Conservative treatment of lacrimal gland malignancies seen increasing

ANAHEIM, Calif. — The need for orbital exenteration in patients with some lacrimal gland malignancies is increasingly being challenged, according to an ocular oncology expert speaking here.

The customary belief has been that exenteration of eyes with primary epithelial malignancies of the lacrimal gland (PEMLG) is mandatory, said Jerry A. Shields, MD, here at the American Society of Ophthalmic Plastic and Reconstructive Surgery meeting. However, there appears to be a trend away from exenteration of such eyes at many centers, he said.

When possible, more conservative eye-sparing procedures such as local resection, usually combined with chemotherapy and radiation, are being used, Dr. Shields said.

In his presentation he reviewed the experience with PEMLG at the ocular oncology section of Wills Eye Hospital in Philadelphia, which he heads. He found that of eight patients with adenoid cystic carcinoma of the lacrimal gland in which brachytherapy was used, “all the patients are alive and well” with a relatively short follow-up of 1 to 11 years. In seven patients the eye was saved, and one tumor that progressed required exenteration.

Dr. Shields also noted that, although adenoid cystic carcinoma is the most frequent form of PEMLG, other neoplasms not previously known to affect the lacrimal gland are being recognized. He and his coauthors reviewed more than 1,200 patients at Wills with space-occupying orbital lesions and found 114 that were of lacrimal origin. Of those, 19 (17%) were PEMLG. In these patients there were 14 cases of adenoid cystic carcinoma, four cases of pleomorphic adenocarcinoma and one of mucoepidermoid carcinoma.

Dr. Shields said that because of their malignant behavior, PEMLG requires prompt diagnosis and carefully planned treatment.