title: Multidisciplinary management of lacrimal sac/nasolacrimal duct carcinomas.
abstract: OBJECTIVE
  To determine the rates of globe-sparing treatment and useful final visual function in patients with primary lacrimal sac/nasolacrimal duct carcinomas treated with multidisciplinary therapy.
  
  
  METHODS
  The medical records of 14 patients with primary lacrimal sac/nasolacrimal duct carcinoma treated at 1 institution were retrospectively reviewed.
  
  
  RESULTS
  The patients were 9 men and 5 women; the median age at diagnosis was 58.5 years (range, 45-73 years). Seven patients presented with epiphora, 7 with a palpable mass in the inferomedial orbit, and 2 with dacryocystitis. In 3 patients, the diagnosis of cancer was not considered until during or after dacryocystorhinostomy. Seven patients had squamous cell carcinoma, 2 transitional cell carcinoma, 2 adenoid cystic carcinoma, and 1 each adenocarcinoma, poorly differentiated carcinoma, and inverted papilloma with carcinoma in situ transformation. Nine patients underwent surgical resection of the lacrimal sac and nasolacrimal duct and resection of the medial upper and lower eyelids, including canaliculi, partial ethmoidectomy, and medial maxillectomy. One patient underwent lacrimal sac biopsy only as another primary malignancy was discovered during the work-up for systemic disease. Four patients underwent orbital exenteration because of extensive involvement of the orbital soft tissue. Radiotherapy was recommended for 13 patients; in 1 patient, radiotherapy was not recommended because the patient had an inverted papilloma with carcinoma in situ transformation that was completely excised. The median radiation dose was 60 Gy. Eight patients received chemotherapy either concurrent with radiation therapy (5 patients), as neoadjuvant treatment (1 patient), or for progressive or metastatic disease (3 patients). The median follow-up time was 27 months (range, 6-96 months). In 10 patients, the globe was spared. In 9 of these 10 patients, visual acuity was the same as at baseline or better than 20/40 at last follow up.
  
  
  CONCLUSIONS
  With multidisciplinary therapy, the eye can be spared and reasonable visual function can be preserved in most patients with primary lacrimal sac/nasolacrimal duct carcinomas.
authors.affiliation: *Orbital Oncology and Ophthalmic Plastic Surgery Program, Department of Plastic Surgery, †Department of Radiation Oncology, and ‡Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A.
authors.forename: Tarek
authors.initials: T
authors.lastname: El-Sawy
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.forename: Ehab
authors.initials: E
authors.lastname: Hanna
authors.forename: Matthew
authors.initials: M
authors.lastname: Sniegowski
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Lai
authors.forename: Qasiem J
authors.initials: QJ
authors.lastname: Nasser
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Myers
authors.forename: Bita
authors.initials: B
authors.lastname: Esmaeli
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000628:therapy*; D003131:Combined Modality Therapy; D005134:Eye Neoplasms / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct; D009669:Nose Neoplasms / Q000628:therapy*; D017233:Orbit Evisceration; D011829:Radiation Dosage; D012189:Retrospective Studies; D014792:Visual Acuity