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Bahl VJ, Bahl A. Adenoid Cystic Cancer of the Lacrimal Gland: Management Aspects and Treatment Outcomes. Indian J Otolaryngol Head Neck Surg 2024; 76:2158-2161. [PMID: 38566663 PMCID: PMC10982151 DOI: 10.1007/s12070-023-04426-5] [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: 10/18/2023] [Accepted: 12/03/2023] [Indexed: 04/04/2024] Open
Abstract
Adenoid cystic carcinoma (ACC) of the lacrimal gland is the most common malignant epithelial tumor of the lacrimal gland. The biological behavior of these tumors is characterized by a slow growth with frequent nerve invasion but rare invasion of the neck nodes. Local extension intracranially with bone erosions is seen in locally advanced tumors. Distant metastasis to lungs bone and liver are commonly reported. Treatments using surgery and radiotherapy are generally preferred for adequate tumor control. However there is still no consensus on the best treatment approach. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04426-5.
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Affiliation(s)
- Vishwa Jyoti Bahl
- Department of Ophthalmology, MM Medical College & Hospital, Solan, HP India
| | - Amit Bahl
- Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India
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2
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He L, Zhang J, Zhu T, Zhao P, Mou P, Tang S. Incidence, clinical features, and survival outcomes of primary malignant lacrimal gland tumors: A population-based analysis. Cancer Med 2024; 13:e6831. [PMID: 38230983 PMCID: PMC10905223 DOI: 10.1002/cam4.6831] [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: 08/31/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Studies on the epidemiological information and prognosis of primary malignant lacrimal gland tumors (MLGTs) are rare for its low occurrence. The goal of our research was to investigate the epidemiological characteristics and survival outcomes of patients with MLGTs. METHODS Incidence and demographic information of patients with MLGTs were collected from the Surveillance, Epidemiology, and End Results (SEER) database. To identify independent prognostic factors for disease-specific survival (DSS) and overall survival (OS), univariate and multivariate Cox regression analysis were performed. RESULTS The overall incidence of primary MLGTs from 1975 to 2020 was 0.413/1,000,000 (according to the 2000 American standard population), with a steadily increasing incidence over years. A total of 964 patients with primary MLGTs were diagnosed, with an average age of 59.3 years. Of these, 53.2% were aged ≥60 years, 57.4% were female, and 77.1% were whites. Multivariate Cox regression analysis demonstrated that year of diagnosis, age, sex, histological type, SEER stage, surgery, and chemotherapy were independent prognostic factors of DSS or OS. CONCLUSIONS Although primary MLGT is rare, its incidence has steadily increased in the past 46 years, and surgery was related to a better prognosis.
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Affiliation(s)
- Lin‐feng He
- Department of OphthalmologyChangzheng Hospital, Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Jin‐di Zhang
- Department of OphthalmologyChangzheng Hospital, Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Teng‐fei Zhu
- Department of AnesthesiologyChangzheng Hospital, Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Peng‐cheng Zhao
- Department of AnesthesiologyShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Pei Mou
- Department of OphthalmologyChangzheng Hospital, Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Shi‐yi Tang
- Department of OphthalmologyGongli Hospital of Shanghai Pudong New AreaShanghaiChina
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Qedair J, Haider AS, Balasubramanian K, Palmisciano P, Hassan T, Shahbandi A, Sabahi M, Kharbat AF, Abou-Al-Shaar H, Yu K, Cohen-Gadol AA, El Ahmadieh TY, Bin-Alamer O. Orbital Exenteration for Craniofacial Lesions: A Systematic Review and Meta-Analysis of Patient Characteristics and Survival Outcomes. Cancers (Basel) 2023; 15:4285. [PMID: 37686561 PMCID: PMC10487227 DOI: 10.3390/cancers15174285] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/27/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The outcomes of orbital exenteration (OE) in patients with craniofacial lesions (CFLs) remain unclear. The present review summarizes the available literature on the clinical outcomes of OE, including surgical outcomes and overall survival (OS). METHODS Relevant articles were retrieved from Medline, Scopus, and Cochrane according to PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management, and outcomes. RESULTS A total of 33 articles containing 957 patients who underwent OE for CFLs were included (weighted mean age: 64.3 years [95% CI: 59.9-68.7]; 58.3% were male). The most common lesion was squamous cell carcinoma (31.8%), and the most common symptom was disturbed vision/reduced visual acuity (22.5%). Of the patients, 302 (31.6%) had total OE, 248 (26.0%) had extended OE, and 87 (9.0%) had subtotal OE. Free flaps (33.3%), endosseous implants (22.8%), and split-thickness skin grafts (17.2%) were the most used reconstructive methods. Sino-orbital or sino-nasal fistula (22.6%), flap or graft failure (16.9%), and hyperostosis (13%) were the most reported complications. Regarding tumor recurrences, 38.6% were local, 32.3% were distant, and 6.7% were regional. The perineural invasion rate was 17.4%, while the lymphovascular invasion rate was 5.0%. Over a weighted mean follow-up period of 23.6 months (95% CI: 13.8-33.4), a weighted overall mortality rate of 39% (95% CI: 28-50%) was observed. The 5-year OS rate was 50% (median: 61 months [95% CI: 46-83]). The OS multivariable analysis did not show any significant findings. CONCLUSIONS Although OE is a disfiguring procedure with devastating outcomes, it is a viable option for carefully selected patients with advanced CFLs. A patient-tailored approach based on tumor pathology, extension, and overall patient condition is warranted.
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Affiliation(s)
- Jumanah Qedair
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia;
- King Abdullah International Medical Research Center (KAIMRC), Jeddah 22384, Saudi Arabia
| | - Ali S. Haider
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Paolo Palmisciano
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95819, USA
| | - Taimur Hassan
- Texas A&M School of Medicine, Texas A&M University, Houston, TX 77030, USA
| | - Ataollah Shahbandi
- Tehran School of Medicine, Tehran University of Medical Science, Tehran 1416634793, Iran
| | - Mohammadmahdi Sabahi
- Department of Neurological Surgery, Pauline Braathen Neurological Centre, Cleveland Clinic Florida, Weston, FL 33331, USA
| | | | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15219, USA
| | - Kenny Yu
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Aaron A. Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Othman Bin-Alamer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15219, USA
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He LF, Mou P, Wei RL. Epidemiology and survival outcomes of patients with orbital region non-cutaneous squamous cell carcinoma: a population-based analysis. Front Oncol 2023; 13:1152337. [PMID: 37213302 PMCID: PMC10196690 DOI: 10.3389/fonc.2023.1152337] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Background Non-cutaneous squamous cell carcinoma (ncSCC) of the orbital region is very rare. Thus, its epidemiological characteristics and prognosis are poorly understood. The aim of the study was to assess the epidemiological characteristics and survival outcomes of ncSCC of the orbital region. Methods Incidence and demographic data on ncSCC of the orbital region were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and analyzed. The chi-square test was used to calculate the differences between groups. Univariate and multivariate Cox regression analyses were performed to determine the independent prognostic factors for disease-specific survival (DSS) and overall survival (OS). Results The overall incidence of ncSCC in the orbital region from 1975 to 2019 was 0.68/1,000,000, and the incidence showed an increasing trend during this period. A total of 1,265 patients with ncSCC of the orbital region (mean age, 65.3 years) were identified in the SEER database. Of these, 65.1% were aged ≥60 years, 87.4% were White, and 73.5% were male. The conjunctiva (74.5%) was the most common primary site, followed by the orbit (12.1%), lacrimal apparatus (10.8%), and overlapping lesion of the eye and adnexa (2.7%). Multivariate Cox regression analysis revealed that age, primary site, SEER summary stage, and surgery were independent prognostic factors for DSS, whereas age, sex, marital status, primary site, SEER summary stage, and surgery were independent prognostic factors for OS. Conclusions The incidence of ncSCC in the orbital region has increased over the past 40 years. It usually affects White people, men, and people aged ≥60 years, and its most common site is the conjunctiva. Orbital SCC has worse survival outcomes than SCC of other sites in the orbital region. Surgery is the independent protective treatment for ncSCC of the orbital region.
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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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Salim N, Libson E, Tumanova K, Krotenkova I. Stereotactic radiosurgery as a successful method to control meningeal metastatic adenoid cystic carcinoma of the lacrimal gland: A case report. Mol Clin Oncol 2022; 17:135. [PMID: 35949893 PMCID: PMC9353865 DOI: 10.3892/mco.2022.2568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 03/28/2022] [Accepted: 06/22/2022] [Indexed: 11/06/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) of the lacrimal gland is a rare tumor. In addition, considering the lack of data on large groups of patients there is no standard of care to treat patients with multiple meningeal metastases of ACC. A two-year analysis of the course of the disease in a patient with synchronous oligometastatic ACC of the lacrimal gland that was treated with stereotactic radiosurgery (SRS) is presented. The aim of the present case report was to evaluate the effect of SRS in the treatment of a patient with ACC. Preliminary results confirmed that this method was highly effective in this patient. The patient is currently living with a good quality of life, normal vision and with no evidence of disease or complications. SRS exhibited reliable local tumor control and insignificant radiation-related complications, rendering it an encouraging treatment option for patients with recurrent or metastatic ACC.
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Affiliation(s)
- Nidal Salim
- Department of Radiation Oncology, European Medical Center, Moscow 129090, Russia
| | - Evgeniy Libson
- Department of Diagnostic Imaging, European Medical Center, Moscow 129090, Russia
| | - Kristina Tumanova
- Department of Radiation Oncology, European Medical Center, Moscow 129090, Russia
| | - Irina Krotenkova
- Department of Diagnostic Imaging, European Medical Center, Moscow 129090, Russia
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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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Zhang J, Yan X, Liu R, Wu S, Liu Q, Li J, Ma J. Bevacizumab is an Efficient Therapeutic Approach with Low Side Effects in Patient-Derived Xenografts of Adenoid Cystic Carcinoma of the Lacrimal Gland. Cancer Manag Res 2022; 14:1023-1032. [PMID: 35283648 PMCID: PMC8912937 DOI: 10.2147/cmar.s352623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/23/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose Adenoid cystic carcinoma (ACC) of the lacrimal gland (LGACC) is an aggressive malignant lacrimal gland tumor with a generally poor prognosis. Survival rates for LGACC are 56% at 5 years and 49% at 10 years. Recent studies have indicated that anti-vascular endothelial growth factor (VEGF) therapy can inhibit angiogenesis in ACC cells. This study was designed to explore the efficacy of the antiangiogenic drug bevacizumab in a LGACC patient-derived xenograft (PDX) animal model. Methods The histological structure of PDX was determined by hematoxylin-eosin staining to confirm successful xenografting. Immunohistochemistry (IHC) was used to detect the expression of neovascularization-related genes in LGACC patients and in the PDX model, including VEGF, VEGFR1, and FGFR. In order to compare the efficacy of antiangiogenic drug and traditional chemotherapy drug, PDX models were treated with bevacizumab and cisplatin respectively, and body weight was evaluated. Subsequently, the neovascularization-related proteins VEGF, VEGFR2, and CD34, tumor suppressor P53 and proliferation-related protein Ki67 were analyzed by IHC. Quantitative real-time PCR was employed to examine the mRNA expression of apoptosis-related genes BAD and Caspase 9, and of HIF1α. Results VEGF, VEGFR1, and FGFR were highly expressed in patients with LGACC and PDX models. Both bevacizumab and cisplatin treatment inhibited PDX tumor growth. The body weight of PDX models treated with cisplatin significantly decreased from day 15, while those treated with bevacizumab did not markedly change. Bevacizumab reduced the expression of VEGF, CD34, and Ki67 in PDX tumors; whereas, bevacizumab upregulated P53 and downregulated HIF1α levels. Conclusion The present study indicates that antiangiogenic drugs may be a promising treatment strategy for LGACC.
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Affiliation(s)
- Jingxue Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, People’s Republic of China
- Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Xuejing Yan
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, People’s Republic of China
| | - Rui Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, People’s Republic of China
| | - Shen Wu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, People’s Republic of China
- Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Qian Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, People’s Republic of China
- Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Jing Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, People’s Republic of China
| | - Jianmin Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, People’s Republic of China
- Correspondence: Jianmin Ma, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, People’s Republic of China, Tel +8610-5826-9968, Fax +8610-5826-9930, Email
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Benali K, Benmessaoud H, Aarab J, Nourreddine A, Kacemi HE, Majjaoui SE, Kebdani T, Benjaafar N. Lacrimal gland adenoid cystic carcinoma: report of an unusual case with literature review. Radiat Oncol J 2021; 39:152-158. [PMID: 34619831 PMCID: PMC8497861 DOI: 10.3857/roj.2021.00122] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/29/2021] [Indexed: 11/03/2022] Open
Abstract
Lacrimal gland adenoid cystic carcinomas are rare, aggressive orbital tumors characterized by poor overall prognosis, tendency for local recurrence and metastasis despite aggressive treatment. Treatment continues to be controversial. Many authorities today will often initiate surgery (orbital exenteration with or without bone removal vs. globe-sparing resection) and adjuvant radiotherapy (external beam or proton beam therapy). We introduce a case of lacrimal gland adenoid cystic carcinoma treated with orbital exenteration and adjuvant volumetric modulated arc therapy, and discuss the related literature.
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Affiliation(s)
- Kenza Benali
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Houda Benmessaoud
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Jihan Aarab
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Abdelati Nourreddine
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Équipe de Science de la Matière et du Rayonnement, Department of Physics, Mohammed V University, Faculty of Science, Rabat, Morocco
| | - Hanan El Kacemi
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Sanaa El Majjaoui
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Tayeb Kebdani
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Noureddine Benjaafar
- Department of Radiation Oncology, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine, Mohammed V University, Rabat, Morocco
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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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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
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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Lin YH, Huang SM, Yap WK, Yang JW, Yeung L, Tsan DL, Chang JTC, Chen LC. Outcomes in patients with lacrimal gland carcinoma treated with definitive radiotherapy or eye-sparing surgery followed by adjuvant radiotherapy. Radiat Oncol 2020; 15:156. [PMID: 32571366 PMCID: PMC7310012 DOI: 10.1186/s13014-020-01601-8] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background The optimal treatment for lacrimal gland cancer remains unclear. Eye-preserving surgery, as opposed to exenteration, followed by adjuvant radiotherapy (RT), has recently been reported to deliver satisfactory outcomes, but evidence is sparse. The aim of the present study was to evaluate outcomes in patients with lacrimal gland cancer treated at two tertiary medical centers. Methods We retrospectively examined data from patients with lacrimal gland cancer who had received eye-preserving surgical treatment followed by adjuvant RT with or without chemotherapy, or (if the tumor was inoperable) needle biopsy with definitive RT with or without chemotherapy. Baseline clinical and pathological characteristics were considered. Outcomes of interest included post-treatment complications, overall survival (OS), locoregional progression-free survival (LPFS), and distant metastasis-free survival (DMFS). Results Eighteen patients were included. Two-year OS, LPFS, and DMFS rates were 69.0, 76.7, and 71.4%, respectively. Patients with early-stage (T1–T2) lacrimal gland cancer had significantly better outcomes than those with advanced-stage disease (T3–T4). Two-year OS, LPFS, and DMFS rates were each 100% in patients with disease stages T1–T2, and 37.5, 50, and 37.5%, respectively, in those with disease stages T3–T4 (P < 0.05). Orbital complications were well tolerated. Conclusions Eye-sparing surgery with adjuvant RT can achieve satisfactory results in patients with T1–T2 lacrimal gland carcinoma. Disease stage T3 and above was associated with poor outcomes even with post-operative RT, likely due to distant metastasis. Adding neoadjuvant chemotherapy or adjuvant chemotherapy to current treatment strategies might be a suitable choice for this group of patients.
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Affiliation(s)
- Yun-Hsuan Lin
- Department of Electro-Optical Engineering, National Taipei University of Technology, 1, Sec. 3, Chung-Hsiao E. Rd, Taipei, 10608, Taiwan, ROC.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wing-Keen Yap
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ju-Wen Yang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ling Yeung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Din-Li Tsan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | | | - Lung-Chien Chen
- Department of Electro-Optical Engineering, National Taipei University of Technology, 1, Sec. 3, Chung-Hsiao E. Rd, Taipei, 10608, Taiwan, ROC.
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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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Anesi A, Negrello S, Lucchetti D, Pollastri G, Trevisiol L, Badiali L, Lazzerini A, Cavallini GM, Chiarini L. Clinical Management of Acinic Cell Carcinoma of the Lacrimal Gland. Case Rep Oncol 2019; 12:777-790. [PMID: 31762749 PMCID: PMC6872994 DOI: 10.1159/000503557] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/19/2019] [Indexed: 12/17/2022] Open
Abstract
To report a case of acinic cell carcinoma occurred in the lacrimal gland. A 59-year-old man was admitted because of sudden blurring of vision, progressive proptosis of the left eye, and mild double vision in left and down directions of the gaze (Hess-Lancaster test). His medical history detailed controlled bilateral keratoconus and open angle glaucoma. On examination, the best corrected visual acuity decreased from 8/20 till 1/50 in one week. There was a swelling of the left upper eyelid. A hard and tender mass was palpated in the superior temporal left orbit. Ultrasound scan showed an extraconal solid mass, situated in the superior lateral corner of the orbit. Computed tomography and magnetic resonance imaging (MRI) revealed a mass of two centimeters in diameter, with round well-defined outline, within the lacrimal gland. We performed an enucleoresection of the mass, via a coronal approach and a lateral orbitotomy by a piezosurgical device. The lesion appeared nodular, brownish, measuring about 2 × 1.5 cm. Histopathological findings were consistent with acinic cell carcinoma with a microcystic, focally papillary-cystic growth of pattern. Follow-up MRI outcomes led to removal of the residual lacrimal gland for suspicion of recurrence. No tumor recurrences where detected at 7-year follow-up.
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Affiliation(s)
- Alexandre Anesi
- Cranio-Maxillo-Facial Surgery Unit, University Hospital of Modena, Modena, Italy
| | - Sara Negrello
- Cranio-Maxillo-Facial Surgery Unit, University Hospital of Modena, Modena, Italy
| | - Donatella Lucchetti
- Institute of General Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Pollastri
- Cranio-Maxillo-Facial Surgery Unit, University Hospital of Modena, Modena, Italy
| | - Lorenzo Trevisiol
- Unit of Dentistry and Maxillo-Facial Surgery, University of Verona, Verona, Italy
| | - Licia Badiali
- Institute of Ophthalmology, University Hospital of Modena, Modena, Italy
| | - Andrea Lazzerini
- Institute of Ophthalmology, University Hospital of Modena, Modena, Italy
| | | | - Luigi Chiarini
- Cranio-Maxillo-Facial Surgery Unit, University Hospital of Modena, Modena, Italy
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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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20
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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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Woo KI, Sagiv O, Han J, Frank SJ, Kim YD, Esmaeli B. Eye-Preserving Surgery Followed by Adjuvant Radiotherapy for Lacrimal Gland Carcinoma: Outcomes in 37 Patients. Ophthalmic Plast Reconstr Surg 2018; 34:570-4. [PMID: 29634603 DOI: 10.1097/IOP.0000000000001106] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the clinical outcomes of eye-preserving surgery followed by adjuvant radiotherapy in patients with lacrimal gland carcinoma. METHODS Thirty-seven patients with lacrimal gland carcinoma who underwent eye-preserving surgery were studied. RESULTS At last follow up, 32 patients were alive without disease, 3 patients were alive with disease with distant metastasis, 1 patient had died of disease, and 1 patient had died of other cause. The 5-year recurrence-free survival rate was worse in patients without than in patients with adjuvant radiotherapy (p = 0.001) and worse in patients with T3-T4 tumors than in patients with T1-T2 tumors (p = 0.027). At last follow up, 25 patients (68%) had visual acuity of 20/40 or better. CONCLUSIONS In patients with lacrimal gland carcinoma, eye-preserving surgery and adjuvant radiotherapy is associated with reasonable local control rates and visual and ocular function. Postoperative adjuvant radiotherapy seems to enhance local control rates.
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Wolkow N, Jakobiec FA, Lee H. Long-term Outcomes of Globe-Preserving Surgery With Proton Beam Radiation for Adenoid Cystic Carcinoma of Lacrimal Gland. Am J Ophthalmol 2019; 201:84-5. [PMID: 30709640 DOI: 10.1016/j.ajo.2018.12.013] [Citation(s) in RCA: 3] [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: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 11/20/2022]
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Esmaeli B, Frank SJ. Long-term Outcomes of Globe-Preserving Surgery with Proton Beam Radiation for Adenoid Cystic Carcinoma of the Lacrimal Gland. Am J Ophthalmol 2019; 201:83-84. [PMID: 30686477 DOI: 10.1016/j.ajo.2018.12.014] [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] [Received: 11/25/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
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Akbaba S, Lang K, Held T, Herfarth K, Rieber J, Plinkert P, Auffarth GU, Rieken S, Debus J, Adeberg S. Carbon-ion radiotherapy in accelerated hypofractionated active raster-scanning technique for malignant lacrimal gland tumors: feasibility and safety. Cancer Manag Res 2019; 11:1155-1166. [PMID: 30774443 PMCID: PMC6362930 DOI: 10.2147/cmar.s190051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Indexed: 12/14/2022] Open
Abstract
Introduction We evaluated treatment outcomes of CIRT in an active raster-scanning technique alone or in combination with IMRT for lacrimal gland tumors. Methods A total of 24 patients who received CIRT for a malignant lacrimal gland tumor at the HIT between 2009 and 2018 were analyzed retrospectively for LC, OS, and distant progression-free survival (DPFS) using Kaplan-Meier estimates. Toxicity was assessed according to the CTCAE version 5. Results Median follow-up was 30 months and overall median LC, OS, and DPFS 24 months, 36 months, and 31 months, respectively. Two-year LC, OS, and DPFS of 93%, 96%, and 87% with CIRT was achieved for all patients. Local failure occurred only in patients with ACC and after a median follow-up of 30 months after the completion of RT (n=5, 21%; P=0.09). We identified a significant negative impact of a macroscopic tumor disease, which was diagnosed on planning CT or MRI before RT, on LC (P=0.026). In contrast, perineural spread (P=0.661), T stage (P=0.552), and resection margins in operated patients (P=0.069) had no significant impact on LC. No grade ≥3 acute or grade >3 chronic toxicity occurred. Late grade 3 side effects were identified in form of a wound-healing disorder 3 months after RT in one patient and temporal lobe necrosis 6 months after RT in another (n=2, 8%). Conclusion Accelerated hypofractionated active raster-scanning CIRT for relative radio-resistant malignant lacrimal gland tumors results in adequate LC rates and moderate acute and late toxicity. Nevertheless, LC for ACC histology remains challenging and risk factors for local recurrence are still unclear. Further follow-up is necessary to evaluate long-term clinical outcome.
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Affiliation(s)
- Sati Akbaba
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Kristin Lang
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Thomas Held
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Klaus Herfarth
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Juliane Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Peter Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Gerd U Auffarth
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Juergen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg 69120, Germany, .,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg 69120, Germany,
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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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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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Andrade JP, Figueiredo S, Matias J, Almeida AC. Surgical resection of invasive adenoid cystic carcinoma of the lacrimal gland and wound closure using a vertical rectus abdominis myocutaneous free flap. BMJ Case Rep 2016; 2016:bcr-2015-209473. [PMID: 27646316 DOI: 10.1136/bcr-2015-209473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 64-year-old man presented with a 3-month history of recurrent conjunctivitis. He was evaluated by an ophthalmologist and submitted to a CT scan that revealed an intraconic mass with invasion of the lateral orbital wall. He was operated, the mass was completely removed (with preservation of the intraorbital structures) and the lateral orbital wall rebuilt. The histopathological analysis revealed an adenoid cystic carcinoma of the lacrimal gland. 4 months later a painful recurrence of the lesion was diagnosed with invasion of the orbital roof and eyelids. After a multidisciplinary discussion and request from the patient, an exenteration of the orbit and removal of the lateral and superior orbital wall and dura mater was performed with the objective of a total resection. The wound and orbit were closed with a vertical rectus abdominis myocutaneous free flap to ensure closure.
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Affiliation(s)
| | | | - Julio Matias
- Department of Plastic Surgery, CHLO, Lisboa, Portugal
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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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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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Sanders JC, Mendenhall WM, Werning JW. Adenoid cystic carcinoma of the lacrimal gland. Am J Otolaryngol 2016; 37:144-7. [PMID: 26954871 DOI: 10.1016/j.amjoto.2015.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/23/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE This is a retrospective analysis of the 50-year University of Florida experience treating adenoid cystic carcinoma of the lacrimal gland with radiation therapy. MATERIALS AND METHODS Between 1965 and 2015, 8 patients with adenoid cystic carcinoma of the lacrimal gland received radiation therapy with curative intent. Four patients received postoperative radiation therapy and 4 received definitive radiation therapy alone. The median follow-up was 3.3 years (range, 0.3 to 11.2 years). RESULTS All 4 patients who received postoperative radiation therapy received 74.4 Gy. The 4 patients who received radiation therapy alone received a median dose of 72.3 Gy (range, 70.0 to 74.4 Gy). The overall survival rates at 5 and 10 years were 25% and 13%, respectively. The cause-specific survival rates at 5 and 10 years were 29% and 14%, respectively. The local control and freedom from metastases rates at 5 and 10 years were both 43%. Local recurrences occurred in 50% of patients, and distant metastatic disease occurred in 38% of patients. No patients experienced acute complications of treatment that warranted a treatment break. Two patients experienced bone exposure as late complications of treatment. CONCLUSIONS The results of this study illustrate the propensity for adenoid cystic carcinoma of the lacrimal gland to recur both locally and with distant metastases despite aggressive local treatment measures. This study also demonstrates the relatively poor outcomes for individuals with this type of tumor.
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Ramakrishna R, Raza SM, Kupferman M, Hanna E, DeMonte F. Adenoid cystic carcinoma of the skull base: results with an aggressive multidisciplinary approach. J Neurosurg 2016; 124:115-21. [DOI: 10.3171/2015.1.jns142462] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Adenoid cystic carcinoma (ACC) is a locally aggressive tumor of salivary gland origin. Little data exist to guide treatment when this tumor extends to involve the structures of the skull base.
METHODS
Fifty-one patients with a diagnosis of ACC affecting the skull base were identified from a prospective database at MD Anderson Cancer Center (from 1992 to 2010).
RESULTS
Median follow-up for study patients was 6.75 years. The 5- and 10-year overall survival (OS) rates were 78% and 50%, respectively. Sixty-six percent of patients had progression of their disease. The 5- and 10-year progression-free survival (PFS) rates were 46.7% and 21.0%, respectively. Gross-total resection was achieved in 75% of patients, with 49% having microscopically negative margins at the time of first operation. On univariate analysis, resections with microscopically negative margins were associated with a significant OS advantage (20.1 ± 3.3 years) compared with resections that left residual disease, even if microscopic (10.3 ± 1.6 years, p = 0.035). In patients who underwent reoperation, the effect persisted, with improved OS in those with negative margins (21.4 ± 0.0 vs 16.7 ± 4.0 years, p = 0.06). The use of adjuvant radiotherapy was associated with an OS advantage (16.2 ± 2.5 vs 5.5 ± 2.2 years, p = 0.03) at initial diagnosis and improved PFS (7.8 ± 1.0 vs 2.1 ± 0.62 years, p = 0.005), whereas repeat irradiation provided no benefit. The use of adjuvant chemotherapy at diagnosis or at recurrence was not associated with any significant advantage. Multivariate analysis revealed margin-negative resection at initial operation and at recurrence retained OS significance, even after controlling for age, radiation therapy, and T stage.
CONCLUSIONS
ACC of the skull base is best treated with a multidisciplinary approach aimed at maximal, safe resection. Adjuvant radiotherapy should be offered, whereas chemotherapy does not confer benefit.
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Affiliation(s)
| | | | | | - Ehab Hanna
- 2Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
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Holliday EB, Esmaeli B, Pinckard J, Garden AS, Rosenthal DI, Morrison WH, Kies MS, Gunn GB, Fuller CD, Phan J, Beadle BM, Zhu XR, Zhang X, Frank SJ. A Multidisciplinary Orbit-Sparing Treatment Approach That Includes Proton Therapy for Epithelial Tumors of the Orbit and Ocular Adnexa. Int J Radiat Oncol Biol Phys 2015; 95:344-352. [PMID: 26454680 DOI: 10.1016/j.ijrobp.2015.08.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/30/2015] [Accepted: 08/04/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Postoperative radiation is often indicated in the treatment of malignant epithelial tumors of the orbit and ocular adnexa. We present details of radiation technique and toxicity data after orbit-sparing surgery followed by adjuvant proton radiation therapy. METHODS AND MATERIALS Twenty patients underwent orbit-sparing surgery followed by proton therapy for newly diagnosed malignant epithelial tumors of the lacrimal gland (n=7), lacrimal sac/nasolacrimal duct (n=10), or eyelid (n=3). Tumor characteristics, treatment details, and visual outcomes were obtained from medical records. Acute and chronic toxicity were prospectively scored using Common Terminology Criteria for Adverse Events version 4.0. RESULTS The median radiation dose was 60 Gy(RBE) (relative biological effectiveness; [range 50-70 Gy]); 11 patients received concurrent chemotherapy. Dose to ipsilateral anterior optic structures was reduced in 13 patients by having them gaze away from the target during treatment. At a median follow-up time of 27.1 months (range 2.6-77.2 months), no patient had experienced local recurrence; 1 had regional and 1 had distant recurrence. Three patients developed chronic grade 3 epiphora, and 3 developed grade 3 exposure keratopathy. Four patients experienced a decrease in visual acuity from baseline but maintained vision sufficient to perform all activities of daily living without difficulty. Patients with grade ≥3 chronic ocular toxicity had higher maximum dose to the ipsilateral cornea (median 46.3 Gy[RBE], range 36.6-52.7 Gy[RBE] vs median 37.4 Gy[RBE], range 9.0-47.3 Gy(RBE); P=.017). CONCLUSIONS Orbit-sparing surgery for epithelial tumors of the orbit and ocular adnexa followed by proton therapy successfully achieved disease control and was well tolerated. No patient required orbital exenteration or enucleation. Chronic grade 3 toxicity was associated with high maximum dose to the cornea. An eye-deviation technique can be used to limit the maximum corneal dose to <35 Gy(RBE).
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Affiliation(s)
- Emma B Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery Program, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jamie Pinckard
- School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, 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
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiarong Ronald Zhu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiaodong Zhang
- Department of Radiation Physics, 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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Ricci M, Amadori E, Chiesa F, Bongiovanni A, Liverani C, Fabbri L, Falasconi MC, Casadei R, Oboldi D, Galassi R, Micheletti S, Severi S, Serra L, Pieri F, Calabrese L, Riva N, Calpona S, Gunelli E, Mercatali L, Amadori D, Ibrahim T. Single bone metastasis from adenocarcinoma of the lacrimal gland: a case report. Future Oncol 2014; 10:1735-9. [DOI: 10.2217/fon.14.36] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Malignant tumors of the lacrimal gland are rare, and single bone metastases from lacrimal gland carcinoma are an exceptional event. We present the case of a 71-year-old man with a history of lumbar pain and left exophthalmos. Surgical resection of the lacrimal lesion and a bone biopsy gave a final histopathological diagnosis of primary ductal adenocarcinoma of the lacrimal gland with bone metastasis. The pathological tissue from both procedures was positive for androgen receptor expression. The patient underwent embolization and radiotherapy in association with total androgen blockade. After 20 months, the patient is still asymptomatic and has maintained the partial response at L1 with no progression to other sites. Our patient would appear to have a better prognosis and the disease a more indolent clinical course than the other cases of ductal adenocarcinoma of the lacrimal gland reported in the literature.
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Affiliation(s)
- Marianna Ricci
- Osteoncology & Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Fausto Chiesa
- Surgical Resources Area, European Institute of Oncology (IEO), Milan, Italy
| | - Alberto Bongiovanni
- Osteoncology & Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Chiara Liverani
- Osteoncology & Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Laura Fabbri
- Palliative Care Unit, Forlì Local Health Authority, Forlì, Italy
| | | | - Roberto Casadei
- Orthopaedic Unit III, Rizzoli Institute IRCCS, Bologna, Italy
| | | | - Riccardo Galassi
- Nuclear Medicine Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | | | | | - Luigi Serra
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Federica Pieri
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Luca Calabrese
- Oral & Oropharyngeal Unit, Head & Neck Department, European Institute of Oncology (IEO), Milan, Italy
| | - Nada Riva
- Osteoncology & Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sebastiano Calpona
- Osteoncology & Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Erica Gunelli
- Osteoncology & Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Laura Mercatali
- Osteoncology & Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dino Amadori
- Osteoncology & Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Toni Ibrahim
- Osteoncology & Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Debnam JM, Mayer RR, Esmaeli B, Weinberg JS, Demonte F, Guha-Thakurta N. Three-Dimensional Multidetector CT for Anatomic Evaluation of Orbital Tumors. J Ophthalmol 2013; 2013:674230. [PMID: 24288594 DOI: 10.1155/2013/674230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 09/01/2013] [Accepted: 09/05/2013] [Indexed: 11/18/2022] Open
Abstract
Intricate resection and complex reconstructive procedures often required for primary and metastatic orbital tumors are facilitated by accurate imaging. A three-dimensional (3D) image can be reconstructed from source axial multidetector computed tomography (MDCT) images to visualize orbital tumors. To assess the utility of 3D images in this setting, the 3D images were reconstructed retrospectively for 20 patients with an orbital tumor and compared to two-dimensional (2D) orthogonal MDCT studies. Both types of images were assessed for their capacity to show the bony orbital walls and foramina, extraocular muscles, and optic nerve in the orbit contralateral to the tumor and, in the affected orbit, the extent of the tumor and its relationship to normal orbital contents and associated bone destruction. 3D imaging is most informative when axial images are acquired at 1.25 mm collimation. The optic nerve, extraocular muscles, and well-circumscribed orbital tumors were well visualized on 3D images. On 3D imaging, tumor-associated destruction of the lateral and superior orbital walls was fairly well demonstrated and that of the inferior and medial walls was not. The 3D images provide the surgeon with a comprehensive view of well-circumscribed orbital tumors and its relationship to extraocular muscles, exiting foramina, and the superior and lateral walls.
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38
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von Holstein SL, Coupland SE, Briscoe D, Le Tourneau C, Heegaard S. Epithelial tumours of the lacrimal gland: a clinical, histopathological, surgical and oncological survey. Acta Ophthalmol 2013; 91:195-206. [PMID: 22471335 DOI: 10.1111/j.1755-3768.2012.02402.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [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: 12/14/2022]
Abstract
Epithelial tumours of the lacrimal gland represent a large spectrum of lesions with similarities in clinical signs and symptoms but with different biological behaviour and prognosis. They are rare, but with aggressive malignant potential. Tumours of the lacrimal gland may present with swelling of the lacrimal gland, displacement of the eyeball, reduced eye motility and diplopia. Pain and symptoms of short duration before the first ophthalmic consultation are characteristic of malignant tumours. The histological diagnosis determines the subsequent treatment regimen and provides important clues regarding the prognosis. The purpose of this paper is to describe the various primary epithelial tumours of the lacrimal gland. In the first part of the review, the frequency, demographics, clinical presentation and diagnostic features are described. In the second part, primarily tumour-specific histological characteristics are given. Finally, treatment modalities including surgical procedures and medical oncology as well as prognosis are discussed.
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MESH Headings
- Adenocarcinoma/epidemiology
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adenoma, Pleomorphic/epidemiology
- Adenoma, Pleomorphic/pathology
- Adenoma, Pleomorphic/surgery
- Adult
- Carcinoma/epidemiology
- Carcinoma/pathology
- Carcinoma/surgery
- Carcinoma, Adenoid Cystic/epidemiology
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Adenoid Cystic/surgery
- Carcinoma, Mucoepidermoid/epidemiology
- Carcinoma, Mucoepidermoid/pathology
- Carcinoma, Mucoepidermoid/surgery
- Eye Neoplasms/epidemiology
- Eye Neoplasms/pathology
- Eye Neoplasms/surgery
- Humans
- Lacrimal Apparatus Diseases/epidemiology
- Lacrimal Apparatus Diseases/pathology
- Lacrimal Apparatus Diseases/surgery
- Male
- Middle Aged
- Neoplasms, Glandular and Epithelial/epidemiology
- Neoplasms, Glandular and Epithelial/pathology
- Neoplasms, Glandular and Epithelial/surgery
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Affiliation(s)
- Sarah Linéa von Holstein
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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Tse DT, Kossler AL, Feuer WJ, Benedetto PW. Long-term outcomes of neoadjuvant intra-arterial cytoreductive chemotherapy for lacrimal gland adenoid cystic carcinoma. Ophthalmology 2013; 120:1313-23. [PMID: 23582989 DOI: 10.1016/j.ophtha.2013.01.027] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 01/12/2013] [Accepted: 01/14/2013] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the long-term outcomes after intra-arterial cytoreductive chemotherapy (IACC) with conventional treatment for lacrimal gland adenoid cystic carcinoma (ACC). DESIGN Retrospective case series. PARTICIPANTS Nineteen consecutive patients treated with IACC, followed by orbital exenteration, chemoradiotherapy, and intravenous chemotherapy. INTERVENTIONS Analyses of the histologic characteristics of biopsy specimens, extent of disease at the time of diagnosis, diagnostic surgical procedures, incidence of locoregional recurrences or distant metastases, disease-free survival time, response to IACC, tumor margins at definitive surgery, and toxicity and complications. MAIN OUTCOME MEASURES Disease relapse, disease-free survival, and chemotherapeutic complications. RESULTS Eight patients with an intact lacrimal artery had significantly better outcomes for survival (100% vs. 28.6% at 10 years), cause-specific mortality, and recurrences (all P = 0.002, log-rank test) than conventionally treated patients from the University of Miami Miller School of Medicine. These 8 patients (group 1) had cumulative 10-year disease-free survival of 100% compared with 50% for 11 patients (group 2) who had an absence of the lacrimal artery or deviated from the treatment protocol (P = 0.035) and 14.3% for conventionally treated patients (P<0.001). Likewise, group 2 was associated with lower cause-specific mortality than the institutional comparator group (P = 0.038). Prior tumor resection with lateral wall osteotomy, delay in IACC implementation or exenteration, and failure to adhere to protocol are risk factors for suboptimal outcomes. CONCLUSIONS Neoadjuvant IACC seems to improve overall survival and decrease disease recurrence. An intact lacrimal artery, no disruption of bone barrier or tumor manipulation other than incisional biopsy, and protocol compliance are factors responsible for favorable outcomes. The chemotoxicity complication rate is limited and manageable.
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Affiliation(s)
- David T Tse
- Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
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Fellman M, Carter K, Call CB, Esmaeli B. Disease recurrence after intraarterial chemotherapy in 2 patients with adenoid cystic carcinoma of lacrimal gland. Can J Ophthalmol 2013; 48:e17-8. [PMID: 23561610 DOI: 10.1016/j.jcjo.2012.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 09/11/2012] [Accepted: 09/24/2012] [Indexed: 10/26/2022]
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Wilson KF, Ward PD, Spector ME, Marentette LJ. Orbitocranial approach for treatment of adenoid cystic carcinoma of the lacrimal gland. Ann Otol Rhinol Laryngol 2011; 120:397-400. [PMID: 21774448 DOI: 10.1177/000348941112000609] [Citation(s) in RCA: 5] [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: 11/17/2022]
Abstract
OBJECTIVES Multiple treatment options exist for management of adenoid cystic carcinoma of the lacrimal gland. Our objective was to perform an analysis of outcomes in a cohort of patients with adenoid cystic carcinoma of the lacrimal gland treated identically with an orbitocranial approach. METHODS We performed a retrospective review of 7 consecutive patients who presented to a tertiary care academic medical center between 1995 and 2009 with adenoid cystic carcinoma of the lacrimal gland. RESULTS All patients were treated with an orbitocranial approach to tumor resection followed by postoperative radiotherapy. The mean and median follow-up times were 39 and 19 months, respectively (range, 7 to 138 months). Six patients had orbital reconstruction using free tissue transfer, and 1 patient had a split-thickness skin graft to line the orbital cavity. Two patients developed distant metastases 18 months and 29 months after surgery and ultimately died with disease. Five patients are alive without disease. CONCLUSIONS The orbitocranial approach followed by postoperative irradiation achieves excellent local and regional control rates for adenoid cystic carcinoma of the lacrimal gland, although patients remain at risk long-term for distant metastases. Orbital bone removal to obtain adequate margins should be a routine part of tumor resection for these malignancies.
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Affiliation(s)
- Kevin F Wilson
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Qin W, Chong R, Huang X, Liu M, Yin ZQ. Adenoid cystic carcinoma of the lacrimal gland: CT and MRI findings. Eur J Ophthalmol 2012; 22:316-9. [PMID: 21725943 DOI: 10.5301/ejo.5000015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2011] [Indexed: 12/18/2022]
Abstract
Purpose To highlight the computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of lacrimal gland adenoid cystic carcinoma. Methods We reviewed the clinical records and imaging findings of 17 patients who were histopathologically diagnosed with primary adenoid cystic carcinoma of the lacrimal gland between August 1998 and November 2010. Orbital CT scans were performed in 17 patients and MRI scans were obtained in 13 patients. Results On the CT scans, out of 4 cases of adenoid cystic carcinoma, 3 showed characteristic features of a soft tissue mass with poorly enhancing areas representing cystic changes, and 4 of 17 cases had contiguous bony erosion. On the MRI scans, all cases had mixed signal intensity on T2-weighted images, and 6 cases showed poorly enhancing areas. Conclusions Enhanced CT and MRI (including T2-weighted) are helpful in the diagnosis of primary adenoid cystic carcinoma of the lacrimal gland.
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Skinner HD, Garden AS, Rosenthal DI, Ang KK, Morrison WH, Esmaeli B, Pinnix CC, Frank SJ. Outcomes of malignant tumors of the lacrimal apparatus: the University of Texas MD Anderson Cancer Center experience. Cancer 2011; 117:2801-10. [PMID: 21656758 DOI: 10.1002/cncr.25813] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 10/21/2010] [Accepted: 10/28/2010] [Indexed: 01/13/2023]
Abstract
BACKGROUND Malignant epithelial neoplasms of the lacrimal apparatus are rare and are typically treated with surgery and occasionally adjuvant radiation therapy (RT). The purpose of this study was to assess treatment outcomes by type of surgery (orbital exenteration vs eye-sparing surgery) and clarify the role of adjuvant RT for this rare disease. METHODS Forty-six patients with malignant epithelial neoplasms of the lacrimal apparatus were treated at a single institution from 1945 through 2008. Twenty-seven patients (59%) were treated with orbital exenteration and 19 (41%) with eye-sparing surgery; 64% of the orbital exenteration group and 83% of the eye-sparing surgery group also received adjuvant RT (median dose, 60 grays). Median follow-up time for all patients was 38 months (range, 3-460 months). RESULTS For the orbital exenteration and eye-sparing surgery groups, the 5-year overall survival (OS) rates were 59% and 62%, and the 5-year disease-free survival (DFS) rates were 49% and 39%, respectively (P = .56, P = .35). Tumor status (T1-2 vs T3-4) was associated with OS (P = .02), and tumor size (<3.5 vs >3.5 cm) with DFS (P = .015). Median time to locoregional recurrence was 85 months for orbital exenteration, and 123 months for eye-sparing surgery. All patients who did not receive RT experienced local recurrence, and RT extended time to locoregional recurrence (median 460 vs 30 months, P = .009). Seven grade ≥3 complications were experienced after adjuvant RT. CONCLUSIONS For appropriately selected patients, an eye-sparing surgery for lacrimal apparatus tumors can achieve similar survival outcomes to those in patients treated with an orbital exenteration. Adjuvant RT should be considered for all patients presenting with these rare tumors.
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Affiliation(s)
- Heath D Skinner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Williams MD, Al-zubidi N, Debnam JM, Shinder R, Demonte F, Esmaeli B. Bone Invasion by Adenoid Cystic Carcinoma of the Lacrimal Gland: Preoperative Imaging Assessment and Surgical Considerations. Ophthalmic Plast Reconstr Surg 2010; 26:403-8. [DOI: 10.1097/iop.0b013e3181df6ab9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [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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Lewis KT, Kim D, Chan WF, Jaiwatana J, Calcote C. Conservative Treatment of Adenoid Cystic Carcinoma With Plaque Radiotherapy: A Case Report. Ophthalmic Plast Reconstr Surg 2010; 26:131-3. [DOI: 10.1097/iop.0b013e3181b8c61d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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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Finger PT. Radiation Therapy for Orbital Tumors: Concepts, Current Use, and Ophthalmic Radiation Side Effects. Surv Ophthalmol 2009; 54:545-68. [DOI: 10.1016/j.survophthal.2009.06.004] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 06/17/2009] [Indexed: 11/16/2022]
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Ahmad SM, Esmaeli B, Williams M, Nguyen J, Fay A, Woog J, Selvadurai D, Rootman J, Weis E, Selva D, McNab A, DeAngelis D, Calle A, Lopez A. American Joint Committee on Cancer Classification Predicts Outcome of Patients with Lacrimal Gland Adenoid Cystic Carcinoma. Ophthalmology 2009. [DOI: 10.1016/j.ophtha.2008.12.049 pmid:193950392009-06-01]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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