Current Trends in the Management of Epithelial Lacrimal Gland Tumors: A Retrospective National Cancer Database Analysis

Abstract

Background: Lacrimal gland tumors are rare with data limited to very few large studies. Contemporary strategies like orbit sparing surgeries and neoadjuvant intraarterial chemotherapy remain controversial.Methods: This is a retrospective cohort analysis of epithelial lacrimal gland tumors from the 2004-2016 National Cancer Database. Patients were stratified based on the type of surgery (limited vs destructive) and various treatment modalities employed.Results: Squamous cell carcinoma (33.48%) and adenoid cystic carcinoma (29.45%) were the commonest histologies (N=669). Comparison of limited (46.33%) vs destructive procedures (53.11%) among 482 patients did not show any survival difference, nor the comparison between surgery vs ± chemotherapy vs ± radiotherapy among 472 patients.Conclusion: Squamous cell carcinoma and adenoid cystic carcinoma are the commonest types of lacrimal gland tumors seen in our study. Tumor spread from adjacent sites may have contributed to the higher percentage of squamous cell carcinomas seen. The type of surgery or chemoradiation use did not alter survival.

Pathologic Features, Treatment, and Clinical Outcomes of Lacrimal Gland Cancer

“…Rather, these cases of squamous cell carcinoma, as well as the cases of transitional cell carcinoma presented in these studies, are highly likely to be tumors of the lacrimal duct or sac. In a more recent study querying the NCDB, 33.5% of cases were squamous cell carcinomas [7], again suggesting that virtually all these cases represented lacrimal duct or sac tumors. Unfortunately, the ICD-O-3 site code for all three subsites (the lacrimal gland, duct, and sac) is C69.5, increasing the difficulty of distinguishing these tumors and potentially altering the validity of outcome reporting in these large-database analyses.…”

“…The addition of adjuvant radiation therapy is often considered for high-risk lesions, and the addition of neoadjuvant chemotherapy has also been suggested to confer benefit [3,4]. Three retrospective large-database analyses of lacrimal gland cancers have been published, two focusing on data from the surveillance, epidemiology, and end results (SEER) program [5,6], and another study, using the national cancer database (NCDB) [7]. However, a large fraction of cases analyzed in these studies represent histologies that are exceedingly rare in the lacrimal gland, including squamous cell carcinomas and transitional cell carcinomas.…”

Lacrimal sac squamous cell carcinoma: From resection to prosthetic rehabilitation. A case report

“… 14 Adjuvant treatment modalities include external beam RT, local RT (plaque brachytherapy), proton therapy, chemotherapy (CHOP regimen) or immunotherapy. 6 , 20 Ashok Kumar et al 21 in their study provided the retrospective cohort analysis of epithelial lacrimal gland tumors type of surgery and various treatment modalities from the National Cancer Database. Patients were divided into eight groups, based on the combinations of adjuvant or neoadjuvant chemotherapy or RT used.…”

The poor prognosis of lacrimal gland adenocarcinoma: a clinical study and literature review

“…Adenocarcinoma of the lacrimal gland is a malignant epithelial tumor of low incidence. Ashok et al analyzed 669 cases of lacrimal gland tumor; adenocarcinoma accounted for 10.46% of them (Ashok Kumar et al 2022 ). Andreoli et al analyzed 702 cases of malignant lacrimal gland tumor; adenocarcinoma accounted for 3.8% of the cases (Andreoli et al 2015 ).…”