Lacrimal Gland Carcinoma Surgery Risky When Tumors Cross The Orbital Midline

Eye-sparing surgery followed by adjuvant radiotherapy in patients with lacrimal gland carcinoma has a reasonable overall visual prognosis but with significant ocular complications, according to research published in the British Journal of Ophthalmology. Careful and appropriate patient selection is necessary for patients receiving this procedure, according to the report.

Researchers retrospectively reviewed the records of all consecutive patients with a diagnosis of lacrimal gland carcinoma who underwent eye-sparing surgery and adjuvant radiation therapy or adjuvant concurrent chemoradiation therapy at a single institution between October 2007 and July 2018. Using clinical data, including details of ophthalmological examinations and radiation treatment, they reported visual outcomes and ocular complications.

The study included 23 patients (65% men and 35% women; 70% White, 13% Hispanic, and 17% Asian), with median age 51 years (range, 17-71). Most patients (87%) received intensity-modulated proton therapy, while the rest (13%) received intensity-modulated radiotherapy. Most patients (83%) received concurrent chemotherapy. 

At a median follow-up duration of 37 months (range, 8-83), the researchers found that 57% of patients had best-corrected visual acuity 20/40 or better; 13% had moderate vision loss (between 20/40 and 20/200); and 30% had severe vision loss (20/200 or worse). 

The team found the most common ocular complications were dry eye disease (91%), radiation retinopathy (70%) and cataract progression (49%). They also found that tumors crossing the orbital midline (P =.014) and Hispanic ethnicity (P =.014) were associated with increased risk of severe vision loss. They found the risk of radiation retinopathy was higher in both patients with Hispanic ethnicity (hazard ratio [HR], 54.4; 95% confidence interval [CI], 6.5-459.0) and patients with Asian ethnicity (HR, 9.6; 95% CI, 2.1-44.7) compared with patients who are White.

“Given the importance of early diagnosis and intervention for reducing the severity of radiation-induced ocular complications, we believe our findings are helpful and noteworthy. In addition, the significance of tumor crossing the orbital midline is an important new observation that will help in counseling of patients with lacrimal gland carcinoma regarding the expected degree of radiation-induced ocular complications,” according to the researchers.

Limitations of the study included its retrospective design, relatively small samples size, and imbalanced racial and ethnic profile.