ASOPRSFall Scientific SymposiumSyllabus
92
Oncology Session
Moderator: JonathanW. Kim,MD
8:02 am
GlobeSparingSurgery andPost-operativehigh-doseRadiationTherapy for
Lacrimal GlandCarcinoma
Bita Esmaeli
1
, VivianYin
1
, EhabHanna
2
,Merrill Kies
3
,WilliamWilliam
3
, DianaBell
4
, Steven Frank
5
.
1
Orbital Oncology&Ophthalmic
PlasticSurgeryProgram,MDAndersonCancer Center, Houston, TX, UnitedStates,
2
Head andNeckSurgeryDepartment,MDAnderson
Cancer Center, Houston, TX, UnitedStates,
3
Head andNeckMedical OncologyDepartment,MDAndersonCancer Center, Houston, TX,
UnitedStates,
4
RadiationOncologyDepartment,MDAndersonCancer Center, Houston, TX, UnitedStates
Introduction:
The standard treatment for lacrimal gland carcinoma has historically entailed orbital exenteration .We herein describe
11 patientswho underwent globe sparing surgical resection of lacrimal gland carcinoma followed by high dose radiotherapy (RT).
We report on early ocular toxicity and local control rates.
Methods:
Themedical records of all consecutive patientswith a diagnosis of lacrimal gland carcinoma treated at a tertiary cancer
center between 2007 and 2014were retrospectively reviewed. Primary endpoints included the histologic type, type and dose of
radiation, ocular toxicity fromRT, local and regional control rates, and disease free survival.
Results:
Eleven of 20 patientswith a diagnosis of lacrimal gland carcinoma during the study period had globe-sparing surgery
followed by high dose RT.These 11 patientswere further studied in detail. Sixmale and 5 female patients had amedian age of
55 yrs (range: 17-65 yrs).The histologic diagnosiswas adenoid cystic carcinoma (n=7), carcinoma ex-pleomorphic adenoma (n=2),
high grade adenocarcinoma (n=1), and low-grade adenocarcinoma (n=1).TheAJCC 7
th
edition “T” categorywas:T1 (n=1),T2
(n=6 ),T3 (n=1),T4b (n=2 ), andT4c (n=1 ).All 11 patients underwent globe-sparing surgical resection of lacrimal gland carcinoma;
all but 3 had negative surgical margins. Postoperative RTwas carried out in 10 patients; one patient refused postoperative radiation
therapy.Three patients had concurrent adjuvant chemotherapy during radiation.The radiationmodalitywas protons (IMPT) in 8
patients, photons (IMRT) in two patients, and gamma knife in one patient.The total radiation dose ranged from 50 to 64Gy
(or CGE for protons); median dose= 62Gy.With amedian follow-up time after radiation therapy of 19months (range: 6- 64
months), ocular toxicity included dry eye syndrome in all 11 patients, and severe corneal and conjunctival toxicity leading to eventual
enucleation in one patient (very first patient in cohort) treatedwith IMRT.All 11 patientswere disease-free at last contact (median:
12months after treatments). Only the one patient who refused postoperative RT experienced local recurrence; she later had gamma
knife for her recurrent lesion.
Conclusions:
Globe sparing surgery followed by high dose radiation therapy is feasible and is associatedwithmild and acceptable
ocular toxicity.Although the follow-up time for this cohort is relatively short, there seems to be reasonable local control achievedwith
this combinedmodality approach.
References:
Esmaeli B, GolioD, KiesM, etal. Surgical management of locally advanced adenoid cystic carcinoma of the lacrimal
gland. Ophthal Plast Reconstr Surg 2006;22:366-70.
Ahmad SM, Esmaeli, B,WilliamsM,etal..AJCC predicts outcome of patientswith lacrimal-gland adenoid cystic carcinoma.
Ophthalmology, 116(6):1210-5, 2009.
DetailedProgram
—Friday,October 17, 2014
