J Neurol Surg B Skull Base 2020; 81(04): 480-496
DOI: 10.1055/s-0040-1713894
Evolution of Care of Orbital Tumors
Review Article

Evolution of Care of Orbital Tumors with Radiation Therapy

Myrsini Ioakeim-Ioannidou
1   Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Shannon M. MacDonald
1   Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
› Institutsangaben

Abstract

Orbital tumors are rare lesions comprising 0.1% of all tumors and less than 20% of all ocular diseases. These lesions in children and adults differ significantly in their incidence, tumor type, and treatment management. Although surgery and systemic therapies are commonly used in the management of these diseases, radiation therapy has become a widely used treatment for both benign and malignant tumors of the orbit. Radiotherapy is used as a definitive treatment to provide local control while avoiding morbidity associated with surgery for some tumors while it is used as an adjuvant treatment following surgical resection for others. For many tumors, radiation provides excellent tumor control with preservation of visual function. This article is dedicated for presenting the most common applications of orbital radiotherapy. A brief overview of the commonly available radiation therapy modalities is given. Dose constraint goals are reviewed and acute and long-term side effects are discussed. Orbital tumors covered in this article include optic glioma, ocular melanoma, retinoblastoma, orbital rhabdomyosarcoma, orbital lymphoma, and lacrimal gland tumors. Background information, indications for radiotherapy, and goals of treatment for each case example are described.



Publikationsverlauf

Artikel online veröffentlicht:
24. August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 MacDonald SM, DeLaney TF, Loeffler JS. Proton beam radiation therapy. Cancer Invest 2006; 24 (02) 199-208
  • 2 Trofimov A, Bortfeld T. Optimization of beam parameters and treatment planning for intensity modulated proton therapy. Technol Cancer Res Treat 2003; 2 (05) 437-444
  • 3 Mohan R, Grosshans D. Proton therapy - present and future. Adv Drug Deliv Rev 2017; 109: 26-44
  • 4 Macdonald SM, Sethi R, Lavally B. et al. Proton radiotherapy for pediatric central nervous system ependymoma: clinical outcomes for 70 patients. Neuro-oncol 2013; 15 (11) 1552-1559
  • 5 MacDonald SM, Trofimov A, Safai S. et al. Proton radiotherapy for pediatric central nervous system germ cell tumors: early clinical outcomes. Int J Radiat Oncol Biol Phys 2011; 79 (01) 121-129
  • 6 De Amorim Bernstein K, Sethi R, Trofimov A. et al. Early clinical outcomes using proton radiation for children with central nervous system atypical teratoid rhabdoid tumors. Int J Radiat Oncol Biol Phys 2013; 86 (01) 114-120
  • 7 Ando K, Kase Y. Biological characteristics of carbon-ion therapy. Int J Radiat Biol 2009; 85 (09) 715-728
  • 8 Goetz G, Mitic M, Mittermayr T, Wild C. Health technology assessment of carbon-ion beam radiotherapy: a systematic review of clinical effectiveness and safety for 54 oncological indications in 12 tumour regions. Anticancer Res 2019; 39 (04) 1635-1650
  • 9 Hayashi K, Koto M, Ikawa H, Ogawa K, Kamada T. Efficacy and safety of carbon-ion radiotherapy for lacrimal gland carcinomas with extraorbital extension: a retrospective cohort study. Oncotarget 2018; 9 (16) 12932-12940
  • 10 Akbaba S, Lang K, Held T. et al. Carbon-ion radiotherapy in accelerated hypofractionated active raster-scanning technique for malignant lacrimal gland tumors: feasibility and safety. Cancer Manag Res 2019; 11: 1155-1166
  • 11 Hu W, Hu J, Gao J. et al. Outcomes of orbital malignancies treated with eye-sparing surgery and adjuvant particle radiotherapy: a retrospective study. BMC Cancer 2019; 19 (01) 776
  • 12 Gordon KB, Char DH, Sagerman RH. Late effects of radiation on the eye and ocular adnexa. Int J Radiat Oncol Biol Phys 1995; 31 (05) 1123-1139
  • 13 Stafford SL, Kozelsky TF, Garrity JA. et al. Orbital lymphoma: radiotherapy outcome and complications. Radiother Oncol 2001; 59 (02) 139-144
  • 14 Barabino S, Raghavan A, Loeffler J, Dana R. Radiotherapy-induced ocular surface disease. Cornea 2005; 24 (08) 909-914
  • 15 Monroe AT, Bhandare N, Morris CG, Mendenhall WM. Preventing radiation retinopathy with hyperfractionation. Int J Radiat Oncol Biol Phys 2005; 61 (03) 856-864
  • 16 Parsons JT, Bova FJ, Fitzgerald CR, Mendenhall WM, Million RR. Radiation retinopathy after external-beam irradiation: analysis of time-dose factors. Int J Radiat Oncol Biol Phys 1994; 30 (04) 765-773
  • 17 Shields JA, Shields CL, Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions: the 2002 Montgomery Lecture, part 1. Ophthalmology 2004; 111 (05) 997-1008
  • 18 Taban M, Perry J. Classification of orbital tumors. In: Singh AD, Damato BE, Pe'er J. , et al, eds. Clinical Ophthalmic Oncology. Philadelphia: Saunders-Elsevier; 2007: 517-519
  • 19 Miller NR. Primary tumours of the optic nerve and its sheath. Eye (Lond) 2004; 18 (11) 1026-1037
  • 20 Cohen ME, Duffner PK. Optic pathway tumors. Neurol Clin 1991; 9 (02) 467-477
  • 21 Listernick R, Charrow J, Greenwald M, Mets M. Natural history of optic pathway tumors in children with neurofibromatosis type 1: a longitudinal study. J Pediatr 1994; 125 (01) 63-66
  • 22 Kelly JP, Leary S, Khanna P, Weiss AH. Longitudinal measures of visual function, tumor volume, and prediction of visual outcomes after treatment of optic pathway gliomas. Ophthalmology 2012; 119 (06) 1231-1237
  • 23 Mishra MV, Andrews DW, Glass J. et al. Characterization and outcomes of optic nerve gliomas: a population-based analysis. J Neurooncol 2012; 107 (03) 591-597
  • 24 Packer RJ, Ater J, Allen J. et al. Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas. J Neurosurg 1997; 86 (05) 747-754
  • 25 Prados MD, Edwards MS, Rabbitt J, Lamborn K, Davis RL, Levin VA. Treatment of pediatric low-grade gliomas with a nitrosourea-based multiagent chemotherapy regimen. J Neurooncol 1997; 32 (03) 235-241
  • 26 Cappellano AM, Petrilli AS, da Silva NS. et al. Single agent vinorelbine in pediatric patients with progressive optic pathway glioma. J Neurooncol 2015; 121 (02) 405-412
  • 27 Bouffet E, Jakacki R, Goldman S. et al. Phase II study of weekly vinblastine in recurrent or refractory pediatric low-grade glioma. J Clin Oncol 2012; 30 (12) 1358-1363
  • 28 Dombi E, Baldwin A, Marcus LJ. et al. Activity of selumetinib in neurofibromatosis type 1-related plexiform neurofibromas. N Engl J Med 2016; 375 (26) 2550-2560
  • 29 Miller C, Guillaume D, Dusenbery K, Clark HB, Moertel C. Report of effective trametinib therapy in 2 children with progressive hypothalamic optic pathway pilocytic astrocytoma: documentation of volumetric response. J Neurosurg Pediatr 2017; 19 (03) 319-324
  • 30 Bavle A, Jones J, Lin FY, Malphrus A, Adesina A, Su J. Dramatic clinical and radiographic response to BRAF inhibition in a patient with progressive disseminated optic pathway glioma refractory to MEK inhibition. Pediatr Hematol Oncol 2017; 34 (04) 254-259
  • 31 Burger MC, Ronellenfitsch MW, Lorenz NI. et al. Dabrafenib in patients with recurrent, BRAF V600E mutated malignant glioma and leptomeningeal disease. Oncol Rep 2017; 38 (06) 3291-3296
  • 32 Kortmann RD, Timmermann B, Taylor RE. et al. Current and future strategies in radiotherapy of childhood low-grade glioma of the brain. Part I: Treatment modalities of radiation therapy. Strahlenther Onkol 2003; 179 (08) 509-520
  • 33 Regueiro CA, Ruiz MV, Millán I, de la Torre A, Romero J, Aragón G. Prognostic factors and results of radiation therapy in optic pathway tumors. Tumori 1996; 82 (04) 353-359
  • 34 Tao ML, Barnes PD, Billett AL. et al. Childhood optic chiasm gliomas: radiographic response following radiotherapy and long-term clinical outcome. Int J Radiat Oncol Biol Phys 1997; 39 (03) 579-587
  • 35 Khafaga Y, Hassounah M, Kandil A. et al. Optic gliomas: a retrospective analysis of 50 cases. Int J Radiat Oncol Biol Phys 2003; 56 (03) 807-812
  • 36 Bitterman DS, MacDonald SM, Yock TI. et al. Revisiting the role of radiation therapy for pediatric low-grade glioma. J Clin Oncol 2019; 37 (35) 3335-3339
  • 37 Hassan WM, Bakry MS, Hassan HM, Alfaar AS. Incidence of orbital, conjunctival and lacrimal gland malignant tumors in USA from Surveillance, Epidemiology and End Results, 1973-2009. Int J Ophthalmol 2016; 9 (12) 1808-1813
  • 38 McLaughlin CC, Wu XC, Jemal A, Martin HJ, Roche LM, Chen VW. Incidence of noncutaneous melanomas in the U.S. Cancer 2005; 103 (05) 1000-1007
  • 39 Aronow ME, Topham AK, Singh AD. Uveal melanoma: 5-year update on incidence, treatment, and survival (SEER 1973-2013). Ocul Oncol Pathol 2018; 4 (03) 145-151
  • 40 Damato B. Progress in the management of patients with uveal melanoma. The 2012 Ashton Lecture. Eye (Lond) 2012; 26 (09) 1157-1172
  • 41 Shields CL, Kaliki S, Livesey M. et al. Association of ocular and oculodermal melanocytosis with the rate of uveal melanoma metastasis: analysis of 7872 consecutive eyes. JAMA Ophthalmol 2013; 131 (08) 993-1003
  • 42 Weis E, Shah CP, Lajous M, Shields JA, Shields CL. The association of cutaneous and iris nevi with uveal melanoma: a meta-analysis. Ophthalmology 2009; 116 (03) 536-543.e2
  • 43 Harbour JW, Onken MD, Roberson ED. et al. Frequent mutation of BAP1 in metastasizing uveal melanomas. Science 2010; 330 (6009): 1410-1413
  • 44 Damato EM, Damato BE. Detection and time to treatment of uveal melanoma in the United Kingdom: an evaluation of 2,384 patients. Ophthalmology 2012; 119 (08) 1582-1589
  • 45 Singh AD, Kivelä T. The collaborative ocular melanoma study. Ophthalmol Clin North Am 2005; 18 (01) 129-142 , ix
  • 46 McCannel TA. Fine-needle aspiration biopsy in the management of choroidal melanoma. Curr Opin Ophthalmol 2013; 24 (03) 262-266
  • 47 The Collaborative Ocular Melanoma Study Group. Factors predictive of growth and treatment of small choroidal melanoma: COMS Report No. 5. Arch Ophthalmol 1997; 115 (12) 1537-1544
  • 48 Collaborative Ocular Melanoma Study Group. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28. Arch Ophthalmol 2006; 124 (12) 1684-1693
  • 49 Sikuade MJ, Salvi S, Rundle PA, Errington DG, Kacperek A, Rennie IG. Outcomes of treatment with stereotactic radiosurgery or proton beam therapy for choroidal melanoma. Eye (Lond) 2015; 29 (09) 1194-1198
  • 50 The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma I: characteristics of patients enrolled and not enrolled. COMS report no. 9. Am J Ophthalmol 1998; 125 (06) 767-778
  • 51 Gragoudas ES, Lane AM, Regan S. et al. A randomized controlled trial of varying radiation doses in the treatment of choroidal melanoma. Arch Ophthalmol 2000; 118 (06) 773-778
  • 52 Gragoudas ES. Proton beam irradiation of uveal melanomas: the first 30 years. The Weisenfeld lecture. Invest Ophthalmol Vis Sci 2006; 47 (11) 4666-4673
  • 53 Gragoudas ES, Egan KM, Walsh SM, Regan S, Munzenrider JE, Taratuta V. Lens changes after proton beam irradiation for uveal melanoma. Am J Ophthalmol 1995; 119 (02) 157-164
  • 54 Seddon JM, Gragoudas ES, Egan KM. et al. Relative survival rates after alternative therapies for uveal melanoma. Ophthalmology 1990; 97 (06) 769-777
  • 55 Gragoudas E, Li W, Goitein M, Lane AM, Munzenrider JE, Egan KM. Evidence-based estimates of outcome in patients irradiated for intraocular melanoma. Arch Ophthalmol 2002; 120 (12) 1665-1671
  • 56 Mittal BB, Deutsch M, Kennerdell J, Johnson B. Paraocular lymphoid tumors. Radiology 1986; 159 (03) 793-796
  • 57 Jenkins C, Rose GE, Bunce C. et al. Histological features of ocular adnexal lymphoma (REAL classification) and their association with patient morbidity and survival. Br J Ophthalmol 2000; 84 (08) 907-913
  • 58 Tsang RW, Gospodarowicz MK, Pintilie M. et al. Localized mucosa-associated lymphoid tissue lymphoma treated with radiation therapy has excellent clinical outcome. J Clin Oncol 2003; 21 (22) 4157-4164
  • 59 Tsang RW, Gospodarowicz MK, Pintilie M. et al. Stage I and II MALT lymphoma: results of treatment with radiotherapy. Int J Radiat Oncol Biol Phys 2001; 50 (05) 1258-1264
  • 60 Baldini L, Blini M, Guffanti A. et al. Treatment and prognosis in a series of primary extranodal lymphomas of the ocular adnexa. Ann Oncol 1998; 9 (07) 779-781
  • 61 Keleti D, Flickinger JC, Hobson SR, Mittal BB. Radiotherapy of lymphoproliferative diseases of the orbit. Surveillance of 65 cases. Am J Clin Oncol 1992; 15 (05) 422-427
  • 62 Esmaeli B, McLaughlin P, Pro B. et al. Prospective trial of targeted radioimmunotherapy with Y-90 ibritumomab tiuxetan (Zevalin) for front-line treatment of early-stage extranodal indolent ocular adnexal lymphoma. Ann Oncol 2009; 20 (04) 709-714
  • 63 Bischof M, Zierhut D, Neuhof D. et al. Indolent stage IE non-Hodgkin's lymphoma of the orbit: results after primary radiotherapy. Ophthalmologica 2007; 221 (05) 348-352
  • 64 Fasola CE, Jones JC, Huang DD, Le QT, Hoppe RT, Donaldson SS. Low-dose radiation therapy (2 Gy × 2) in the treatment of orbital lymphoma. Int J Radiat Oncol Biol Phys 2013; 86 (05) 930-935
  • 65 Pinnix CC, Dabaja BS, Milgrom SA. et al. Ultra-low-dose radiotherapy for definitive management of ocular adnexal B-cell lymphoma. Head Neck 2019; 41 (05) 1546
  • 66 Kim YH, Fayos JV. Primary orbital lymphoma: a radiotherapeutic experience. Int J Radiat Oncol Biol Phys 1976; 1 (11-12): 1099-1105
  • 67 Abramson DH, Schefler AC. Update on retinoblastoma. Retina 2004; 24 (06) 828-848
  • 68 Sachdeva UM, O'Brien JM. Understanding pRb: toward the necessary development of targeted treatments for retinoblastoma. J Clin Invest 2012; 122 (02) 425-434
  • 69 Kleinerman RA, Yu CL, Little MP. et al. Variation of second cancer risk by family history of retinoblastoma among long-term survivors. J Clin Oncol 2012; 30 (09) 950-957
  • 70 Chantada G, Fandiño A, Dávila MT. et al. Results of a prospective study for the treatment of retinoblastoma. Cancer 2004; 100 (04) 834-842
  • 71 Schipper J, Tan KE, van Peperzeel HA. Treatment of retinoblastoma by precision megavoltage radiation therapy. Radiother Oncol 1985; 3 (02) 117-132
  • 72 Abramson DH, Beaverson KL, Chang ST, Dunkel IJ, McCormick B. Outcome following initial external beam radiotherapy in patients with Reese-Ellsworth group Vb retinoblastoma. Arch Ophthalmol 2004; 122 (09) 1316-1323
  • 73 Cassady JR, Sagerman RH, Tretter P, Ellsworth RM. Radiation therapy in retinoblastoma. An analysis of 230 cases. Radiology 1969; 93 (02) 405-409
  • 74 Merchant TE, Gould CJ, Hilton NE. et al. Ocular preservation after 36 Gy external beam radiation therapy for retinoblastoma. J Pediatr Hematol Oncol 2002; 24 (04) 246-249
  • 75 Krengli M, Hug EB, Adams JA, Smith AR, Tarbell NJ, Munzenrider JE. Proton radiation therapy for retinoblastoma: comparison of various intraocular tumor locations and beam arrangements. Int J Radiat Oncol Biol Phys 2005; 61 (02) 583-593
  • 76 Lee CT, Bilton SD, Famiglietti RM. et al. Treatment planning with protons for pediatric retinoblastoma, medulloblastoma, and pelvic sarcoma: how do protons compare with other conformal techniques?. Int J Radiat Oncol Biol Phys 2005; 63 (02) 362-372
  • 77 Kleinerman RA, Tucker MA, Tarone RE. et al. Risk of new cancers after radiotherapy in long-term survivors of retinoblastoma: an extended follow-up. J Clin Oncol 2005; 23 (10) 2272-2279
  • 78 Sethi RV, Shih HA, Yeap BY. et al. Second nonocular tumors among survivors of retinoblastoma treated with contemporary photon and proton radiotherapy. Cancer 2014; 120 (01) 126-133
  • 79 Wong FL, Boice Jr JD, Abramson DH. et al. Cancer incidence after retinoblastoma. Radiation dose and sarcoma risk. JAMA 1997; 278 (15) 1262-1267
  • 80 Marees T, Moll AC, Imhof SM, de Boer MR, Ringens PJ, van Leeuwen FE. Risk of second malignancies in survivors of retinoblastoma: more than 40 years of follow-up. J Natl Cancer Inst 2008; 100 (24) 1771-1779
  • 81 Egbert PR, Donaldson SS, Moazed K, Rosenthal AR. Visual results and ocular complications following radiotherapy for retinoblastoma. Arch Ophthalmol 1978; 96 (10) 1826-1830
  • 82 Kaste SC, Chen G, Fontanesi J, Crom DB, Pratt CB. Orbital development in long-term survivors of retinoblastoma. J Clin Oncol 1997; 15 (03) 1183-1189
  • 83 Mouw KW, Sethi RV, Yeap BY. et al. Proton radiation therapy for the treatment of retinoblastoma. Int J Radiat Oncol Biol Phys 2014; 90 (04) 863-869
  • 84 Shields JA, Shields CL. Rhabdomyosarcoma: review for the ophthalmologist. Surv Ophthalmol 2003; 48 (01) 39-57
  • 85 Crist W, Gehan EA, Ragab AH. et al. The Third Intergroup Rhabdomyosarcoma Study. J Clin Oncol 1995; 13 (03) 610-630
  • 86 Wilson MC. et al. Orbital rhabdomyosarcoma fifty-seven years after radiotherapy for retinoblastoma. Orbit 1996; 15 (02) 97-100
  • 87 Newton Jr WA, Soule EH, Hamoudi AB. et al. Histopathology of childhood sarcomas, Intergroup Rhabdomyosarcoma Studies I and II: clinicopathologic correlation. J Clin Oncol 1988; 6 (01) 67-75
  • 88 Maurer HM, Beltangady M, Gehan EA. et al. The Intergroup Rhabdomyosarcoma Study-I. A final report. Cancer 1988; 61 (02) 209-220
  • 89 Maurer HM, Gehan EA, Beltangady M. et al. The Intergroup Rhabdomyosarcoma Study-II. Cancer 1993; 71 (05) 1904-1922
  • 90 Crist WM, Anderson JR, Meza JL. et al. Intergroup rhabdomyosarcoma study-IV: results for patients with nonmetastatic disease. J Clin Oncol 2001; 19 (12) 3091-3102
  • 91 Oberlin O, Rey A, Anderson J. , et al; International Society of Paediatric Oncology Sarcoma Committee, Intergroup Rhabdomyosarcoma Study Group, Italian Cooperative Soft Tissue Sarcoma Group, German Collaborative Soft Tissue Sarcoma Group. Treatment of orbital rhabdomyosarcoma: survival and late effects of treatment--results of an international workshop. J Clin Oncol 2001; 19 (01) 197-204
  • 92 Raney RB, Walterhouse DO, Meza JL. et al. Results of the Intergroup Rhabdomyosarcoma Study Group D9602 protocol, using vincristine and dactinomycin with or without cyclophosphamide and radiation therapy, for newly diagnosed patients with low-risk embryonal rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group. J Clin Oncol 2011; 29 (10) 1312-1318
  • 93 Wharam MD, Meza J, Anderson J. et al. Failure pattern and factors predictive of local failure in rhabdomyosarcoma: a report of group III patients on the third Intergroup Rhabdomyosarcoma Study. J Clin Oncol 2004; 22 (10) 1902-1908
  • 94 Ermoian RP, Breneman J, Walterhouse DO. et al. 45 Gy is not sufficient radiotherapy dose for Group III orbital embryonal rhabdomyosarcoma after less than complete response to 12 weeks of ARST0331 chemotherapy: a report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group. Pediatr Blood Cancer 2017 64(09):
  • 95 Donaldson SS, Anderson J. Factors that influence treatment decisions in childhood rhabdomyosarcoma. Intergroup Rhabdomyosarcoma Study Group of the Children's Cancer Group, the Pediatric Oncology Group, and the Intergroup Rhabdomyosarcoma Study Group Statistical Center. Radiology 1997; 203 (01) 17-22
  • 96 Wolden SL, Anderson JR, Crist WM. et al. Indications for radiotherapy and chemotherapy after complete resection in rhabdomyosarcoma: a report from the Intergroup Rhabdomyosarcoma Studies I to III. J Clin Oncol 1999; 17 (11) 3468-3475
  • 97 Bernardini FP, Devoto MH, Croxatto JO. Epithelial tumors of the lacrimal gland: an update. Curr Opin Ophthalmol 2008; 19 (05) 409-413
  • 98 Montalban A, Liétin B, Louvrier C. et al. Malignant lacrimal sac tumors. Eur Ann Otorhinolaryngol Head Neck Dis 2010; 127 (05) 165-172
  • 99 Wright JE, Rose GE, Garner A. Primary malignant neoplasms of the lacrimal gland. Br J Ophthalmol 1992; 76 (07) 401-407
  • 100 Henderson JW. Adenoid cystic carcinoma of the lacrimal gland, is there a cure?. Trans Am Ophthalmol Soc 1987; 85: 312-319
  • 101 Byers RM, Berkeley RG, Luna M, Jesse RH. Combined therapeutic approach to malignant lacrimal gland tumors. Am J Ophthalmol 1975; 79 (01) 53-55
  • 102 Gamel JW, Font RL. Adenoid cystic carcinoma of the lacrimal gland: the clinical significance of a basaloid histologic pattern. Hum Pathol 1982; 13 (03) 219-225
  • 103 Esmaeli B, Ahmadi MA, Youssef A. et al. Outcomes in patients with adenoid cystic carcinoma of the lacrimal gland. Ophthal Plast Reconstr Surg 2004; 20 (01) 22-26
  • 104 Wolkow N, Jakobiec FA, Lee H, Sutula FC. Long-term outcomes of globe-preserving surgery with proton beam radiation for adenoid cystic carcinoma of the lacrimal gland. Am J Ophthalmol 2018; 195: 43-62
  • 105 Ahmad SM, Esmaeli B, Williams M. et al. American Joint Committee on Cancer classification predicts outcome of patients with lacrimal gland adenoid cystic carcinoma. Ophthalmology 2009; 116 (06) 1210-1215
  • 106 Woo KI, Sagiv O, Han J, Frank SJ, Kim YD, Esmaeli B. Eye-preserving surgery followed by adjuvant radiotherapy for lacrimal gland carcinoma: outcomes in 37 patients. Ophthal Plast Reconstr Surg 2018; 34 (06) 570-574
  • 107 Meldrum ML, Tse DT, Benedetto P. Neoadjuvant intracarotid chemotherapy for treatment of advanced adenocystic carcinoma of the lacrimal gland. Arch Ophthalmol 1998; 116 (03) 315-321