Conservative Treatment of Adenoid Cystic Carcinoma With Plaque Radiotherapy: A Case Report

Abstract

Adenoid cystic carcinoma is a rare but aggressive malignant tumor of the lacrimal gland. Mortality rates have been found to be quite high (>50%). This has led to the traditional method of treatment with radical surgery including orbital exenteration and bone resection, followed by external beam radiotherapy to the orbital bed. Despite this aggressive treatment strategy, mortality rates still remain high with only a few reported cases with long-term survival. Recently, several cases of successful treatment of adenoid cystic carcinoma with plaque radiotherapy have been documented. These may show promise of a conservative treatment strategy in selected cases. The authors present a functionally monocular patient with a well-circumscribed adenoid cystic carcinoma that was treated with local excision of the tumor with reverse plaque brachytherapy "boost" to the lacrimal tumor bed followed by a lower dose of radiotherapy to the orbit. The patient is alive and without local recurrence at nearly 4 years.

Adenoid Cystic Carcinoma of the Lacrimal Gland

“…Later, the eye-sparing procedures with complete tumor excision (without RT) became more common. Because this approach was not effective in controlling local recurrence, radical orbital exenteration (without RT) with bone removal was selected in some patients despite the high mortality and low survival rates of 20% [20][21][22][23][24][25].…”

Outcomes after eye‐sparing surgery vs orbital exenteration in patients with lacrimal gland carcinoma

“…The first treatment proposed was radiotherapy, followed in the 1950s by eye-sparing procedures. 11 Because of concerns of local recurrence and potential ocular toxicity from delivery of high-dose radiation near the eye, orbital exenteration became the therapy of choice, 4,5,[11][12][13][14][15] but this radical surgical procedure is associated with a high level of functional and psychological disability. 16 As a consequence, eyesparing surgery followed by radiotherapy is now starting to be recognized as a possible alternative.…”