Orbitocranial Approach for Treatment of Adenoid Cystic Carcinoma of the Lacrimal Gland

• Published in: Annals of otology, rhinology & laryngology Vol. 120; no. 6; pp. 397 - 400
• Main Authors: Wilson, Kevin F., Ward, P. Daniel, Spector, Matthew E., Marentette, Lawrence J.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-06-2011; Annals Publishing Compagny; SAGE PUBLICATIONS, INC
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Adenoid Cystic - diagnosis; Carcinoma, Adenoid Cystic - surgery; Eye Neoplasms - diagnosis; Eye Neoplasms - surgery; Female; Follow-Up Studies; Humans; Lacrimal Apparatus - pathology; Lacrimal Apparatus - surgery; Lacrimal Apparatus Diseases - diagnosis; Lacrimal Apparatus Diseases - surgery; Male; Medical sciences; Middle Aged; Ophthalmologic Surgical Procedures - methods; Orbit - surgery; Otorhinolaryngology. Stomatology; Retrospective Studies; Skull - surgery; Treatment Outcome; adenoid cystic carcinoma; lacrimal gland; orbitocranial resection; Cystic adenoid carcinoma; Lacrimal gland; Treatment; Surgery; Surgical resection; ENT; Malignant tumor; Cancer
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/000348941112000609

Objectives:
Multiple treatment options exist for management of adenoid cystic carcinoma of the lacrimal gland. Our objective was to perform an analysis of outcomes in a cohort of patients with adenoid cystic carcinoma of the lacrimal gland treated identically with an orbitocranial approach.
Methods:
We performed a retrospective review of 7 consecutive patients who presented to a tertiary care academic medical center between 1995 and 2009 with adenoid cystic carcinoma of the lacrimal gland.
Results:
All patients were treated with an orbitocranial approach to tumor resection followed by postoperative radiotherapy. The mean and median follow-up times were 39 and 19 months, respectively (range, 7 to 138 months). Six patients had orbital reconstruction using free tissue transfer, and 1 patient had a split-thickness skin graft to line the orbital cavity. Two patients developed distant metastases 18 months and 29 months after surgery and ultimately died with disease. Five patients are alive without disease.
Conclusions:
The orbitocranial approach followed by postoperative irradiation achieves excellent local and regional control rates for adenoid cystic carcinoma of the lacrimal gland, although patients remain at risk long-term for distant metastases. Orbital bone removal to obtain adequate margins should be a routine part of tumor resection for these malignancies.