Bengoa-González Alvaro, Mencía-Gutiérrez Enrique, Garrido María, Salvador Elena, Lago-Llinás María-Dolores
Ophthalmology Department, 12 de Octubre Hospital, Complutense University, Madrid, Spain.
Pathology Department, 12 de Octubre Hospital, Complutense University, Madrid, Spain.
J Ophthalmol. 2024 Feb 29;2024:4347707. doi: 10.1155/2024/4347707. eCollection 2024.
Basal cell carcinoma (BCC) is the most frequent malignant periocular tumor. It is associated with exposure to ultraviolet radiation, and its incidence is gradually increasing. It may occasionally display more aggressive behavior and result in orbital or intracranial invasion. Mortality from periocular BBC with orbital invasion is very low, but the associated morbidity can be significant, from disfigurement to blindness. Traditionally, these cases have been treated with orbital exenteration or with radiotherapy (RT), but in recent years, hedgehog pathway inhibitors (HPIs) have emerged, are effective in more serious cases, and are used primarily or combined with surgery, changing our perspective on the management of these patients.
We studied 24 cases of periocular BCC with orbital invasion, some primary and others recurrent, which were treated between 2011 and 2021 in the same hospital. All patients had clinical or radiological evidence of orbital invasion. Orbital exenteration was performed on 9/24 of the patients (1 received vismodegib after surgery), and 12/24 were treated, surgically preserving the eyeball, with 3 of them receiving adjuvant vismodegib. Three of the twenty-four patients were treated exclusively with vismodegib (Erivedge®, Genentech).
One patient died due to poor tumor evolution, but the rest evolved favorably and they have had no recurrences. Vismodegib was generally well tolerated, except for in one patient who discontinued treatment due to the side effects.
In advanced BBC with orbital invasion, mutilating surgical treatments such as exenteration or potentially vision-threatening treatments such as RT remain as options. In recent years, however, very promising new medical therapies have emerged, such as HPI, which can be used effectively instead of surgery or in combination with it, preserving the eye and vision, which implies a new approach to treatment.
基底细胞癌（BCC）是最常见的眼周恶性肿瘤。它与紫外线辐射暴露有关，且发病率逐渐上升。它偶尔可能表现出更具侵袭性的行为，并导致眼眶或颅内侵犯。伴有眼眶侵犯的眼周基底细胞癌的死亡率很低，但相关的发病率可能很高，从毁容到失明不等。传统上，这些病例采用眼眶内容剜除术或放射治疗（RT），但近年来，刺猬通路抑制剂（HPIs）已出现，在更严重的病例中有效，主要单独使用或与手术联合使用，改变了我们对这些患者治疗的看法。
我们研究了24例伴有眼眶侵犯的眼周基底细胞癌病例，其中一些是原发性的，另一些是复发性的，这些病例于2011年至2021年在同一家医院接受治疗。所有患者均有眼眶侵犯的临床或影像学证据。9/24的患者接受了眼眶内容剜除术（其中1例术后接受了维莫德吉治疗），12/24的患者接受了保留眼球的手术治疗，其中3例接受了辅助维莫德吉治疗。24例患者中有3例仅接受维莫德吉（Erivedge®，基因泰克公司）治疗。
1例患者因肿瘤进展不佳死亡，但其余患者病情进展良好，且无复发。维莫德吉总体耐受性良好，除了1例因副作用而停药的患者。
在伴有眼眶侵犯的晚期基底细胞癌中，诸如眼眶内容剜除术等致残性手术治疗或诸如放射治疗等可能威胁视力的治疗方法仍是选择。然而，近年来出现了非常有前景的新的药物治疗方法，如刺猬通路抑制剂，它可以有效地替代手术或与手术联合使用，保留眼睛和视力，这意味着一种新的治疗方法。
