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No survival rate improvement seen after cranio-orbital resection for lacrimal gland carcinoma
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Local resection with radiotherapy has comparable results with cranio-orbital resection in terms of tumor recurrence and survival rate in patients with lacrimal gland carcinoma. Therefore, this method should be preferred because it is less disfiguring and preserves useful vision, according to a study.
Seventy-nine patients treated at Moorfields Eye Hospital for lacrimal gland carcinoma between 1972 and 2014 were identified. The mean age at presentation was 48 years. Most of those treated after 1992 had local tumor resection and postoperative radiotherapy (LRR). Before 1992, patients had cranio-orbital resection (COR), LRR or external beam radiotherapy (EBR) only. The median follow-up was 4.7 years, ranging between 1.5 months and 30 years. Those with a follow-up of less than 2 years were patients who died from tumor complications or other causes.
The probability of overall survival for the entire cohort was 0.59 at 5 years and 0.52 at 10 years. Fifty patients died during the follow-up, with the tumor being the cause in 72% of the cases. Persistent tumor growth or recurrence was reported in 56% of the cases. Metastases mainly affected the lungs, liver, lymph nodes and brain.
When comparing treatment modalities, the authors found that patients who had EBR alone had the worst prognosis, while patients who had COR and LRR had the same overall survival and similar rates for recurrence and metastasis.
“We, therefore, strongly advocate abandonment of orbital exenteration and bone resection (COR) for most patients with lacrimal gland carcinomas — this treatment not only causing major facial disfigurement but also sacrificing a functioning eye,” the authors wrote.
They also called EBR alone “inadequate” and said it was associated with higher rates of recurrence and death. – by Michela Cimberle
Disclosures: The authors report no relevant financial disclosures.
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