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Lee Boniao E, Allen RC, Sundar G. Targeted therapy and immunotherapy for orbital and periorbital tumors: a major review. Orbit 2024; 43:656-673. [PMID: 37728602 DOI: 10.1080/01676830.2023.2256848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
Traditionally, for patients who are poor candidates for surgery and/or radiotherapy, palliative chemotherapy is often offered but with significant toxic side effects. However, recent advancements in our understanding of tumor biology and molecular genetics have brought new understanding to the molecular pathways of certain tumors and cancers. This has ushered in a new era of precision medicine specific to a tumor or cancer treatment pathway (targeted therapy) or directed to host-tumor responses (immunotherapy). This article will focus on recent updates in the application of available targeted and immunotherapy for managing orbital and periorbital tumors and tumor-like conditions, which include cutaneous basal cell carcinoma, cutaneous squamous cell carcinoma, cutaneous melanoma, Merkel cell carcinoma, sebaceous gland carcinoma, solitary fibrous tumor, dermatofibrosarcoma protuberans, orbital meningioma, neurofibromatosis, Langerhans cell histiocytosis, ocular adnexal lymphoma, orbital lymphatic malformation, and adenoid cystic carcinoma.
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Affiliation(s)
- Emmanuel Lee Boniao
- Orbit & Oculofacial Surgery, Ophthalmic Oncology, Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, Amai Pakpak Medical Center, Marawi City, Philippines
| | - Richard C Allen
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Gangadhara Sundar
- Orbit & Oculofacial Surgery, Ophthalmic Oncology, Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore, Singapore
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Yunoki T, Miyakoshi A, Hayashi A. Clinicopathologic Features of Eyelid Sebaceous Gland Carcinoma Requiring Immunohistochemical Diagnosis. Ocul Oncol Pathol 2024; 10:131-138. [PMID: 39224525 PMCID: PMC11368396 DOI: 10.1159/000538537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/21/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction The aim of the study was to evaluate the clinicopathological features of eyelid sebaceous gland carcinoma (SGC), which requires immunohistochemical examination for a definitive diagnosis. Methods Twenty-seven patients with a final diagnosis of eyelid SGC at Toyama University Hospital between April 2016 and April 2022 were retrospectively studied. In cases with a strong clinical suspicion of SGC, if the initial pathological diagnosis by hematoxylin-eosin staining was non-SGC, additional detailed pathology was performed, including immunostaining for adipophilin (ADP) and androgen receptor (AR). Results Five patients (18.5%) had a diagnosis other than SGC, including three with squamous cell carcinoma (SCC), one with basal cell carcinoma, and one with Bowen disease. In these 5 cases, detailed pathology, including immunostaining for ADP and AR, was performed again, which ultimately led to the diagnosis of SGC. ADP was positive in all 5 cases, and AR was positive in 4 cases. The 3 patients diagnosed with SCC were characterized by a high Ki-67 index, active mitosis, and relatively low differentiation. Conclusion SGC can be pathologically diagnosed in other cancers, such as SCC and BCC. When SCC was diagnosed, it was often hypo-differentiated and required more attention. Immunostaining for ADP and AR is invaluable for confirming SGC diagnosis.
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Affiliation(s)
- Tatsuya Yunoki
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Akio Miyakoshi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Niinimäki P, Siuko M, Tynninen O, Kivelä TT, Uusitalo M. Cutaneous squamous cell carcinoma of the eyelid in northern latitudes, a 25-year experience in Finland. Acta Ophthalmol 2024; 102:535-543. [PMID: 38057922 DOI: 10.1111/aos.15819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/10/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To evaluate the incidence, clinical features, diagnostic challenges, management and prognosis of cutaneous squamous cell carcinoma of the eyelid (ecSCC) in southern Finland, northern Europe, latitude 62° N. METHODS Patients were identified from the Finnish Cancer Registry and the Helsinki University Hospital databases during a 25-year period (1998-2022). Age, sex, location, clinical and histopathological diagnosis, treatment and outcome were retrieved. RESULTS Cutaneous squamous cell carcinoma of the eyelid (ecSCC) was diagnosed in 58 patients. The mean age-standardized incidence was 1.03 per 100 000. Median age at the time of histopathological diagnosis was 79 (range 55-93) years; sex ratio was 0.52. Clinical diagnosis in the referral was ecSCC in only three patients. The most frequent misdiagnosis (38%) was basal cell carcinoma (BCC). One or more of the known risk factors (smoking, history of extensive sun exposure, systemic immunosuppression and previous in situ cSCC/cSCC) were documented in 71% of the patients. More than one third (38%) of the patients developed in situ SCC elsewhere on the skin; one third (31%) of the patients had invasive cSCC elsewhere. During the median follow-up time of 24 months, three patients experienced local recurrence, four patients developed metastatic disease (median 19 months) and two patients died of metastatic ecSCC. CONCLUSION The estimated incidence of ecSCC in Finland (predominantly white Caucasian) was higher than in a previous study from Europe. Clinical diagnosis of ecSCC is difficult and often misdiagnosed as BCC. Immunosuppression as a risk factor should noticed. Recurrences of ecSCC, which may be lethal, were infrequent.
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Affiliation(s)
- Paula Niinimäki
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mika Siuko
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Olli Tynninen
- Department of Pathology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tero T Kivelä
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marita Uusitalo
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Esmaeli B, Fan J, Goldberg H, Lu T, Gross ND, Akhave N, Sousa LG, Ferrarotto R. Immune checkpoint inhibitors with or without chemotherapy for orbital, conjunctival, and ocular adnexal squamous cell carcinoma. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00166-2. [PMID: 39043259 DOI: 10.1016/j.jcjo.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/28/2024] [Accepted: 05/20/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Periocular squamous cell carcinoma (SCC) is relatively rare and presents unique anatomic considerations due to proximity to the eye and risk to ocular structures associated with high-dose radiation therapy or radical surgery. We present our observations in patients with periocular SCC treated with immune checkpoint inhibitor (ICI) therapy in an effort to decrease surgical morbidity or avoid high-dose radiation therapy. METHODS Retrospective review of patients with orbital, conjunctival, or periocular SCC who were treated with ICI either in the neoadjuvant setting prior to surgery or for treatment of perineural spread in the orbit/skull base. RESULTS Twelve men and 5 women with orbital (n = 6), conjunctival (n = 5), or lacrimal sac/duct (n = 2) SCC, or SCC with perineural spread (n = 4) were treated with ICI (cemiplimab or pembolizumab) either as single drug (n = 9) or combined with chemotherapy (n = 8). Overall, 5 patients achieved complete response, 8 patients achieved partial response, and 4 patients achieved stable disease, using the response evaluation criteria in solid tumors (RECIST) criteria. The objective response rate was 76.5%. In 12 patients ICI was used in the neoadjuvant setting prior to surgery. In 4 patients with perineural spread and unresectable disease, ICI was used to avoid high-dose radiation therapy. One additional patient with conjunctival SCC with nodal metastasis was treated with ICI alone and achieved a dramatic complete response and has thus far managed to avoid surgery altogether. CONCLUSIONS ICI either as single drug or in combination with chemotherapy has a high response rate in patients with periocular SCC. Future prospective trials should aim to correlate molecular data with response.
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Affiliation(s)
- Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Janet Fan
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hila Goldberg
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tracy Lu
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Neal Akhave
- Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Luana Guimaraes Sousa
- Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Renata Ferrarotto
- Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Chebib E, Rougier G, Dubray-Vautrin A, Martin J, Ghanem W, Lesnik M, Sabran B, Matet A, Malaise D, Cassoux N, Dendale R, Choussy O, Badois N. Lymph Node Evolution in Eyelid and Orbit Squamous Cell Carcinomas. Laryngoscope 2024. [PMID: 39031611 DOI: 10.1002/lary.31584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/04/2024] [Accepted: 05/22/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVES To describe a large cohort of eyelid and periorbital SCCs, to compare the location of the tumor and of the pathological lymph nodes, and to analyze the risk factors for lymph node involvement among tumor characteristics. METHODS All patients managed inside our institution for an eyelid and periorbital SCCs were included. Tumor characteristics, imaging setup, excision margins, lymph node evolution features, local, regional, and distant recurrences rates, and global survival were reported. The risk for lymph node involvement and location of pathological lymph nodes were analyzed through univariate and multivariate analyses. RESULTS Between January 2012 and August 2022, 115 patients were included, and 18 presented a lymph node evolution (15.7%), involving the parotid gland in 16 cases (88.9%), the submental and submandibular areas in seven cases (38%), and the jugular and carotid areas in four cases (22%). Tumor size above 20 mm, infiltration of the external canthus and periorbital structures, the presence of perineural invasion or vascular embolism, the depth of infiltration, and the presence of a local recurrence were significantly associated with the risk of lymph node evolution. CONCLUSION Periorbital and eyelid SCCs present a true potential for lymph node evolution especially through the parotid gland. Extension setup including the parotid gland and neck should be mandatory, and lymph node dissection should be associated in case of parotidectomy for lymph node involvement. LEVEL OF EVIDENCE IV Laryngoscope, 2024.
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Affiliation(s)
- Emilien Chebib
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Guillaume Rougier
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Antoine Dubray-Vautrin
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Joey Martin
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Wahib Ghanem
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Maria Lesnik
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Baptiste Sabran
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Alexandre Matet
- Ophthalmology and Ocular Oncology Department, Institut Curie, Paris, France
- Université Paris Cité, Paris, France
| | - Denis Malaise
- Ophthalmology and Ocular Oncology Department, Institut Curie, Paris, France
| | - Nathalie Cassoux
- Ophthalmology and Ocular Oncology Department, Institut Curie, Paris, France
- Université Paris Cité, Paris, France
| | - Rémi Dendale
- Radiation Oncology Department, Institut Curie, Paris, France
| | - Olivier Choussy
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Nathalie Badois
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
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Sato Y, Takahashi S, Toshiyasu T, Tsuji H, Hanai N, Homma A. Squamous cell carcinoma of the eyelid. Jpn J Clin Oncol 2024; 54:4-12. [PMID: 37747408 PMCID: PMC10773209 DOI: 10.1093/jjco/hyad127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023] Open
Abstract
Eyelid squamous cell carcinoma is a major type of rare eyelid cancer, together with basal cell carcinoma and sebaceous gland carcinoma. It is a painless disease that progresses slowly and is often detected by the appearance of nodules or plaques. Risk factors include exposure to ultraviolet light, fair skin, radiation and human papillomavirus infection. The standard treatment is surgical removal, and in cases of orbital invasion, orbital content removal is required. If sentinel node biopsy reveals a high risk of lymph node metastasis, adjuvant radiotherapy may be considered. Local chemotherapy, such as imiquimod and 5-fluorouracil, may be used for eyelid squamous cell carcinoma in situ. When surgery or radiotherapy is not recommended for distant metastases or locally advanced disease, drug therapy is often according to head and neck squamous cell carcinoma in Japan. The treatment often requires a multidisciplinary team to ensure the preservation of function and cosmetic appearance.
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Affiliation(s)
- Yasuyoshi Sato
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Chemotherapy and Cancer Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Toshiyasu
- Department of Radiation Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hideki Tsuji
- Department of Ophthalmology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Tong JY, Huilgol SC, James C, Selva D. Recommendations for risk stratification of periocular squamous cell carcinoma. Surv Ophthalmol 2023; 68:964-976. [PMID: 37172747 DOI: 10.1016/j.survophthal.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Periocular squamous cell carcinoma is a common cutaneous malignancy with generally favorable outcomes; however, the periocular region is intrinsically a high-risk location, and there exist a subset of lesions with a propensity for poor outcomes. Orbital invasion, intracranial perineural spread, nodal and distant metastasis are feared complications. There are several staging systems for eyelid carcinoma and cutaneous squamous cell carcinoma, but the definition of high-risk lesions remains heterogeneous. It is unclear exactly which lesions can be safely deescalated, and which require nodal evaluation and adjuvant multimodal therapy. We seek to answer these questions by summarizing the literature on clinicopathologic variables, molecular markers, and gene profiling tests in periocular squamous cell carcinoma, with the extrapolation of data from the cutaneous squamous cell carcinoma literature. Standardized pathology reports with information on tumor dimensions, histological subtype and grade, perineural invasion, and lymphovascular invasion should become uniform. Integration with gene expression profiling assessments will individualize and improve the predictive accuracy of risk stratification tools to ultimately inform multidisciplinary decision-making.
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Affiliation(s)
- Jessica Y Tong
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Save Sight Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Shyamala C Huilgol
- Adelaide Skin & Eye Centre, South Australia, Australia; Department of Dermatology, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Craig James
- Clinpath Laboratories, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Adelaide Skin & Eye Centre, South Australia, Australia
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Tiosano A, Ben-Ishai M, Cnaany Y, Markel G, Kurman N, Popovtzer A, Bar Sela G, Ben Simon G, Gershoni A, Yassur I. Primary cemiplimab treatment for orbital squamous cell carcinoma is effective and may alleviate the need for orbital exenteration. Eye (Lond) 2023; 37:2482-2487. [PMID: 36690728 PMCID: PMC10397183 DOI: 10.1038/s41433-022-02358-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/17/2022] [Accepted: 12/02/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of cemiplimab, a Programmed-cell-death-1(PD-1) protein inhibitor, for the treatment of cutaneous periocular-locally-advanced squamous-cell-carcinoma (POLA-SCC) with orbital-invasion. METHODS Multicentre real-world retrospective study. Demographic and clinical data were collected and analysed for patients with biopsy-proven POLA-SCC(AJCC-T4) with orbital-invasion who were treated with cemiplimab at one of four tertiary medical centres in 2019-2022. RESULTS The cohort included 13 patients, 8 males and 5 females, of median age 76 years (IQR65-86). The median duration of treatment was 5.0months (IQR3.5-10.5) and the median follow-up time, 15.0 months (IQR10.5-30). The overall response rate was 69.2%. Complete response was documented in seven patients (53.8%), partial response in two (15.4%), stable disease in one (7.7%), and progressive disease in two (15.4%); in one patient (7.7%), response was not evaluable. Six complete responders (46.1% of the cohort) received no further treatment and did not have a recurrence during an average follow-up of 6.14 (±6.9) months from treatment cessation. None of the patients underwent orbital-exenteration. The majority of adverse events were mild (grade-1), except for a moderate increase in creatinine level (grade-2), severe bullous dermatitis (grade-3), and myocarditis (grade-5) in one patient each. Four patients (30.7%) died during the follow-up period, all of whom had an Eastern-Cooperative-Oncology-Group score of 4 at presentation. CONCLUSIONS To our knowledge, this is the largest study to date on cemiplimab therapy for cutaneous POLA-SCC with orbital-invasion. Treatment was shown to be effective, with an overall response rate of 69.2%. Cemiplimab holds promise for the treatment of patients with tumours invading the orbit as it may alleviate the need for orbital exenteration.
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Affiliation(s)
- Alon Tiosano
- Ophthalmology Division, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meydan Ben-Ishai
- Ophthalmology Division, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaacov Cnaany
- Ophthalmology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Gal Markel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Davidoff Comprehensive Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Noga Kurman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Davidoff Comprehensive Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Aron Popovtzer
- Sharett Institute of Oncology, Hebrew University Hadassah Medical Center, Jerusalem, Israel
| | - Gil Bar Sela
- Oncology and Hematology Division, Emek Medical Center, Afula, Israel
| | - Guy Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Assaf Gershoni
- Ophthalmology Division, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iftach Yassur
- Ophthalmology Division, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Goldfarb JA, Ferrarotto R, Gross N, Goepfert R, Debnam JM, Gunn B, Nagarajan P, Esmaeli B. Immune checkpoint inhibitors for treatment of periorbital squamous cell carcinoma. Br J Ophthalmol 2023; 107:320-323. [PMID: 34625433 DOI: 10.1136/bjophthalmol-2021-319417] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To report on the outcomes of immunotherapy in patients with locally advanced periorbital squamous cell carcinoma. METHODS We performed a retrospective chart review of seven consecutive patients with locally advanced periorbital cutaneous squamous cell carcinoma treated with anti-PD-1 immunotherapy. Treatments and therapeutic outcomes were reviewed. RESULTS Of the seven patients, six were treated with cemiplimab, and one was treated with pembrolizumab. Five patients were treated with immunotherapy as neoadjuvant therapy before planned surgical resection; two patients received immunotherapy for treatment of advanced recurrent lesions deemed unresectable following multiple previous excisions and radiation therapy. In all seven patients, measurable clinical and/or radiologic response was observed. CONCLUSIONS Our findings support the emerging role of anti-PD-1 immunotherapy in the management of locally advanced periorbital cutaneous squamous cell carcinoma.
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Affiliation(s)
- Jeremy Allan Goldfarb
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neil Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James Matthew Debnam
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Division of Radiation Oncology, Houston, Texas, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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10
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Fan W, Rokohl AC, Kupka P, Hou X, Liu J, Li S, Kopecky A, Ju S, Matos PAW, Guo Y, Heindl LM. Reproducibility of Three-Dimensional Volumetric Measurement of Periocular Tumor Models. Ophthalmol Ther 2023; 12:111-123. [PMID: 36245061 PMCID: PMC9834469 DOI: 10.1007/s40123-022-00595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/06/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION In this study, we measured the volume of customized tumor models in the periocular area using three-dimensional (3D) stereophotogrammetry and evaluated the reproducibility of these measurements. METHODS Five tumor models of different colors and sizes were placed in different periocular positions, and 3D facial images were obtained from 68 healthy adult volunteers. Subsequently, the volumes of the tumor models were measured, and the intra- and interrater reproducibility was assessed. RESULTS The gray 6 mm model revealed the highest reliable measurements in both Caucasians (intra- and interrater intraclass correlation coefficients of 0.981 and 0.899, mean absolute difference of 1.446 and 3.327 mm3, relative error measurement of 3.497% and 8.120%, technical error of measurement of 1.450 and 3.105 mm3, and relative technical error of measurement of 3.506% and 7.580%) and Asians (0.968 and 0.844, 1.974 and 4.067 mm3, 4.772% and 9.526%, 2.100 and 4.302 mm3, and 5.076% and 10.076%, respectively). The highest reliability of measurements in the lateral upper eyelid (0.88 and 0.95, 4.042 and 3.626 mm3, 9.730% and 9.020%, 5.714 and 3.358 mm3, and 9.730% and 8.350%, respectively) and medial upper eyelid (0.81 and 0.89, 4.313 and 4.226 mm3, 9.730% and 9.020%, 6.098 and 4.069 mm3, and 9.730% and 8.350%, respectively) with eyes closed was evident in Caucasians, while the same trend (0.841 and 0.815, 2.828 and 3.757 mm3, 9.860% and 9.840%, 4.052 and 4.308 mm3, and 9.860% and 9.740%, respectively) was observed in Asians in the medial canthus with eyes closed. CONCLUSIONS This study confirms, for the first time, the high reliability of periocular tumor volume measurements using 3D stereophotogrammetry, suggesting its feasibility for eyelid tumor measurement. Further trials are required to investigate its clinical use for documentation and follow-up of different eyelid tumors.
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Affiliation(s)
- Wanlin Fan
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Alexander C. Rokohl
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany ,Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
| | - Patrick Kupka
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Xiaoyi Hou
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Jinhua Liu
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Senmao Li
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Adam Kopecky
- grid.412727.50000 0004 0609 0692Ophthalmology Clinic, University Hospital Ostrava, Ostrava, Czech Republic
| | - Sitong Ju
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Philomena A. Wawer Matos
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Yongwei Guo
- grid.13402.340000 0004 1759 700XEye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009 China ,grid.13402.340000 0004 1759 700XZhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Ludwig M. Heindl
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany ,Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
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11
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Tong JY, Slattery J, Vrodos N, Selva D. Transorbital drillout to the cavernous sinus: an approach for squamous cell carcinoma with perineural spread. Illustrative cases. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22400. [PMID: 36647252 PMCID: PMC9844528 DOI: 10.3171/case22400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/24/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND This study describes a transorbital apical approach to the cavernous sinus, where the greater wing of sphenoid (GWS) and superior orbital fissure (SOF) are drilled out to access the interdural incision zone and lateral wall of the cavernous sinus. OBSERVATIONS This was a retrospective series of 3 patients with periocular squamous cell carcinoma (SCC) and radiological evidence of perineural spread to the cavernous sinus. Following an orbital exenteration, the GWS was drilled to reach the lateral border of the SOF. The meningo-orbital band, a periosteal transition between the frontotemporal basal dura and periorbita, was incised to enter the lateral wall of the cavernous sinus. The relevant cranial nerves were biopsied to provide an accurate zonal classification of disease. LESSONS The transorbital apical approach via the SOF provides a corridor of access to the cranial nerves within the lateral wall of the cavernous sinus. This technique was successfully performed on 3 patients with periocular SCC. One case had radiological evidence of intracavernous oculomotor nerve involvement, 1 patient demonstrated nasociliary nerve enlargement at the SOF, and another had frontal nerve involvement extending into the cavernous sinus. Cerebrospinal fluid leak occurred in 1 case addressed with fat packing and fascial closure.
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Affiliation(s)
- Jessica Y. Tong
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; and
| | | | - Nick Vrodos
- Neurosurgery, Flinders Medical Centre, Adelaide, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; and
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12
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Tan B, Seth I, Fischer O, Hewitt L, Melville G, Bulloch G, Ashford B. Sex Disparity for Patients with Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Systematic Review. Cancers (Basel) 2022; 14:cancers14235830. [PMID: 36497312 PMCID: PMC9740937 DOI: 10.3390/cancers14235830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The incidence of head and neck cutaneous squamous cell carcinoma (HNcSCC) is unevenly distributed between men and women. At present, the mechanism behind this disparity remains elusive. This study conducted a systematic review and meta-analysis of proportions to investigate the disparity between sexes for patients with HNcSCC. PubMed, Scopus, EMBASE, MEDLINE, Emcare and CINAHL were searched in November 2021 and June 2022 (N > 50, English, human), and studies which examined the association between sex and HNcSCC were included. Analysis was conducted using RStudio with data and forest plots displaying males as a proportion of total patients with HNcSCC. Two independent researchers performed study selection, data extraction, data analysis and risk of bias. Eighty-two studies (1948 to 2018) comprising approximately 186,000 participants (67% male, 33% female) from 29 countries were included. Significantly more males had HNcSCC overall (71%; CI: 67−74). Males were also significantly more affected by cSCC of the ear (92%; CI: 89−94), lip (74%; CI: 66−81), and eyelid (56%; CI: 51−62). This study found HNcSCC disproportionately affected males overall and across all subtypes. Improving our understanding of sex-specific mechanisms in HNcSCC will better inform our preventive, therapeutic and prognostic practices.
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Affiliation(s)
- Brandon Tan
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Ishith Seth
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Olivia Fischer
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Lyndel Hewitt
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Correspondence: ; Tel.: +61-02-42534801
| | - Geoffrey Melville
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Gabriella Bulloch
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Bruce Ashford
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
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Perineural invasion and perineural spread in periocular squamous cell carcinoma. Eye (Lond) 2022; 37:875-884. [PMID: 36400852 PMCID: PMC10050156 DOI: 10.1038/s41433-022-02306-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/14/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
AbstractPerineural invasion (PNI) in cutaneous squamous cell carcinoma (SCC) of the periocular region is a prognostic marker of adverse tumour outcomes. PNI carries a well-established risk of tumour recurrence, regional metastasis and higher likelihood of mortality. This review will explore and stratify the risks conferred by histological PNI parameters. The radiological features of perineural spread (PNS) and the imaging sequences that delineate these findings will also be highlighted. Surgical excision with en face margin control is the preferred technique for achieving histological clearance. Adjuvant radiotherapy improves treatment outcomes in the setting of concomitant high-risk features. For locally advanced or metastatic cutaneous SCC, immunotherapy represents a novel treatment alternative. This review will provide an algorithm for the diagnosis and management of periocular SCC with PNI and PNS.
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14
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García RLB, Jimenez J, Gubbay C, Castañeda JF, Granados Á. Squamous cell carcinoma of the conjunctiva. Case report. Int J Surg Case Rep 2022; 91:106785. [PMID: 35093703 PMCID: PMC8808077 DOI: 10.1016/j.ijscr.2022.106785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction The prevalence of squamous cell carcinoma of the eyeball is low, and this is a rare condition. There are multiple therapeutic strategies for the treatment and depend on the degree of local involvement and extension of the tumor which, in turn, will have an impact on the patient's prognosis. Presentation of case We present a case of a patient with a mass of progressive growth on the left eyeball whit vision damage. The biopsy showed a squamous cell carcinoma of the conjunctiva, and imaging studies showed orbital invasion cT4bN0cM0, so surgery was indicated. The surgery was done with macroscopic margins of 5 mm. After resection, a radial free flap reconstruction was performed. Adjuvant treatment with radiotherapy was performed without complications. After six months, the patient manifested an improvement in his quality of life, and there is no evidence of relapse. Discussion The prevalence of squamous cell carcinoma of the conjunctiva is low. The most important risk factor is exposure to UV rays. Most are derived from conjunctival intraepithelial neoplasms. There are topical management protocols with chemotherapeutic agents and in patients with ocular or orbital invasion, enucleation and exanteration are the treatments of choice. Conclusion The squamous cell carcinoma of the conjunctive is rare. The management in the locally advanced tumors is surgical. The use of a radial free flap reconstruction is one of the reconstructive strategies to take into account, and the knowledge of additional strategies required to control the disease is important to ensure an optimal treatment. Squamous cell carcinoma is the most frequent tumor of the eyeball. The most important risk factor is the exposure to UV rays (damage in repairing DNA). There are topical management protocols with multiple chemotherapeutic agents. In patients with ocular or orbital invasion, the surgery is the GOLD standard of care. Adjuvant therapies are useful tools in the oncological management of these patients.
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Affiliation(s)
- Rogers Leonardo Baquero García
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia.
| | - Julián Jimenez
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia
| | - Carlos Gubbay
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia
| | - Juan Fernando Castañeda
- San José Hospital, Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), FUCS, Colombia
| | - Álvaro Granados
- San Jose Hospital, Professor at Fundación Universitaria de Ciencias de la Salud (University Foundation of Health Sciences), Colombia
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de Preux M, Gurtner C, Klebic I, Waschk MA, Drögemüller C, Brünisholz HP. Skeletal metastasis from a squamous cell carcinoma of the nictitating membrane in a Haflinger horse. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. de Preux
- Swiss Institute for Equine Medicine Vetsuisse Faculty University of Bern, and Agroscope Bern Switzerland
| | - C. Gurtner
- Institute of Animal Pathology Vetsuisse Faculty University of Bern BernSwitzerland
| | - I. Klebic
- Institute of Animal Pathology Vetsuisse Faculty University of Bern BernSwitzerland
| | - M. A. Waschk
- Division of Clinical Radiology Vetsuisse Faculty University of Bern BernSwitzerland
| | - C. Drögemüller
- Institute of Genetics Vetsuisse Faculty University of Bern BernSwitzerland
| | - H. P. Brünisholz
- Swiss Institute for Equine Medicine Vetsuisse Faculty University of Bern, and Agroscope Bern Switzerland
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16
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Wang H, Bata B, Currie Z, Salvi S, Tan J. Systemic acitretin in the management of periocular squamous cell carcinoma. BMJ Case Rep 2021; 14:14/4/e241167. [PMID: 33883116 PMCID: PMC8061867 DOI: 10.1136/bcr-2020-241167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of periocular squamous cell carcinoma invading the anterior orbit that significantly reduced in size and regressed from invasive to in situ following treatment with oral acitretin, a second-generation retinoid. The residual in situ disease was then successfully treated with cryotherapy and the patient remains in remission 12 months following cessation of systemic acitretin.
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Affiliation(s)
- Haoyu Wang
- Ophthalmology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bashar Bata
- Ophthalmology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK .,Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Zanna Currie
- Ophthalmology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sachin Salvi
- Ophthalmology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Jennifer Tan
- Ophthalmology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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17
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Luo Y, Chen H, Ge S, Rao Y, Yu J, Fan X, Jia R, Xu S, Wang Y. Clinical and pathological risk factors for worse stage and mortality of eyelid and periocular squamous cell carcinoma. Br J Ophthalmol 2021; 106:1338-1343. [PMID: 33879470 DOI: 10.1136/bjophthalmol-2020-317546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The clinical and pathological risk factors for worse T stage and prognosis in eyelid and periocular squamous cell carcinomas (SCCs) remain unclear. P63 was reported to predict a worse prognosis in other SCCs; however, this correlation was not validated in eyelid and periocular SCCs. METHODS We reported on a retrospective case series of 85 consecutive patients with eyelid and periocular SCCs from 1995 to 2019. Cox proportional hazards regression models and logistic regression models were applied for risk factor analysis. RESULTS Thirty-nine (45.8%) patients were diagnosed with T4 SCCs. Four (5.1%) patients developed nodal metastasis, and five (6.4%) patients developed distant metastasis during the follow-up. 2-year and 5-year disease-specific survival rates were 95.3% and 86.4%, respectively. Poorly or moderately differentiated eyelid and periocular SCCs were associated with worse T stage (p=0.001; p=0.008). Poor differentiation was associated with a higher risk of recurrence (p=0.024). Disease-specific death was more common in patients with T4 stage SCCs (p=0.038, HR=9.05). P63 expression was more common in patients with T3c or worse stage (p=0.008, OR=3.77). P63 expression alone was associated with worse differentiation (p=0.029), higher risk of perineural invasion (p=0.042, OR=4.61) and metastasis (p=0.009, HR=3.99). P63 expression (p=0.012, HR=7.80), coexpression of P63 and Ki67 (p=0.007, HR=9.21) and distant metastasis (p=0.001, HR=11.23) were associated with disease-specific death. CONCLUSION Patients presented with more aggressive orbital invasion features and a higher rate of distant metastasis in this cohort. P63 and coexpression of Ki67 predicted a worse stage, differentiation and prognosis, including metastasis and death due to disease.
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Affiliation(s)
- Yingxiu Luo
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Huifang Chen
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shengfang Ge
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yamin Rao
- Department of pathology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jie Yu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shiqiong Xu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yefei Wang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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18
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19
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Zeng S, Fu L, Zhou P, Ling H. Identifying risk factors for the prognosis of head and neck cutaneous squamous cell carcinoma: A systematic review and meta-analysis. PLoS One 2020; 15:e0239586. [PMID: 32991600 PMCID: PMC7523977 DOI: 10.1371/journal.pone.0239586] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/10/2020] [Indexed: 01/22/2023] Open
Abstract
In this study, we sought to identify the potential impacts of disease characteristics on the prognosis of cutaneous squamous cell carcinoma (cSCC). We searched the PubMed, EmBase, and Cochrane Library databases from their inception until February 2020 to identify studies that investigated the prognosis of cSCC. The pooled effect estimates were applied using odds ratios (OR) and 95% confidence intervals (CI) and were calculated using the random-effects model. Forty-three studies including a total of 21,530 patients and reporting 28,627 cases of cSCC were selected for the final meta-analysis. Poor differentiation (OR, 3.54; 95% CI, 2.30–5.46; P < 0.001), perineural invasion (OR, 3.27; 95% CI, 1.60–6.67; P = 0.001), Breslow greater than 2 mm (OR, 5.47; 95% CI, 2.63–11.37; P < 0.001), diameter greater than 20 mm (OR, 4.62; 95% CI, 2.95–7.23; P < 0.001), and location on temple (OR, 3.20; 95% CI, 1.12–9.15; P = 0.030) were associated with an increased risk of recurrence, whereas immunosuppression status and location on cheek, ear, or lip were not associated with the risk of recurrence. Poor differentiation (OR, 6.82; 95% CI, 4.66–9.99; P < 0.001); perineural invasion (OR, 7.15; 95% CI, 4.73–10.83; P < 0.001); Breslow greater than 2 mm (OR, 6.11; 95% CI, 4.05–9.21; P < 0.001); diameter greater than 20 mm (OR, 5.01; 95% CI, 2.56–9.80; P < 0.001); and location on ear (OR, 2.38; 95% CI, 1.39–4.09; P = 0.002), lip (OR, 2.15; 95% CI, 1.26–3.68; P = 0.005), and temple (OR, 2.77; 95% CI, 1.20–6.40; P = 0.017) were associated with an increased risk of metastasis, whereas immunosuppression status and location on cheek did not affect the risk of metastasis. Finally, poor differentiation (OR, 5.97; 95% CI, 1.82–19.62; P = 0.003), perineural invasion (OR, 6.64; 95% CI, 3.63–12.12; P < 0.001), and Breslow greater than 2 mm (OR, 3.42; 95% CI, 1.76–6.66; P < 0.001) were associated with an increased risk of disease-specific death, whereas diameter; immunosuppression status; and location on ear, lip, and temple did not affect the risk of disease-specific death. We found that differentiation, perineural invasion, depth, diameter, and location could affect the prognosis of cSCC. The potential role of other patient characteristics on the prognosis of cSCC should be identified in further large-scale prospective studies.
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Affiliation(s)
- Shihua Zeng
- Department of Dermatology, Chengdu Second People’s Hospital, Chengdu, China
- * E-mail:
| | - Lixin Fu
- Department of Dermatology, Chengdu Second People’s Hospital, Chengdu, China
| | - Peimei Zhou
- Department of Dermatology, Chengdu Second People’s Hospital, Chengdu, China
| | - Hua Ling
- Department of Anesthesiology, Chengdu Second People’s Hospital, Chengdu, China
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20
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Ong Beng Seng M, Meyer D, Gichuhi S, Tong L, Sudharshan S, Biswas J, Testi I, Agrawal R. Ocular Surface Disorders in Patients with Human Immunodeficiency Virus (HIV) Infection. Ocul Immunol Inflamm 2020; 28:1015-1021. [PMID: 32501744 DOI: 10.1080/09273948.2020.1757122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To describe ocular surface disorders associated with human immunodeficiency virus (HIV). Methods: Narrative review. Results: Ocular surface neoplastic conditions, such as Kaposi's sarcoma, conjunctival lymphoma and ocular squamous cell carcinoma along with blepharitis, dry eye disease, and vernal keratoconjunctivitis, constitute ocular surface complications in HIV-infected individuals. Conclusion: This review will provide a summary of clinical presentations and treatment options for the most common HIV-related ocular surface diseases, indicating the need for a comprehensive ocular examination including ocular surface in all HIV patients 22.
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Affiliation(s)
| | - David Meyer
- Division of Ophthalmology, Stellenbosch University , Stellenbosch, South Africa
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi , Nairobi, Kenya
| | - Louis Tong
- Singapore National Eye Centre , Singapore, Singapore.,Singapore Eye Research Institute , Singapore, Singapore.,Eye-Academic Clinical Program, Duke-National University of Singapore , Singapore, Singapore.,Department of Ophthalmology, Tong Loo Lin School of Medicine , NUS, Singapore, Singapore
| | | | - Jyotirmay Biswas
- Medical Research Foundation, Tan Tock Seng Hospital , Chennai, India
| | - Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust , London, UK
| | - Rupesh Agrawal
- Singapore Eye Research Institute , Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust , London, UK.,Tan Tock Seng Hospital , Singapore, Singapore
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21
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Xie M, Yu J, Li L, Jia R, Song X, Wang Y, Fan X. Nomogram for Preoperative Estimation of Orbit Invasion Risk in Periocular Squamous Cell Carcinoma. Front Oncol 2020; 10:564. [PMID: 32426276 PMCID: PMC7203342 DOI: 10.3389/fonc.2020.00564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/30/2020] [Indexed: 01/11/2023] Open
Abstract
Importance: Orbital invasion occurs in some periocular squamous cell carcinoma (SCC), compromising surgical outcomes, and prognoses of patients. To date, however, there are no validation studies on the clinical features related to orbital invasion in patients with periocular SCC. Objective: To explore clinical features that may be associated with orbital invasion and build a model for predicting the risk of orbital invasion. Design, Setting, and Participants: In this retrospective mono-center case-control study, 90 patients with periocular SCC were treated at the Ninth People's Hospital Shanghai Jiao Tong University School of Medicine from January 2005 to August 2019. “Case” is defined as a SCC patient with orbit invasion prior to operation. “Exposure” is defined as the different sites of lesion. Main Outcomes and Measures: Clinical features, including “time to relapse after surgery,” were collected. Multivariate logistic regression analysis was applied to identify the independent risk clinical features associated with orbital invasion, which was then incorporated into a nomogram. Results: Of the 90 patients included in this study, 33 patients (36.7%) had orbital invasion. 14 of the 33 orbit-invasive patients had local recurrence, while 11 of 57 orbit non-invasive patients had local recurrence, suggesting that orbital invasion is a risk factor for local recurrence. The multivariate binary logistic regression indicated that the lesions at the medial canthus [odds ratio (OR), 5.024, 95% CI, 1.409–17.912, P = 0.013], the age at diagnosis (10-years intervals; OR, 0.590, 95% CI, 0.412–0.844, P = 0.004), and bleeding in the lesion (OR, 3.480, 95% CI, 1.254–9.660, P = 0.017) were three preoperative clinical features significantly associated with orbital invasion. Conclusion: For periocular SCC, lesions at the medial canthus, the younger age of the patients at diagnosis, and bleeding in the lesion were the three main clinical features associated with orbital invasion. The risk score model for orbital invasion can act as a supportive tool for optimized clinical evaluation and treatment decisions.
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Affiliation(s)
- Minyue Xie
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jie Yu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Lunhao Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xin Song
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yefei Wang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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22
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Xu S, Sagiv O, Rubin ML, Sa HS, Tetzlaff MT, Nagarajan P, Ning J, Esmaeli B. Validation Study of the AJCC Cancer Staging Manual, Eighth Edition, Staging System for Eyelid and Periocular Squamous Cell Carcinoma. JAMA Ophthalmol 2020; 137:537-542. [PMID: 30869769 DOI: 10.1001/jamaophthalmol.2019.0238] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance To our knowledge, there are no validation studies to date of the prognostic value of the AJCC Cancer Staging Manual, eighth edition (AJCC 8), criteria for eyelid and periocular squamous cell carcinoma. Objective To determine the association of tumor (T) category in AJCC 8 with local recurrence, nodal metastasis, distant metastasis, and disease-specific survival (DSS) for eyelid and periocular squamous cell carcinoma. Design, Setting, and Participants In this retrospective, single-center cohort study, 109 consecutive patients with eyelid and periocular squamous cell carcinoma treated from January 1999 to April 2018 were included. Patients with secondary involvement of the periocular region were excluded. Main Outcomes and Measures Local recurrence, nodal metastasis, distance metastasis, and DSS. Results Of the 109 included patients, 81 (74.3%) were male, and the median (range) age was 66 (40-91) years. At presentation, 43 patients (39.4%) had recurrent tumor, 4 (3.7%) had nodal metastasis, and 1 (0.9%) had distant metastasis. The median (range) follow-up was 23 (1-161) months. During follow-up, 11 patients (10.1%) developed local recurrence, 7 (6.4%) developed nodal metastasis, 2 (1.8%) developed distant metastasis, and 9 (8.3%) died of disease. The 5-year DSS rate was 87.7% (95% CI, 79.5-96.9). Chronic immunosuppression (hazard ratio, 47.24; 95% CI, 7.33-304.30; P < .001) and presentation with recurrent squamous cell carcinoma (hazard ratio, 5.22; 95% CI, 1.12-24.31; P = .04) were associated with local recurrence during follow-up. Of the 11 patients with local recurrence during follow-up, 7 (64%) had perineural invasion. T category was associated with nodal metastasis; clinical stage of T2c or worse at presentation was associated with higher risk of nodal metastasis and death of disease but not with a higher risk of local recurrence. Distant metastasis was associated with nodal metastasis at presentation (hazard ratio, 32.50; 95% CI, 1.97-536.40; P = .02) and during follow-up. A total of 33 patients (30.3%) had different T categories depending on whether disease was staged according to the seventh or eighth edition of the AJCC Cancer Staging Manual. Compared with AJCC 7, AJCC 8 showed a better predictive value in terms of local recurrence (T3, 17% vs 14%; T4, 11% vs 16%) and DSS. Conclusions and Relevance These findings suggest that T category in AJCC 8 is associated with nodal metastasis and DSS. Immunosuppression and presentation with recurrent disease are associated with increased risk of future local recurrence. Patients with tumors of clinical stage T2c or worse at presentation are at increased risk of nodal metastasis and worse DSS and should undergo surveillance for nodal metastasis. Future studies, ideally prospective in design, could provide greater confidence in these findings.
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Affiliation(s)
- Shiqiong Xu
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston.,Department of Ophthalmology, School of Medicine, Shanghai Jiao Tong University, Shanghai Ninth People's Hospital, Shanghai, China
| | - Oded Sagiv
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Maria Laura Rubin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Ho-Seok Sa
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston.,Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
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Henriksen JR, Ramberg I, Mikkelsen LH, Heegaard S. The role of infectious agents in cancer of the ocular region. APMIS 2020; 128:136-149. [PMID: 32003084 DOI: 10.1111/apm.13017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Abstract
The purpose of the study was to investigate the association between infectious agents and the development of cancer in the ocular adnexa. A comprehensive literary study was carried out, reviewing and summarizing previous reports on the topic. A broad range of malignancies of the ocular adnexa are associated with infectious agents. A strong association and possible causal relationship between the infectious agent and the development of ocular adnexal cancer are seen in Merkel cell carcinoma (Merkel cell polyomavirus), Burkitt lymphoma (Epstein-Barr virus) and Kaposi sarcoma (human herpesvirus 8). Infection with Chlamydia psittaci has been associated with the development of extranodal marginal zone B-cell lymphoma in Italy. Human papillomavirus infection has been associated with the development of squamous cell carcinomas of the ocular adnexa, although with a highly variable reported prevalence. By exploring the role of infectious agents in the ocular adnexa and the mechanism by which they contribute to oncogenesis, the diagnostics, management and prevention of these malignancies may also improve. Antibiotic treatment and vaccines against infectious agents may be valuable in future treatment. Additionally, the presence of infectious agents within the tumours may have a prognostic or predictive value.
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Affiliation(s)
- Josephine Raun Henriksen
- Eye Pathology Section, Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ingvild Ramberg
- Eye Pathology Section, Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Eye Pathology Section, Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Steffen Heegaard
- Eye Pathology Section, Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Predictive Value of Preoperative Periocular Skin Cancer Measurements for Final Mohs Defect Size. Ophthalmic Plast Reconstr Surg 2020; 35:604-608. [PMID: 31206459 DOI: 10.1097/iop.0000000000001421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the relationship between pre-Mohs skin cancer lesion measurements with the post-Mohs defect size in order to most accurately estimate post-Mohs defect size. METHODS This is a retrospective analysis of patients who underwent Mohs excision by one of 3 Mohs surgeons followed by reconstruction for basal cell carcinoma or squamous cell carcinoma of the eyelid. The study included all patients from January 2011 to May 2018 operated on by a single oculoplastic surgeon (R.M.) at the University of Texas Southwestern Medical Center. Maximum horizontal and vertical (H/V) dimensions were determined clinically by Mohs surgeons at the time of excision and photographs of the lesion and defect size were analyzed in order to determine the total area of the lesion preoperatively and the defect postoperatively with Image J using H/V dimensions and the area tracing function. RESULTS Forty-two patients with periocular skin cancers underwent Mohs resection followed by reconstruction. The Mohs defect was overall 4.88 times the size of the preoperative skin cancer measurement using maximum H/V dimensions by Mohs surgeons (p < 0.0001). When using Image J, the area of the Mohs defect was 6.5 times the size of the preoperative lesion (p < 0.0001) using both the maximum H/V dimensions and the area tracing function. There was a statistically significant difference between the Image J area tracing and area determined with H/V dimensions by both the Mohs surgeon and Image J. CONCLUSIONS Postoperative Mohs defect size can be estimated based on maximum H/V dimensions clinically or with Image J technology. Image J digital photograph analysis using the area tracing function more accurately determines the pre-Mohs lesion size and the post-Mohs defect area when compared with standard maximum H/V measurements and digital photographic analysis of maximum H/V measurements with Image J.The preoperative periocular skin cancer measurements can assist in determining the post-Mohs defect size.
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25
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Kalemaki MS, Karantanas AH, Exarchos D, Detorakis ET, Zoras O, Marias K, Millo C, Bagci U, Pallikaris I, Stratis A, Karatzanis I, Perisinakis K, Koutentakis P, Kontadakis GA, Spandidos DA, Tsatsakis A, Papadakis GZ. PET/CT and PET/MRI in ophthalmic oncology (Review). Int J Oncol 2020; 56:417-429. [PMID: 31939615 PMCID: PMC6959466 DOI: 10.3892/ijo.2020.4955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/31/2019] [Indexed: 12/16/2022] Open
Abstract
Orbital and ocular anatomy is quite complex, consisting of several tissues, which can give rise to both benign and malignant tumors, while several primary neoplasms can metastasize to the orbital and ocular space. Early detection, accurate staging and re-staging, efficient monitoring of treatment response, non-invasive differentiation between benign and malignant lesions, and accurate planning of external radiation treatment, are of utmost importance for the optimal and individualized management of ophthalmic oncology patients. Addressing these challenges requires the employment of several diagnostic imaging techniques, such as high-definition digital fundus photography, ultrasound imaging, optical coherence tomography, optical coherence tomography (OCT)-angiography, computed tomography (CT) and magnetic resonance imaging (MRI). In recent years, technological advances have enabled the development of hybrid positron emission tomography (PET)/CT and PET/MRI systems, setting new standards in cancer diagnosis and treatment. The capability of simultaneously targeting several cancer-related biochemical procedures using positron emitting-radiopharmaceuticals, while morphologically characterizing lesions by CT or MRI, together with the intrinsic quantitative capabilities of PET-imaging, provide incremental diagnostic information, enabling accurate, highly efficient and personalized treatment strategies. Aim of the current review is to discuss the current applications of hybrid PET/CT and PET/MRI imaging in the management of patients presenting with the most commonly encountered orbital and ocular tumors.
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Affiliation(s)
- Maria S Kalemaki
- Department of Ophthalmology, Venizeleio General Hospital of Heraklion, 71409 Heraklion, Greece
| | | | - Dimitris Exarchos
- Department of CT‑MRI and PET/CT, Evangelismos Hospital, 10676 Athens, Greece
| | - Efstathios T Detorakis
- Department of Ophthalmology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Odysseas Zoras
- Department of Surgical Oncology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Kostas Marias
- Foundation for Research and Technology Hellas (FORTH), Computational Biomedicine Laboratory (CBML), 70013 Heraklion, Greece
| | - Corina Millo
- Positron Emission Tomography Department, Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD 20814, USA
| | - Ulas Bagci
- Center for Research in Computer Vision (CRCV), University of Central Florida (UCF), Orlando, FL 32816, USA
| | - Ioannis Pallikaris
- Department of Ophthalmology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Andreas Stratis
- Foundation for Research and Technology Hellas (FORTH), Computational Biomedicine Laboratory (CBML), 70013 Heraklion, Greece
| | - Ioannis Karatzanis
- Foundation for Research and Technology Hellas (FORTH), Computational Biomedicine Laboratory (CBML), 70013 Heraklion, Greece
| | - Kostas Perisinakis
- Department of Medical Physics, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Pavlos Koutentakis
- Department of Ophthalmology, Venizeleio General Hospital of Heraklion, 71409 Heraklion, Greece
| | - Georgios A Kontadakis
- Department of Ophthalmology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Aristidis Tsatsakis
- Laboratory of Forensic Sciences and Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Georgios Z Papadakis
- Department of Radiology, Medical School, University of Crete, 71003 Heraklion, Greece
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26
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Genders RE, Weijns ME, Dekkers OM, Plasmeijer EI. Metastasis of cutaneous squamous cell carcinoma in organ transplant recipients and the immunocompetent population: is there a difference? a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2019; 33:828-841. [PMID: 30793804 DOI: 10.1111/jdv.15396] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/14/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Organ transplant recipients (OTR) have a higher risk of developing cutaneous squamous cell carcinoma (cSCC) compared to the immunocompetent population. Immunosuppression is often stated as a risk factor for metastasis. However, evidence for this is scarce. OBJECTIVES To investigate the cSCC metastasis risk in OTR and the immunocompetent population by systematically reviewing the literature. METHODS A systematic review of the literature was performed up to January 2018 using: Medline; Embase; Web of Science and ISI Science Citation Index. Studies assessing cSCC metastasis risk in ORT or immunocompetent cohorts were considered. A pooled risk estimate for metastasis was calculated for the immunocompetent population and OTR separately. RESULTS The pooled metastasis risk estimate for OTR was, respectively, 7.3% (95% CI 6.2-8.4) for cSCC on total body, and 11.0% (95% CI 7.7-14.8) for cSCC of the head neck area. For the immunocompetent population reported risk estimate analysis showed a pooled metastatic risk of 3.1% (95% CI 2.8-3.4) in total body cSCC and of 8.5% (95% CI 7.3-9.8) in cSCC of the head and neck area. Pooled risk estimate per single cSCC in OTR was 1.3% (95% CI 1.0-1.7) in total body cSCC and 4.0% (95% CI 2.7-5.5) in cSCC of the head and neck area. In the immunocompetent population, these pooled risk estimates were, respectively, 2.4% (95% CI 2.1-2.6) and 6.7% (95% CI 5.7-7.8). CONCLUSIONS Organ transplant recipients show a higher overall risk of cSCC metastasis compared to the immunocompetent population. Metastasis risks per single cSCC were substantially lower in both groups. However, due to heterogeneity and differences between studies, comparisons are difficult. Comprehensive follow-up studies with defined cohorts are necessary to adequately asses the risk for cSCC metastasis.
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Affiliation(s)
- R E Genders
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - M E Weijns
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - O M Dekkers
- Department of clinical epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - E I Plasmeijer
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands
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Prognostic Value of the Staging System for Eyelid Tumors in the 7th Edition of the American Joint Committee on Cancer Staging Manual. Ophthalmic Plast Reconstr Surg 2017; 33:317-324. [DOI: 10.1097/iop.0000000000000901] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Silverman N, Shinder R. What's New in Eyelid Tumors. Asia Pac J Ophthalmol (Phila) 2017; 6:143-152. [PMID: 28399340 DOI: 10.22608/apo.201701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/03/2017] [Indexed: 11/08/2022] Open
Abstract
Eyelid malignancies represent between 5% and 10% of all skin cancers. Basal cell carcinoma is the most common, followed by squamous cell carcinoma, sebaceous cell carcinoma, Merkel cell carcinoma, and melanoma. The gold standard treatment for periocular epithelial malignancies is surgical excision. Given the constraints of the anatomy and function of the eyelids, excision with negative margins and reconstruction can be challenging. In cases of significant tissue invasion or metastasis, complete tumor removal may not be possible. This review examines the management of periocular skin cancer from diagnosis and staging, including the role of sentinel lymph node biopsy, to both surgical and nonsurgical treatment. The development of targeted drug therapy against specific genetic mutations in cutaneous malignancies has allowed for the treatment of specific cancer cells with less systemic toxicity than more traditional treatments.
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Affiliation(s)
- Nora Silverman
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Roman Shinder
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY
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30
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The Role for Sentinel Lymph Node Biopsy in the Management of Conjunctival Melanoma. Int Ophthalmol Clin 2016; 57:87-101. [PMID: 27898616 DOI: 10.1097/iio.0000000000000161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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31
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Thompson AK, Kelley BF, Prokop LJ, Murad MH, Baum CL. Risk Factors for Cutaneous Squamous Cell Carcinoma Recurrence, Metastasis, and Disease-Specific Death: A Systematic Review and Meta-analysis. JAMA Dermatol 2016; 152:419-28. [PMID: 26762219 DOI: 10.1001/jamadermatol.2015.4994] [Citation(s) in RCA: 334] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE To date, the magnitude of association and the quality of evidence for cutaneous squamous cell carcinoma (cSCC) and risk factors for outcomes have not been reviewed and analyzed systematically. OBJECTIVE To systematically analyze all published data on risk factors for recurrence, metastasis, and disease-specific death (DSD) of cSCC. DATA SOURCES Comprehensive search of Ovid MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus, from each database's inception to May 14, 2015. STUDY SELECTION Inclusion criteria were studies of at least 10 patients, comparative data for at least 1 cSCC risk factor, and an outcome of interest. Exclusion criteria were noncutaneous squamous cell carcinoma (SCC), anogenital SCC, inability to extract cSCC data from other malignancy data, SCC in situ, Marjolin ulcer, and genetic disorders predisposing to cSCC. DATA EXTRACTION AND SYNTHESIS Two reviewers independently abstracted the data. Meta-analysis was performed using the random-effects model. Risk of bias was assessed by the Newcastle-Ottawa Scale. MAIN OUTCOMES AND MEASURES A priori outcomes were recurrence, metastasis, and DSD. RESULTS Thirty-six studies (17 248 patients with 23 421 cSCCs) were included. Significant risk factors for recurrence were the following: Breslow thickness exceeding 2 mm (risk ratio [RR], 9.64; 95% CI, 1.30-71.52), invasion beyond subcutaneous fat (RR, 7.61; 95% CI, 4.17-13.88), Breslow thickness exceeding 6 mm (RR, 7.13; 95% CI, 3.04-16.72), perineural invasion (RR, 4.30; 95% CI, 2.80-6.60), diameter exceeding 20 mm (RR, 3.22; 95% CI, 1.91-5.45), location on the temple (RR, 3.20; 95% CI, 1.12-9.15), and poor differentiation (RR, 2.66; 95% CI, 1.72-4.14). Significant risk factors for metastasis were: invasion beyond subcutaneous fat (RR, 11.21; 95% CI, 3.59-34.97), Breslow thickness exceeding 2 mm (RR, 10.76; 95% CI, 2.55-45.31), Breslow thickness exceeding 6 mm (RR, 6.93; 95% CI, 4.02-11.94), diameter exceeding 20 mm (RR, 6.15; 95% CI, 3.56-10.65), poor differentiation (RR, 4.98; 95% CI, 3.30-7.49), perineural invasion (RR, 2.95; 95% CI, 2.31-3.75), immunosuppression (RR, 1.59; 95% CI, 1.07-2.37), and location on the temple (RR, 2.82; 95% CI, 1.72-4.63), ear (RR, 2.33; 95% CI, 1.67-3.23), or lip (RR, 2.28; 95% CI, 1.54-3.37). Significant risk factors for DSD were: diameter exceeding 20 mm (RR, 19.10; 95% CI, 5.80-62.95), poor differentiation (RR, 5.65; 95% CI, 1.76-18.20), location on the ear (RR, 4.67; 95% CI, 1.28-17.12) or lip (RR, 4.55; 95% CI, 1.41-14.69), invasion beyond subcutaneous fat (RR, 4.49; 95% CI, 2.05-9.82), and perineural invasion (RR, 4.06; 95% CI, 3.10-5.32). Evidence quality was considered low to moderate. CONCLUSIONS AND RELEVANCE Tumor depth is associated with the highest RR of local recurrence and metastasis of cSCC, and tumor diameter exceeding 20 mm is associated with the highest RR of DSD. Unified, consistent collection and reporting of risk factors in a prospective, multicentered effort are needed to further understand the increasing incidence of cSCC.
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Affiliation(s)
| | | | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota4Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
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Wang YQ, Yuan Y, Jiang S, Jiang H. Promoter methylation and expression of CDH1 and susceptibility and prognosis of eyelid squamous cell carcinoma. Tumour Biol 2016; 37:9521-6. [PMID: 26790440 DOI: 10.1007/s13277-016-4851-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022] Open
Abstract
Eyelid skin tumors are the most frequent type of cancer in ophthalmology. And, eyelid squamous cell carcinoma (SCC) accounts for a large part of it. CDH1 encodes E-cadherin, a glycoprotein that plays an important part in cell-cell interaction. Loss of CDH1 function was suspected to be associated with tumorigenesis. Methylation of CDH1 promotors can alter the expression of its protein and is also considered as a contributor to various cancers. In this study, CDH1 methylation and expression profile as well as prognosis of 38 cases of eyelid SCC and the corresponding adjacent tissues were analyzed to clarify the role of CDH1 methylation in SCC carcinogenesis and prognosis. Methylation was detected by PCR, and CDH1 expression was evaluated by immunohistochemistry. We observed that CDH1 methylation is significantly correlated with decreased CDH1 protein expression in eyelid SCC patients. Patients with methylation and low expression of CDH1 are significantly associated with advanced and aggressive phenotypes. Therefore, CDH1 methylation and CDH1 expression are both independent prognostic factors for prognosis of eyelid SCC patients.
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Affiliation(s)
- Yong-Qiang Wang
- Department of Ophthalmology, Jinan Military General Hospital, No. 25 Shifan Road, Jinan, 250031, China
| | - Ye Yuan
- Department of Ophthalmology, Jinan Military General Hospital, No. 25 Shifan Road, Jinan, 250031, China
| | - Shan Jiang
- Department of Rehabilitation and Physiotherapy, The First Affiliated Hospital, Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China.
| | - Hua Jiang
- Department of Ophthalmology, Jinan Military General Hospital, No. 25 Shifan Road, Jinan, 250031, China.
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Jardel P, Caujolle JP, Gastaud L, Maschi C, Sauerwein W, Thariat J. [Malignant tumours of the eye: Epidemiology, diagnostic methods and radiotherapy]. Cancer Radiother 2015; 19:762-74. [PMID: 26508321 DOI: 10.1016/j.canrad.2015.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/23/2015] [Indexed: 12/12/2022]
Abstract
Malignant tumours of the eye are not common, barely representing 1 % of all cancers. This article aims to summarise, for each of the main eye malignant diseases, aspects of epidemiology, diagnostic methods and treatments, with a focus on radiation therapy techniques. The studied tumours are: eye metastasis, intraocular and ocular adnexal lymphomas, uveal melanomas, malignant tumours of the conjunctive, of the lids, and retinoblastomas. The last chapter outlines ocular complications of radiation therapy and their management.
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Affiliation(s)
- P Jardel
- Service d'oncologie radiothérapie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - J-P Caujolle
- Service d'ophtalmologie, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France
| | - L Gastaud
- Service d'oncologie médicale, centre Antoine-Lacassagne, 33, avenue de la Lanterne, 06189 Nice, France
| | - C Maschi
- Service d'ophtalmologie, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France
| | - W Sauerwein
- NC Team, Strahlenklinik, hôpital universitaire, 45122 Essen, Allemagne
| | - J Thariat
- Unité CyberKnife et protonthérapie, service d'oncologie radiothérapie, centre Antoine-Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
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Hoffman GR, Jefferson ND, Reid CBA, Eisenberg RL. Orbital Exenteration to Manage Infiltrative Sinonasal, Orbital Adnexal, and Cutaneous Malignancies Provides Acceptable Survival Outcomes: An Institutional Review, Literature Review, and Meta-Analysis. J Oral Maxillofac Surg 2015; 74:631-43. [PMID: 26475973 DOI: 10.1016/j.joms.2015.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Orbital exenteration (OE) is an aggressive operative undertaking that results in a disfiguring and dysfunctional outcome for patients. The purpose of our study was to determine the survival outcome for patients who underwent OE for malignant disease that had invaded the orbit. MATERIALS AND METHODS We conducted an ambispective cohort study based on a review of the records of 31 consecutive patients who had undergone OE within John Hunter Hospital. The study period was 2006 to 2013. The predictor variables were the demographic, tumor site, and clinicopathologic characteristics that might influence survival. The secondary outcome variable was survival. Descriptive statistics were calculated for the categorical and continuous variables. Kaplan-Meier estimates of the survival distribution were plotted. We also performed a review of published studies and a meta-analysis to investigate the nature of OE performed by various surgical disciplines. RESULTS Of the 31 patients included in the present study, 24 were men and 7 were women. The mean age was 65 years. Of the 31 cases, 15 were squamous cell carcinoma, 8 were basal cell carcinoma, and 8 were a mixture of other pathologic types. The time to median (50%) survival for all patients was 78.4 months. The 1-year survival rate was 93.4% and the 5-year survival rate was 54.1%. Although not statistically significant, notable differences were found in the interval to death with respect to the identification of perineural invasion, lymphovascular invasion, and histopathologic features. The review of published studies suggested a difference in the histologic features and location of the disorder treated, the extent of OE undertaken, and the method of reconstruction between the ophthalmology and nonophthalmology surgical disciplines. CONCLUSIONS Although OE results in significant disfigurement and dysfunction, it does provide good survival outcomes, given the extent of disease at presentation, evident in our group of patients. Continuation of the study, with greater numbers of patients, will serve to increase the statistical power of our observations.
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Affiliation(s)
- Gary Russell Hoffman
- Visiting Medical Officer (Attending Surgeon), Division of Oral-Maxillofacial-Head and Neck Surgery, Head and Neck Surgeon, and Head, Department of Maxillofacial Surgery, John Hunter Hospital, and Conj. Associate Professor, University of Newcastle Medical School, New South Wales, Australia.
| | - Niall David Jefferson
- Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Colin Bruce A Reid
- Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Robert Leonard Eisenberg
- Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia
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Tao R, Ma D, Takiar V, Frank SJ, Fuller CD, Gunn GB, Beadle BM, Morrison WH, Rosenthal DI, Edson MA, Esmaeli B, Kupferman ME, Hanna EY, Garden AS, Phan J. Orbital carcinomas treated with adjuvant intensity-modulated radiation therapy. Head Neck 2015; 38 Suppl 1:E580-7. [PMID: 25782700 DOI: 10.1002/hed.24044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess outcomes of patients with orbital carcinomas treated with orbital exenteration and intensity-modulated radiation therapy (IMRT). METHODS Twenty-nine patients were treated with orbital exenteration and postoperative IMRT between 2002 through 2011; their medical records were retrospectively reviewed. RESULTS Adenoid cystic carcinoma represented the most common histology (41%) followed by squamous cell carcinoma (21%). Perineural invasion (PNI) was identified in 22 patients (76%). The median radiation dose was 60 Gy (range, 60-70). Seven patients (24%) received neck radiation. The median follow-up was 43 months (range, 5-102 months). Five-year local control, overall survival (OS), and disease-free survival rates were 83%, 60%, and 55%, respectively. PNI (p = .01) and especially involvement of a named nerve (p = .001) significantly correlated with worse OS. CONCLUSION Favorable disease control rates for orbital carcinomas are achievable with IMRT after orbital exenteration even for patients with advanced disease. Toxicity for the contralateral eye was minimal. © 2015 Wiley Periodicals, Inc. Head Neck 38: E580-E587, 2016.
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Affiliation(s)
- Randa Tao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dominic Ma
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinita Takiar
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark A Edson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bita Esmaeli
- Section of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Sentinel lymph node biopsy for eyelid and conjunctival tumors: what is the evidence? Int Ophthalmol Clin 2015; 55:123-36. [PMID: 25436498 DOI: 10.1097/iio.0000000000000051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Sun MT, Andrew NH, O'Donnell B, McNab A, Huilgol SC, Selva D. Periocular Squamous Cell Carcinoma: TNM Staging and Recurrence. Ophthalmology 2015; 122:1512-6. [PMID: 25972255 DOI: 10.1016/j.ophtha.2015.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/03/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To analyze the TNM stage, management, and recurrence rates of patients with histologically confirmed squamous cell carcinoma (SCC) of the eyelid. DESIGN Retrospective case series from 3 Australian centers. PARTICIPANTS A total of 254 cases of eyelid SCC from 254 patients (median age, 73 years; range, 28-102 years; 159 were male). METHODS Tumors were staged according to The American Joint Committee on Cancer 7th edition TNM criteria for eyelid carcinoma. MAIN OUTCOME MEASURES Outcomes and recurrence rates according to TNM stage at presentation. RESULTS A total of 25 cases (9.8%) were recurrent tumors. TNM classifications were as follows: T1N0M0, 74 patients (29.1%); T2aN0M0, 92 patients (36.2%); T2bN0M0, 50 patients (19.7%); T3aN0M0, 31 patients (12.2%); T3bN0M0, 5 patients (2.0%); T2bN0M1, 1 patient (0.4%); and T3bN1M1, 1 patient (0.4%). Perineural invasion (PNI) was present histologically in 8.3% of cases. Treatment modalities included Mohs microsurgery (31.1%), wide local excision (WLE) with paraffin section control (21.7%), WLE with frozen-section control (19.3%), and excision without margin control (24.4%). Three cases did not receive treatment. Median follow-up was 40 months (range, <1-132 months). Local recurrence occurred in 17 treated patients (6.8%). The recurrence rate was 5.3% (12/226 patients) for primary tumors and 20% (5/25 patients) for recurrent tumors (P = 0.019). Four patients (1.6%) died of their disease during follow-up. Higher T stage was significantly associated with both PNI (P = 0.035) and local recurrence (P < 0.001). We could not identify a T-stage threshold below which there was no risk of recurrence, as evidenced by 3 T1 primary tumors that recurred. CONCLUSIONS Higher T stage was significantly associated with local recurrence, and recurrent tumors had a 4-fold increased risk of further recurrence compared with primary tumors. Therefore, it may be reasonable to consider sentinel lymph node biopsy or close nodal surveillance and follow-up for patients with recurrent or high T-stage tumors. Of note, we could not identify a T-stage threshold below which there was no risk of recurrences; therefore, clinicians should be aware of the potential for low T-stage tumors to recur.
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Affiliation(s)
- Michelle T Sun
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia.
| | - Nicholas H Andrew
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
| | - Brett O'Donnell
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Alan McNab
- Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Shyamala C Huilgol
- Department of Dermatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
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Yin VT, Merritt HA, Sniegowski M, Esmaeli B. Eyelid and ocular surface carcinoma: Diagnosis and management. Clin Dermatol 2015; 33:159-69. [DOI: 10.1016/j.clindermatol.2014.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Campbell AA, Grob SR, Freitag SK. Controversies in Sentinel Lymph Node Biopsy for Ocular Neoplasms. Int Ophthalmol Clin 2015; 55:73-79. [PMID: 26322427 DOI: 10.1097/iio.0000000000000089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Yin VT, Merritt H, Esmaeli B. Targeting EGFR and sonic hedgehog pathways for locally advanced eyelid and periocular carcinomas. World J Clin Cases 2014; 2:432-8. [PMID: 25232546 PMCID: PMC4163765 DOI: 10.12998/wjcc.v2.i9.432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 07/24/2014] [Accepted: 08/27/2014] [Indexed: 02/05/2023] Open
Abstract
For patients with metastatic or locally advanced eyelid and periocular carcinoma not amenable to surgical excision, targeted therapies have shown efficacy with better tolerability compared to cytotoxic chemotherapy. Overexpression of epithelial growth factor receptor was found in squamous cell carcinomas. Vismodegib targets the mutation in the hedgehog pathway identified in basal cell carcinoma and basal cell nevus syndrome. Targeted therapies provide a novel and potentially effective treatment alternative for patients with eyelid carcinoma not amendable for surgery, including those with metastatic, locally advanced disease, advanced age, and significant comorbidities. High cost, need for long-term treatment, and toxicity are relative limitations.
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Nasser QJ, Roth KG, Warneke CL, Yin VT, El Sawy T, Esmaeli B. Impact of AJCC 'T' designation on risk of regional lymph node metastasis in patients with squamous carcinoma of the eyelid. Br J Ophthalmol 2014; 98:498-501. [PMID: 24429279 DOI: 10.1136/bjophthalmol-2013-304434] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/AIMS Squamous cell carcinoma (SCC) of eyelid is the second most common cancer of the eyelid with the potential for nodal metastasis. The purpose of this report is to determine whether primary tumour size and 'T' designation in the American Joint Committee on Cancer (AJCC) staging system, 7th edition, correlate with the risk of regional nodal metastasis in patients with eyelid SCC. METHODS Sixty-five consecutive patients with eyelid SCC treated by one ophthalmologist from March 1999 through July 2011 were included in this retrospective cohort study. Disease was staged using the AJCC 7th edition criteria based on clinical, pathological and radiographical data. Main outcome measures included regional lymph node metastasis at presentation, local recurrence, distant metastasis and survival at last follow-up. RESULTS 40 men and 25 women had a median age of 67.0 years (range 41-89). TNM designations at presentation per the AJCC 7th edition were as follows: T1N0M0, 6 patients; T2aN0M0, 11 patients; T2bN0M0, 17 patients; T2bN1M0, 2 patients; T3aN0M0, 22 patients; T3bN0M0, 2 patients; T3bN1M0, 1 patient; T4N0M0, 3 patients; and T4N1M0, 1 patient. Median follow-up was 27 months (range 1-150). Four patients had nodal metastasis at presentation. Two of these four patients had T2bN1M0 disease, one had T3bN1M0 disease and one had T4N1M0 disease. Two patients, with T3aN0M0 and T4N0M0 tumours, respectively, at presentation, developed lymph node metastasis at 2 weeks and 8.4 months, respectively, after tumour excision. The four patients who had lymph node metastases at presentation and the two who developed lymph node metastases during follow-up had tumours ≥18 mm in greatest dimension or T2b or higher at presentation. Seven local recurrences were observed during follow-up. Two-year and 3-year recurrence-free survival rates were 93% (95% CI 80% to 98%) and 82% (95% CI 63% to 92%), respectively. No distant metastasis or tumour-related death was observed during follow-up. The 2-year and 3-year disease-free survival rates were 90% (95% CI 77% to 96%) and 79% (95% CI 61% to 89%), respectively. CONCLUSIONS Regional nodal metastases were observed among patients who presented with tumours >T2b. Tumour size and the AJCC TNM designations correlate with metastasis and should be reported more often for eyelid SCCs to allow comparisons across centres.
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Affiliation(s)
- Qasiem J Nasser
- Orbital Oncology & Ophthalmic Plastic Surgery Program, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, , Houston, Texas, USA
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Abstract
PURPOSE Traditional descriptions of lymphatic drainage show eyelids emptying into the submandibular or preauricular basin. However recent studies based on in vivo lymphatic imaging show a possible predilection for the preauricular basin. We describe lymphoscintigraphy and report findings in patients with eyelid malignancies undergoing sentinel lymph node biopsy (SLNB). METHODS Retrospective chart review of 15 consecutive patients at a single institution with eyelid carcinoma undergoing SLNB. The primary outcome measure was primary facial lymphatic drainage site from the eyelid as determined by lymphoscintigraphy. RESULTS The preauricular basin was the site of focal radioactive uptake in all 15 patients. The location of the primary tumor was as follows: medial upper eyelid (1), medial canthus (3), medial lower eyelid (3), lateral upper eyelid (3), and lateral lower eyelid (5). The types of tumor were: invasive squamous cell carcinoma (7), malignant melanoma (3), and sebaceous cell carcinoma (2), Merkel cell carcinoma (2), and conjunctival spindle cell carcinoma (1). CONCLUSIONS Lymphoscintigraphy is increasingly used in the context of SLNB for periocular malignancy. The recent literature suggests that the preauricular lymph node basin may be the primary site of eyelid lymphatic drainage and this is corroborated by our series. Further data will elucidate the biology of eyelid lymphatic channels in humans but the preauricular basin may be the prime lymphatic metastastic site in eyelid malignancies.
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Affiliation(s)
- Julio C Echegoyen
- Gavin Herbert Eye Institute, University of California Irvine, Irvine CA, United States
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A Positive Sentinel Lymph Node in Periocular Invasive Squamous Cell Carcinoma. Ophthalmic Plast Reconstr Surg 2013; 29:6-10. [DOI: 10.1097/iop.0b013e31826a50f7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
It is estimated that 5-10% of all cutaneous malignancies involve the periocular region and management of periocular skin cancers account for a significant proportion of the oculoplastic surgeon's workload. Epithelial tumours are most frequently encountered, including basal cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma, in decreasing order of frequency. Non-epithelial tumours, such as cutaneous melanoma and Merkel cell carcinoma, rarely involve the ocular adnexae. Although non-surgical treatments for periocular malignancies are gaining in popularity, surgery remains the main treatment modality and has as its main aims tumour clearance, restoration of the eyelid function, protection of the ocular surface, and achieving a good cosmetic outcome. The purpose of this article is to review the management of malignant periocular tumours, with particular emphasis on surgical management.
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Affiliation(s)
- C Rene
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Mendenhall WM, Ferlito A, Takes RP, Bradford CR, Corry J, Fagan JJ, Rinaldo A, Strojan P, Rodrigo JP. Cutaneous head and neck basal and squamous cell carcinomas with perineural invasion. Oral Oncol 2012; 48:918-922. [DOI: 10.1016/j.oraloncology.2012.02.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/15/2012] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
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Mair TS, Sherlock CE, Pearson GR. Delayed metastasis of ocular squamous cell carcinoma following treatment in five horses. EQUINE VET EDUC 2012. [DOI: 10.1111/j.2042-3292.2012.00435.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND The periocular skin is susceptible to numerous benign and malignant neoplasms. Periocular malignancies may present differently, behave more aggressively, and pose greater challenges for treatment and repair than malignancies at other cutaneous sites. Between 5% and 10% of cutaneous malignancies occur periorbitally, with basal cell carcinoma reported as the most common malignant periocular tumor, followed by squamous cell carcinoma, sebaceous gland carcinoma, cutaneous melanoma, Merkel cell carcinoma, and other rare tumors. OBJECTIVE To review the current literature on cutaneous malignancies of the periocular region pertaining to etiology, incidence, clinical presentation, differential diagnosis, complications, and treatment options. MATERIALS AND METHODS An extensive literature review was conducted using PubMed, searching for articles on periocular and periorbital cutaneous malignancies. CONCLUSIONS Timely diagnosis and management of periocular malignancies is essential because of their proximity to and potential to invade vital structures such as the orbit, sinuses, and brain. Surgical excision remains the standard of care for the majority of periorbital malignancies, but given the sensitive anatomic location, tissue-sparing techniques with margin control such as Mohs micrographic surgery are the preferred method for most nonmelanoma skin cancers. Depending on tumor type, other treatment modalities may include radiation, chemotherapy, cryosurgery, topical medications, and photodynamic therapy.
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Affiliation(s)
- Jordan B Slutsky
- Department of Dermatology, Saint Louis University, Saint Louis, Missouri 63104, USA.
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Sentinel Lymph Node Biopsy in Patients With Conjunctival and Eyelid Cancers. Ophthalmic Plast Reconstr Surg 2012; 28:30-4. [DOI: 10.1097/iop.0b013e31822fb44b] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The diagnosis and treatment of orbital and periorbital malignancies are challenging. These tumors can result in blindness, death, and significant cosmetic deformities. Herein, we present the most common ocular malignancies and a systematic approach to diagnosis. Further, we integrate the seventh edition American Joint Committee on Cancer staging system, biomarkers, and multidisciplinary approaches to treatment.
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Affiliation(s)
- Robert M Schwarcz
- The Department of Ocular Tumor and Orbital Disease, The New York Eye Cancer Center, New York City, NY, USA
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