Eye Cancer Service, Horus Specialty Eye Care, Bangalore, India.
Departments of Ophthalmic Plastic Surgery, Orbit and Ocular Oncology; and Ophthalmic Pathology, LV Prasad Eye Institute, Hyderabad, India.
Ophthalmic Plast Reconstr Surg. 2022;38(4):348-354. doi: 10.1097/IOP.0000000000002108. Epub 2022 Dec 6.
To evaluate the efficacy of multimodal treatment in adenoid cystic carcinoma (ACC) of the lacrimal gland.
A retrospective comparative case series of 40 consecutive patients with ACC of the lacrimal gland without systemic metastasis at the initial presentation and primarily managed by one of the 3 treatment protocols-surgery + external beam radiotherapy (EBRT) (group 1), surgery + EBRT + adjuvant chemotherapy (group 2), and neoadjuvant chemotherapy + surgery + EBRT + adjuvant chemotherapy (multimodal treatment) (group 3) at a tertiary care ocular oncology center. Local tumor control, eye salvage, and systemic metastasis were the primary outcome measures.
The age ranged from 11 to 72 (mean ± SD, 36 ± 13; median, 36) years with 26 (65%) male and 14 (35%) female patients. Twelve (30%) patients belonged to group 1, 8 (20%) to group 2, and 20 (50%) to group 3. Primary surgery included tumor excision in 36 (90%) and orbital exenteration in 4 (10%). Chemotherapy composed of cisplatin + 5 fluorouracil (5FU) for 6 cycles in 28 (70%) patients. Extended-field stereotactic EBRT with a dose of 5,000-6,000 cGy included the entire pretreatment extent of the tumor with a 10-mm margin all around, superior orbital fissure, inferior orbital fissure, cavernous sinus, and temporal fossa. Mean duration of follow up after completion of treatment was 58 ± 26 (range, 29-180; median, 60) months. In all, local tumor recurrence occurred in 10 (25%) patients at a mean of 38 ± 23 (range, 12-120; median, 24) months. Local tumor recurrence was noted in 5 (42%) patients in group 1, 2 (25%) in group 2, and 3 (15%) in group 3. Overall, eye salvage was possible in 34 (85%) patients, with visual acuity >20/40 in 28 (82%). Systemic metastasis occurred in 10 (25%) patients at a mean of 53 ± 28 (range, 12-120; median, 43) months. Eight (67%) patients in group 1, 1 (13%) in group 2, and 1 (5%) in group 3 developed systemic metastasis. Six (15%) overall, 5 (42%) in group 1 and 1 (13%) in group 2, died with systemic metastasis.
Multimodal treatment with sequential neoadjuvant chemotherapy, followed by surgery, extended-field stereotactic EBRT, and adjuvant chemotherapy seems relatively more effective in providing local tumor control and eye salvage and in minimizing the risk of systemic metastasis in ACC of the lacrimal gland.
评估多模式治疗在泪腺癌中的疗效。
对在初始表现时无全身转移且主要通过以下 3 种治疗方案之一治疗的 40 例连续的原发性泪腺癌患者进行回顾性对比病例系列研究：手术+外照射放疗（EBRT）（第 1 组）、手术+EBRT+辅助化疗（第 2 组）和新辅助化疗+手术+EBRT+辅助化疗（多模式治疗）（第 3 组），在一家三级眼科肿瘤治疗中心进行。局部肿瘤控制、保眼和全身转移是主要的观察指标。
年龄为 11 至 72 岁（平均±标准差，36±13；中位数，36），26 例（65%）为男性，14 例（35%）为女性。12 例（30%）患者属于第 1 组，8 例（20%）属于第 2 组，20 例（50%）属于第 3 组。初次手术包括肿瘤切除术 36 例（90%）和眶内容切除术 4 例（10%）。化疗包括顺铂+5-氟尿嘧啶（5FU）6 个周期，28 例（70%）患者接受了化疗。扩展野立体定向 EBRT 采用 5000-6000cGy 剂量，包括整个肿瘤预处理范围，周围 10mm 边界，眶上裂、眶下裂、海绵窦和颞窝。治疗完成后平均随访 58±26（范围，29-180；中位数，60）个月。所有患者中，10 例（25%）患者在平均 38±23（范围，12-120；中位数，24）个月时出现局部肿瘤复发。第 1 组 5 例（42%）、第 2 组 2 例（25%）和第 3 组 3 例（15%）患者出现局部肿瘤复发。总体而言，34 例（85%）患者实现了保眼，28 例（82%）患者视力>20/40。10 例（25%）患者出现全身转移，平均 53±28（范围，12-120；中位数，43）个月。第 1 组 8 例（67%）、第 2 组 1 例（13%）和第 3 组 1 例（5%）患者出现全身转移。6 例（15%）患者、第 1 组 5 例（42%）和第 2 组 1 例（13%）患者因全身转移而死亡。
多模式治疗包括序贯新辅助化疗、手术、扩展野立体定向 EBRT 和辅助化疗，在提供局部肿瘤控制和保眼、降低泪腺癌全身转移风险方面似乎更为有效。
