Meldrum M L, Tse D T, Benedetto P
Department of Ophthalmology, University of Miami School of Medicine, Fla, USA.
Arch Ophthalmol. 1998 Mar;116(3):315-21. doi: 10.1001/archopht.116.3.315.
To investigate a new chemotherapeutic regimen as an adjunct to the conventional surgical management of patients with advanced adenocystic carcinoma of the lacrimal gland.
Two patients with extensive adenocystic carcinoma of the lacrimal gland were treated with intracarotid cisplatin and intravenous doxorubicin hydrochloride prior to orbital exenteration. Postoperatively, the patients received 55 to 60 Gy of orbital irradiation, augmented by additional intravenous cisplatin and doxorubicin. Serial clinical and computed tomographic scan examinations were performed to monitor for evidence of recurrent disease.
Tumor shrinkage was documented radiographically following this preoperative chemotherapy regimen, downstaging the disease in one case from intracranial involvement to a more surgically amenable intraorbital process. Tumor necrosis was confirmed in the exenteration specimen. Limited morbidity was experienced and both patients have achieved long-term survival to date of 9 1/2 years (114 months) and 7 1/2 years (94 months).
To our knowledge, this is the first report of the efficacy of neoadjuvant intracarotid chemotherapy in the treatment of an advanced adenocystic carcinoma of the lacrimal gland. The combination of cisplatin and doxorubicin and the methods of drug delivery may be factors contributory to the favorable response. The results of this new treatment regimen are encouraging and justify further investigation.
研究一种新的化疗方案，作为晚期泪腺腺样囊性癌患者传统手术治疗的辅助手段。
两名泪腺广泛腺样囊性癌患者在眼眶内容剜除术前接受了颈内动脉注射顺铂和静脉注射盐酸多柔比星治疗。术后，患者接受了55至60 Gy的眼眶放疗，并额外静脉注射顺铂和多柔比星。进行了系列临床和计算机断层扫描检查，以监测疾病复发的证据。
术前化疗方案后影像学记录显示肿瘤缩小，其中一例疾病分期从颅内累及降为更适合手术的眶内病变。在剜除标本中证实有肿瘤坏死。患者出现的并发症有限，两名患者均已获得长期生存，至今分别为9年半（114个月）和7年半（94个月）。
据我们所知，这是关于新辅助颈内动脉化疗治疗晚期泪腺腺样囊性癌疗效的首例报告。顺铂和多柔比星的联合应用以及给药方法可能是产生良好反应的因素。这种新治疗方案的结果令人鼓舞，值得进一步研究。
