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Sheila M. Garcia-Santana, Anshu Jain, Roya Ghafouri; Treatment Outcomes for Malignant Tumors of the Lacrimal Gland. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1262.
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© ARVO (1962-2015); The Authors (2016-present)
Malignant tumors of the lacrimal gland are a very rare entity and the optimal treatment approach has not been well defined. The purpose of this study was to characterize the factors affecting survival outcomes of patients with lacrimal gland tumors using data available from the NCI SEER database.
From 1973 to 2008, a total of 256 cases with primary malignant neoplasms of the lacrimal gland were identified from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program database. TNM subgroup analyses were conducted for patients who had American Joint Committee on Cancer (AJCC) 6th edition staging at time of diagnosis. Factors significantly associated with cause-specific and overall survival were determined by chi-square test method. Cause-specific and overall survival curves were generated using the Kaplan Meier method, and statistical significance was analyzed using log rank testing.
The incidence of malignant lacrimal gland tumors had a bimodal age distribution, with peaks occurring at 40-44 and 55-74 years of age. The most common histology was adenoid cystic carcinoma (n=81; 31.6%), followed by squamous cell carcinoma (n=72; 28.1%), mixed malignant tumors (n=36; 14.1%), and mucoepidermoid carcinoma (n=21, 8.2%). Of the 62 patients that had AJCC staging, 34% had T1 or T2 tumors (n=21), and 66% had T3 or T4 tumors (n=41). Most patients were treated with either surgery alone (35%) or surgery followed by adjuvant radiation (44.5%).A total of 130 patients from 1998 to 2008 were classified as either having local excision of tumor or radical surgery with enucleation. There was no significant survival benefit for patients receiving radical surgery versus globe preserving surgery (p=0.396).Both adenoid cystic carcinoma and squamous cell carcinoma were associated to lower cause specific survival (p=0.004 and p=0.019 respectively). Mucoepidermoid carcinoma and mixed malignant tumors were not associated to cause specific survival (p=0.269 and p=0.995 respectively). Adjuvant radiation conferred a statistically significant survival benefit in patients with T3/T4 tumors (p=0.006), but did not have benefit for patients with T1/T2 tumors (p=0.290).
This data supports the recommendation that globe-preserving surgery be considered whenever possible, as there does not appear to be a survival benefit as compared to more radical surgery. Additionally, adjuvant radiation therapy should be considered in locally advanced tumors of the lacrimal gland.
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