title: Neutron radiotherapy for adenoid cystic carcinoma of the lacrimal gland.
abstract: OBJECTIVE
  Lacrimal gland adenoid cystic carcinomas are rare, aggressive orbital tumors that share histopathologic similarities with salivary gland malignancies. Neutron radiotherapy may be useful for treatment due to its high biological effectiveness for salivary malignancies.
  
  
  METHODS
  The authors retrospectively reviewed the outcomes for 11 lacrimal gland adenoid cystic carcinoma patients treated with neutrons from 1988 to 2011. Most had undergone surgery prior to radiation therapy. However, gross residual disease was present in 8 patients. The most common American Joint Committee on Cancer stage was T4cN0M0. Four patients with skull base involvement received a radiosurgery boost and 1 received a proton therapy boost.
  
  
  RESULTS
  Median follow up was 6.2 years. Median overall survival was 11.1 years and median disease-free survival was 6.3 years. Five-year local control was estimated by the Kaplan-Meier method as 80%. Three patients had a local recurrence; 4 developed distant metastases. Six patients died. Seven patients had intact vision in the affected eye before neutron radiation. Two required enucleation for a painful dry eye. Of the 5 who avoided an enucleation, 3 had either severe visual impairment (20/400) or only light perception and 2 were without known vision compromise or complications at the time of their death. One patient developed asymptomatic frontal lobe radionecrosis after 2 courses of radiation therapy.
  
  
  CONCLUSIONS
  Neutron radiation therapy achieved excellent 5-year local control in this series of high-risk patients, with most cases having gross residual disease. Late recurrences and distant metastases remain a challenge. Meaningful ipsilateral vision preservation was not possible in most cases in the long term, although only 2 patients required an enucleation for treatment effects.
authors.affiliation: University of Washington Medical Center, Seattle, Washington 98195, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Gensheimer
authors.forename: David
authors.initials: D
authors.lastname: Rainey
authors.forename: James G
authors.initials: JG
authors.lastname: Douglas
authors.forename: Jay J
authors.initials: JJ
authors.lastname: Liao
authors.forename: George E
authors.initials: GE
authors.lastname: Laramore
authors.forename: Arash
authors.initials: A
authors.lastname: Jian-Amadi
authors.forename: Laura Q M
authors.initials: LQ
authors.lastname: Chow
authors.forename: Wui-Jin
authors.initials: WJ
authors.lastname: Koh
authors.forename: Upendra
authors.initials: U
authors.lastname: Parvathaneni
mesh_terms: D000328:Adult; D003528:Carcinoma, Adenoid Cystic / Q000401:mortality / Q000532:radiotherapy*; D005134:Eye Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009502:Neutrons / Q000627:therapeutic use*; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult