This is retrospective review of outcomes of lacrimal gland epithelial tumours treated between 1972 and 2014 at Moorfields Eye Hospital. Seventy-nine patients were reported, comprising 53 adenoid cystic carcinomas, 15 primary adenocarcinomas and 11 carcinomas ex-pleomorphic adenoma. The authors compare the survival of nine patients treated by exenteration and removal of adjacent bone (cranio-orbital resection – COR) with 44 who underwent local tumour resection and radiotherapy. An unspecified number of exenteration patients also received radiotherapy. A further 22 patients received radiotherapy alone and four were lost to follow-up. The median disease-free interval for all patients was 3.5 years. The probabilities for overall survival and disease-free survival at five and ten years were similar for those patients undergoing COR with radiotherapy compared with local resection with radiotherapy. Of the 50 patients who had eye-preserving treatment and for whom long-term visual acuity data was available, half had an acuity of 6/24 or better. Those undergoing radiotherapy alone had the worst outcomes, but may have had more extensive disease at diagnosis. The authors state the data supports their hypothesis that radical surgery with exenteration and bone removal does not improve survival. This is a large series with data spanning a treatment period of over 40 years. A weakness of the study is that the COR group were mainly treated prior to 1992, and therefore improvements in radiotherapy since then would not be reflected in the outcomes for this group. 

Cranio-orbital resection does not appear to improve survival of patients with lacrimal gland carcinoma.
Rose GE, Gore SK, Plowman NP.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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