title: American Joint Committee on Cancer classification predicts outcome of patients with lacrimal gland adenoid cystic carcinoma.
abstract: OBJECTIVE
  To investigate whether American Joint Committee on Cancer (AJCC) classification at initial diagnosis of lacrimal gland adenoid cystic carcinoma predicts outcome of treatment on local recurrence.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Consecutive patients with adenoid cystic carcinoma of the lacrimal gland treated at 8 institutions between January 1986 and December 2007.
  
  
  METHODS
  Clinical records, including pathology reports and imaging studies, were reviewed.
  
  
  METHODS
  AJCC classification, histologic subtype, local recurrence rate, and survival.
  
  
  RESULTS
  AJCC classification at initial diagnosis was assessable for 53 patients and was as follows: T1N0M0, 7 patients; T2N0M0, 8 patients; T3aN0M0, 14 patients; T3aNxM0, 1 patient; T3aN0M1, 1 patient; T3bN0M0, 13 patients; T3bN0M1, 1 patient; T4aN0M0, 2 patients; T4bN0M0, 4 patients; T4bN0M1, 1 patient; and T4bNXM0, 1 patient. Thirty-eight (72%) of the 53 patients had >T3 tumors at presentation. Of the 38 patients with >T3 tumors, 20 were treated with orbital exenteration and postoperative adjuvant radiotherapy (RT), 6 were treated with orbital exenteration without RT, and 12 were treated with globe-preserving surgery (10 with RT and 2 without RT). Of the 15 patients with <T3 tumors, 6 were treated with globe-preserving surgery and RT, 2 were treated with globe-preserving surgery without RT, 6 were treated with orbital exenteration with bone removal and RT, and 1 was treated with orbital exenteration with bone removal without RT. Only 1 patient with a <T3 tumor, had local recurrence. Among patients with >T3 tumors, the risk of local recurrence (in the orbit or skull base) was higher in patients treated with conservative surgery as opposed to orbital exenteration and RT. Only 4 (20%) of the 20 patients treated with orbital exenteration and RT had local recurrence, compared with 3 (50%) of the 6 patients treated with orbital exenteration without RT and 8 (67%) of the 12 patients treated with globe-preserving surgery. Overall, 17 (45%) of the 38 patients with >T3 tumors and only 1 (7%) of the 15 patients with <T3 tumors died of disease during the study period.
  
  
  CONCLUSIONS
  In patients with lacrimal gland adenoid cystic carcinoma, AJCC >T3 disease at initial diagnosis correlates with worse outcomes than does AJCC <T3 disease.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: S Mehdi
authors.initials: SM
authors.lastname: Ahmad
authors.forename: Bita
authors.initials: B
authors.lastname: Esmaeli
authors.forename: Michelle
authors.initials: M
authors.lastname: Williams
authors.forename: John
authors.initials: J
authors.lastname: Nguyen
authors.forename: Aaron
authors.initials: A
authors.lastname: Fay
authors.forename: John
authors.initials: J
authors.lastname: Woog
authors.forename: Deepan
authors.initials: D
authors.lastname: Selvadurai
authors.forename: Jack
authors.initials: J
authors.lastname: Rootman
authors.forename: Ezekiel
authors.initials: E
authors.lastname: Weis
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
authors.forename: Alan
authors.initials: A
authors.lastname: McNab
authors.forename: Dan
authors.initials: D
authors.lastname: DeAngelis
authors.forename: Alberto
authors.initials: A
authors.lastname: Calle
authors.forename: Adriana
authors.initials: A
authors.lastname: Lopez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003528:Carcinoma, Adenoid Cystic / Q000145:classification* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002648:Child; D003131:Combined Modality Therapy; D005134:Eye Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000145:classification* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D013508:Ophthalmologic Surgical Procedures; D011878:Radiotherapy; D012189:Retrospective Studies; D012955:Societies, Medical; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States