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Neutron Radiotherapy for Adenoid Cystic Carcinoma of the Lacrimal Gland

Gensheimer, Michael F. M.D.*; Rainey, David B.S.*; Douglas, James G. M.D., M.S.; Liao, Jay J. M.D.*; Laramore, George E. Ph.D., M.D.*; Jian-Amadi, Arash M.D.; Chow, Laura Q. M. M.D.*; Koh, Wui-Jin M.D.*; Parvathaneni, Upendra M.B.B.S., F.R.A.N.Z.C.R.*

Ophthalmic Plastic & Reconstructive Surgery: July/August 2013 - Volume 29 - Issue 4 - p 256–260
doi: 10.1097/IOP.0b013e318295f99b
Original Investigation

Purpose: Lacrimal gland adenoid cystic carcinomas are rare, aggressive orbital tumors that share histopathologic similarities with salivary gland malignancies. Neutron radiotherapy may be useful for treatment due to its high biological effectiveness for salivary malignancies.

Methods: The authors retrospectively reviewed the outcomes for 11 lacrimal gland adenoid cystic carcinoma patients treated with neutrons from 1988 to 2011. Most had undergone surgery prior to radiation therapy. However, gross residual disease was present in 8 patients. The most common American Joint Committee on Cancer stage was T4cN0M0. Four patients with skull base involvement received a radiosurgery boost and 1 received a proton therapy boost.

Results: Median follow up was 6.2 years. Median overall survival was 11.1 years and median disease-free survival was 6.3 years. Five-year local control was estimated by the Kaplan–Meier method as 80%. Three patients had a local recurrence; 4 developed distant metastases. Six patients died. Seven patients had intact vision in the affected eye before neutron radiation. Two required enucleation for a painful dry eye. Of the 5 who avoided an enucleation, 3 had either severe visual impairment (20/400) or only light perception and 2 were without known vision compromise or complications at the time of their death. One patient developed asymptomatic frontal lobe radionecrosis after 2 courses of radiation therapy.

Conclusions: Neutron radiation therapy achieved excellent 5-year local control in this series of high-risk patients, with most cases having gross residual disease. Late recurrences and distant metastases remain a challenge. Meaningful ipsilateral vision preservation was not possible in most cases in the long term, although only 2 patients required an enucleation for treatment effects.

Eleven patients were treated with neutron radiotherapy for lacrimal gland adenoid cystic carcinoma; 5-year local control was superior to historically reported outcomes with orbital exenteration or conventional radiotherapy.

*University of Washington Medical Center, Seattle, Washington; Indiana University School of Medicine, Bloomington, Indiana; and Harborview Medical Center, Seattle, Washington, U.S.A.

Accepted for publication March 21, 2013.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Upendra Parvathaneni, M.B.B.S., F.R.A.N.Z.C.R., University of Washington Medical Center, 1959 NE Pacific Street, Box 356043, Seattle, WA 98195. E-mail: upendra@u.washington.edu

© 2013 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.