title: Orbitocranial approach for treatment of adenoid cystic carcinoma of the lacrimal gland.
abstract: OBJECTIVE
  Multiple treatment options exist for management of adenoid cystic carcinoma of the lacrimal gland. Our objective was to perform an analysis of outcomes in a cohort of patients with adenoid cystic carcinoma of the lacrimal gland treated identically with an orbitocranial approach.
  
  
  METHODS
  We performed a retrospective review of 7 consecutive patients who presented to a tertiary care academic medical center between 1995 and 2009 with adenoid cystic carcinoma of the lacrimal gland.
  
  
  RESULTS
  All patients were treated with an orbitocranial approach to tumor resection followed by postoperative radiotherapy. The mean and median follow-up times were 39 and 19 months, respectively (range, 7 to 138 months). Six patients had orbital reconstruction using free tissue transfer, and 1 patient had a split-thickness skin graft to line the orbital cavity. Two patients developed distant metastases 18 months and 29 months after surgery and ultimately died with disease. Five patients are alive without disease.
  
  
  CONCLUSIONS
  The orbitocranial approach followed by postoperative irradiation achieves excellent local and regional control rates for adenoid cystic carcinoma of the lacrimal gland, although patients remain at risk long-term for distant metastases. Orbital bone removal to obtain adequate margins should be a routine part of tumor resection for these malignancies.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Wilson
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Ward
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Spector
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Marentette
mesh_terms: D000328:Adult; D000368:Aged; D003528:Carcinoma, Adenoid Cystic / Q000175:diagnosis / Q000601:surgery*; D005134:Eye Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007765:Lacrimal Apparatus / Q000473:pathology* / Q000601:surgery; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery*; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery; D016896:Treatment Outcome