Long-Term Outcomes of Neoadjuvant IntraArterial Chemotherapy for Locally Invasive Lacrimal Gland Carcinoma ex Pleomorphic Adenoma.

Purpose: There is no current standard treatment regimen for carcinoma ex pleomorphic adenoma (CXPA) of the lacrimal gland. Neoadjuvant intraarterial cytoreductive chemotherapy (IACC) followed by multimodal therapy has achieved good locoregional control in adenoid cystic carcinoma of the lacrimal gland. We reviewed our experience with neoadjuvant IACC followed by multimodal therapy for CXPA of the lacrimal gland.

Methods: Three patients with CXPA of the lacrimal gland treated with neoadjuvant ICAA therapy followed by multimodal therapy at the University of Michigan were retrospectively reviewed.

Results: Three patients had stage T4cN0M0 CXPA of the lacrimal gland (American Joint Committee on Cancer 8th ed). The first patient underwent 2 cycles of neoadjuvant IACC followed by multimodal therapy (exenteration, chemoradiotherapy, and adjuvant systemic chemotherapy). At 10 years of follow-up, there was no local recurrence or systemic metastasis. The second patient underwent 1 cycle of neoadjuvant IACC with multimodal therapy (systemic chemotherapy, globe-sparing orbital surgery, and chemoradiotherapy). After 5-year follow-up, there was no local recurrence or systemic metastasis. The third patient underwent 2 cycles of neoadjuvant IACC followed by multimodal therapy (globe-sparing orbital surgery, chemoradiotherapy, and adjuvant systemic chemotherapy). After 2 years, he developed parotid and retromandibular metastasis and underwent total parotidectomy with total neck dissection followed by chemoradiation and systemic anti-androgen therapy. After 7 years, he did not have any local recurrence or systemic metastasis.

Conclusions: Neoadjuvant IACC with multimodal therapies can achieve favorable outcomes with locoregional control and improve disease-specific survival in patients with locally invasive advanced-stage CXPA of the lacrimal gland.