Outcomes in patients with lacrimal gland carcinoma treated with definitive radiotherapy or eye-sparing surgery followed by adjuvant radiotherapy

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.

Lacrimal gland adenoid cystic carcinoma: report of an unusual case with literature review

“…However, the risk of local recurrence is increased with conservative surgery in patients with advanced-stage disease (T3–T4) at initial diagnosis. Orbital exenteration and adjuvant radiotherapy seems to be a more reasonable option in this group of patients [ 10 , 16 , 17 ].…”

“…Adjuvant radiotherapy is recommended after surgical resection, regardless of its extent, especially for patients at high risk of recurrence, including those with an advanced stage tumor and/or multiple unfavorable pathological factors such as bony structure invasion, positive surgical margins, lymphovascular space invasion, or perineural invasion [ 10 , 15 , 17 ].…”

“…Adjuvant radiation therapy has proven to be effective in preventing locoregional recurrences with local control rates of approximately 50%–80% at 5 years, despite no benefit in survival [ 10 , 18 ]. Addition of radiotherapy following incompletely resected ACC (R0/R1) could decrease the risk of progression, but not following R2 resection [ 8 , 17 ].…”

Aberrantly expressed GFRα-1/RET in patients with lacrimal adenoid cystic carcinoma is associated with high recurrence risk: a retrospective study of 51 LACC cases

“…To determine the potential correlation between recurrence and PNI, we enrolled 51 patients with LACC in our hospital. Representative photographs of a patient with eye-sparing surgery followed by adjuvant radiotherapy 17 , 18 are presented in Figure 1A . Representative images of PNI with H&E staining are shown in Figure 1B .…”

Diagnostic Pitfalls: A Case Series of 5 Patients with Lacrimal Gland Mass

“…A wide variety of space occupying lesions may be encountered in orbit. Out of which, lacrimal gland lesions constitute 10% of all lesions [1,2]. They are further divided into benign and malignant lesions.…”