of English language articles published between January 2014 and December 2016 using the following search items: orbit, tumors, lacrimal gland, lymphoma, hemangioma, lymphangioma. The authors included reviews, original articles, case series, and case reports with relevant new information. There is new information about the clinical spectrum of orbital tumors, capillary hemangioma, cavernous hemangioma, lymphangioma, orbital venous malformation, lacrimal gland tumors, and orbital lymphoma. This review highlights the current understanding, practice, and guidelines in the diagnosis and management of common tumors of the orbit.
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Affiliation(s)
- Santosh G Honavar
- Departments of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, Center for Sight, Hyderabad
| | - Fairooz P Manjandavida
- Departments of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, HORUS Specialty Eye Care, Bangalore, India
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Maamari RN, Custer PL, Harocopos GJ. Incidentally Discovered Adenoid Cystic Carcinoma of the Lacrimal Gland with Isolated Liver Metastases. Ocul Oncol Pathol 2017; 3:262-266. [DOI: 10.1159/000461585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/05/2017] [Indexed: 11/19/2022] Open
Abstract
<b><i>Aim:</i></b> To report a rare presentation of adenoid cystic carcinoma (ACC) of the lacrimal gland. <b><i>Method:</i></b> This is a case report presenting clinical, radiographic, and histopathologic findings. <b><i>Results:</i></b> A 72-year-old female with no reported ocular symptoms was found to have an incidental right orbital mass on imaging. Additional studies revealed multiple liver lesions, which were biopsied and found to be consistent with ACC. She was then referred to the ophthalmology service, where ocular examination demonstrated 2.5 mm of right proptosis with elevation and abduction deficits. Diplopia could be elicited in extreme upgaze and right lateral gaze. An excisional biopsy of the orbital mass was performed, with histopathology confirming the diagnosis of primary ACC of the lacrimal gland, thereby also supporting the initial suspicion that the hepatic ACC lesions represented metastases. <b><i>Conclusion:</i></b> The authors describe a rare presentation of ACC of the lacrimal gland, initially asymptomatic, with metastatic lesions restricted to the liver at the time of diagnosis. Three previous cases of ACC with isolated metastatic hepatic lesions at the time of diagnosis have been reported; all of these cases localized the primary tumor to the salivary glands.
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Woo KI, Yeom A, Esmaeli B. Management of Lacrimal Gland Carcinoma: Lessons From the Literature in the Past 40 Years. Ophthalmic Plast Reconstr Surg. 2016;32:1-10. [PMID: 26291539 DOI: 10.1097/iop.0000000000000531] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To review the published literature on management strategies for lacrimal gland carcinomas. METHODS Review of relevant articles in PubMed published in English from the year of 1970 through September 2014. RESULTS A review of literature suggests that treatment strategies for adenoid cystic carcinoma of lacrimal gland are varied, but local control does not necessarily prevent future delayed distant relapse. Tumor size and histologic features of lacrimal gland carcinoma seem to be important prognostic features. With improved imaging modalities providing better tumor diagnosis and staging, and availability of more focused radiation delivery techniques, multimodality globe sparing management of lacrimal gland carcinomas may be possible in selected cases. The availability of targeted drugs based on the molecular signature of an individual lacrimal gland carcinoma may offer possible targeted treatments for patients with nonresectable or metastatic disease. CONCLUSION Given the rarity of lacrimal gland carcinoma, multi-institutional studies and consistent reporting of size and histologic type of tumors in the literature may be prudent. Particularly, multimodality globe-sparing treatment strategies should be studied further.
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Li B, Iordanous Y, Wang Y, Chakrabarti S, Allen LH. Adenoid cystic carcinoma presenting as an orbital apex mass with intracranial extension. Can J Ophthalmol 2016; 51:e65-7. [DOI: 10.1016/j.jcjo.2015.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/08/2015] [Accepted: 12/16/2015] [Indexed: 11/17/2022]
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Esmaeli B, Yin VT, Hanna EY, Kies MS, William WN, Bell D, Frank SJ. Eye-sparing multidisciplinary approach for the management of lacrimal gland carcinoma. Head Neck 2016; 38:1258-62. [PMID: 27027275 DOI: 10.1002/hed.24433] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We analyzed local control and early ocular toxicity after eye-sparing management of lacrimal gland carcinoma. METHODS For consecutive patients with lacrimal gland carcinoma treated during 2007 to 2014, we reviewed tumor characteristics, treatment details, ocular toxic effects, and recurrence. RESULTS Twenty patients, median age 55 years, were treated for lacrimal gland carcinoma during the study period; 11 had globe-sparing surgery. Seven patients had adenoid cystic carcinoma, 2 had carcinoma ex pleomorphic adenoma, and 1 each had high-grade and low-grade adenocarcinoma. Ten patients underwent postoperative radiotherapy, median 60 Gy (range, 52-64 Gy), 6 with concurrent chemotherapy. At a median of 30 months after radiation, all patients had dry eye syndrome, and 1 patient had severe corneal and conjunctival damage leading to enucleation. All 11 patients were disease free at last contact, median follow-up after surgery of 33 months. CONCLUSION An eye-sparing approach with surgery followed by adjuvant radiotherapy or chemoradiotherapy is feasible for selected patients with lacrimal gland carcinoma and is associated with a reasonable locoregional control and ocular toxicity profile. © 2016 Wiley Periodicals, Inc. Head Neck 38:1258-1262, 2016.
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Affiliation(s)
- Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vivian T Yin
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Merrill S Kies
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William N William
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diana Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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