Today, we turn to a rare salivary gland tumor to illustrate the potential impact of using chemotherapy before surgery. The lacrimal glands are ones that secrete tears and are located above and to the side of the eye. Lacrimal tumors can be either benign (not cancer) or malignant (cancer, meaning that it has the capacity to spread to distant part of the body). One rare type of lacrimal gland tumor is adenoid cystic carcinoma (AdCC). As it grows, AdCC can push the due forward, causing it to bulge. This is known as proptosis. Some patients may have associated pain, owing to invasion of nearby nerves.
The Study: Investigators at the University of Miami Miller School of Medicine (USA) looked at 19 consecutively treated patients. Patients who had chemotherapy (through an artery) before the surgery had better outcomes (longer survival). All patients were treated with intra-arterial chemotherapy to reduce the tumor size before surgery (that is, they had neoadjuvant chemotherapy). The patients then had a removal of the affected eye (orbital exenteration), chemotherapy with radiation therapy, and intravenous chemotherapy.
Reference: Tse DT. Ophthalmology 2013;120:1313-1323.
Results: Kudos! I know, I know. Small study… Eight of the 19 patients in the analysis had an intact lacrimal artery. Those patients demonstrated a 10-year overall and disease free survival rate of 100%, as compared to 29% for the group that did not get the intra-arterial chemotherapy.
My Take: Intra-arterial pre surgical chemotherapy appears to improve overall survival, while decreasing disease recurrence. An intact lacrimal artery, no disruption of the nearby bone, and no upfront tumor manipulation, and protocol compliance were associated with favorable outcomes. The authors describe the complication rate as limed (and manageable). A small series, but certainly suggestive of a potential role for intra-arterial neoadjuvant chemotherapy (in addition to the standard approaches). I’m Dr. Michael Hunter.
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