1
|
Meel R, Pushker N, Kashyap S, Chaurasia S, Rathod A, Bajaj MS, Sen S, Agrawal S. Clinicodemographic profile of orbital exenteration in a tertiary eye care center - A 20-year experience. Indian J Ophthalmol 2024; 72:S610-S615. [PMID: 38454866 DOI: 10.4103/ijo.ijo_2716_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/11/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE This study aimed to determine the clinical indications for orbital exenteration, demographic profile of these patients, and clinicopathologic correlations in the current times and to compare these results with previous published data. METHODS It was a retrospective study. All exenterations performed at a tertiary eye care center over a period of 20 years (from January 2001 to June 2020) were retrospectively evaluated. Patient records were reviewed to obtain demographic data, presenting symptoms and their duration, laterality, and clinical and histopathologic diagnosis. RESULTS A total of 352 cases (males:females = 222:130) who underwent exenteration were identified. Patients age ranged from 11 months to 87 years (mean: 43.86 years, median: 50 years). The most common indication for exenteration was found to be eyelid malignancy in 54.36%, followed by retinoblastoma in 18.75% and primary orbital tumors in 14.49%. Out of 156 cases of eyelid malignancies requiring exenteration, squamous cell carcinoma (SCC) was the most common histologic subtype ( n = 94, 60.26%), followed by sebaceous gland carcinoma ( n = 40, 25.64%) and basal cell carcinoma ( n = 20, 12.82%). The most common primary orbital tumors requiring exenteration were adenocystic carcinoma of the lacrimal gland in adults and rhabdomyosarcoma in the pediatric age group. Benign conditions requiring exenteration included fulminant fungal orbital infections and lymphangioma among others. CONCLUSION The number of exenterations performed have significantly increased in terms of absolute numbers. However, the ratio of exenteration to other tumor-related surgeries, mainly excision biopsy, has reduced compared to that reported from a previous study. The most common indication in our study remains eyelid malignancy followed by intraocular malignancy. However, SCC has emerged as the most common tumor histologic subtype requiring exenterations.
Collapse
Affiliation(s)
- Rachna Meel
- Oculoplasty and Oncology Services, AIIMS, New Delhi, India
| | - Neelam Pushker
- Oculoplasty and Oncology Services, AIIMS, New Delhi, India
| | - Seema Kashyap
- Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | | | | | - Seema Sen
- Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Sahil Agrawal
- Oculoplasty and Oncology Services, AIIMS, New Delhi, India
| |
Collapse
|
2
|
Singalavanija T, Ceylanoglu KS, Juntipwong S, Beser BG, Elner VM, Worden FP, Demirci H. Review of Targeted Therapy, Vismodegib, for the Treatment of Periocular Basal Cell Carcinoma. Ophthalmic Plast Reconstr Surg 2024; 40:1-10. [PMID: 37552493 DOI: 10.1097/iop.0000000000002464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE Periocular locally advanced basal cell carcinoma (POLA-BCC) is characterized by orbital involvement and/or extensive invasion of periocular structures. Hedgehog pathway inhibitors have been used for POLA-BCC with promising outcomes. METHODS The authors reviewed 11 articles published in English literature from January 2012 to July 2022 and reported the outcomes of patients with POLA-BCC who were treated with vismodegib. RESULTS A total of 384 patients were treated with vismodegib. The mean age was 72 years, and the median treatment duration was 9 months. The overall response rate was 75% with a median follow-up time of 14.4 months. Following vismodegib treatment, the median number of patients who required adjuvant surgery was 43% with a median time to surgery of 6.5 months. The exenteration rate was 6% (overall 8 patients). In total 93.7% of patients experienced grade I adverse events, 26.7% to 37.5% grade II, 8.8% to 10% grade III-IV, and 0.8% to 4.8% grade V. Major side effects included dysgeusia (30-100%), muscle spasm (15-100%), alopecia (47-75%), weight loss (23-83%), and decreased appetite (19-42%). The median percentage of patients who discontinued treatment due to toxicity was 29% with a median interval of 5 months before the development of side effects. The median recurrence rate following discontinuation of vismodegib was 7.8% with a median recurrence duration of 20 months. CONCLUSIONS In patients with POLA-BCC, vismodegib, a hedgehog pathway inhibitor, provided high rates of orbital preservation, reducing exenteration rates to 6%. Neoadjuvant therapy with vismodegib can also be suggested for patients with POLA-BCC. While extremely effective, side effects lead to temporary or permanent discontinuation of vismodegib in small numbers of patients.
Collapse
Affiliation(s)
- Tassapol Singalavanija
- Department of Ophthalmology and Visual Sciences, W.K, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A
- Department of Ophthalmology, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kubra Serbest Ceylanoglu
- Department of Ophthalmology and Visual Sciences, W.K, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Sarinee Juntipwong
- Department of Ophthalmology and Visual Sciences, W.K, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Buse Guneri Beser
- Department of Ophthalmology and Visual Sciences, W.K, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Victor Maurice Elner
- Department of Ophthalmology and Visual Sciences, W.K, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Francis Paul Worden
- Department of Internal Medicine, Division of Hematology-Oncology, Roger Cancer Center, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Hakan Demirci
- Department of Ophthalmology and Visual Sciences, W.K, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A
| |
Collapse
|
3
|
Saad AL-Zomia A, AL-Zehefa IA, Alqarni AM, Al Muidh AM, Mesfer Almousa A, Faez Al-Qaed A, Alshahrani AS, Mohammed Asiri B, Asiri GB, Ali Lahiq L, Al-Amri MA, Al-Nujimi MS, Alfaisal SM, Tawhari I. A Retrospective Study of Ocular Cancer in Saudi Arabia: 25-Year Analysis. Clin Ophthalmol 2023; 17:3103-3111. [PMID: 37877115 PMCID: PMC10591673 DOI: 10.2147/opth.s433118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023] Open
Abstract
Background Ocular malignancies are uncommon among eye diseases; however, they jeopardize both vision and life. The main objective of this study was to use to describe the epidemiology of eye and ocular adnexa malignancies across different ages and sex. Methods The King Khaled University institutional review board approved this study. Data on ocular cancer were retrieved from the Saudi Cancer Registry between 1994 and 2018. The registry collected important patient information such as demographic information (age, gender, and nationality), clinical details, and tumor classification. Results The total number of cases with ocular cancer diagnosed was 1051 cases. The highest number was recorded in Riyadh (35.39%, n=372), followed by Makkah (16.93%, n=178). The incidence was higher in the 0-4 years' age group (55.21%), and it got down as people got older. The data also revealed differences in the number of reported cases over time, as well as in the representation of eye cancer cases by gender and nationality. While many ocular cancer pathologies were seen, with "Retinoblastoma, not otherwise specified" being the most common (53.32%), the incidence rates for males and females remained largely stable over time. Conclusion The study emphasizes the need for continued monitoring, research, and analysis of potential of epidemiology of ocular cancer occurrence in Saudi Arabia. Identifying the geographical distribution and age pattern of Ocular malignancies have the potential to assist healthcare authorities and policymakers in developing precise strategies to reduce, recognize at an early stage, and successfully manage this condition.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lama Ali Lahiq
- Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | | | | | - Ibrahim Tawhari
- Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
| |
Collapse
|
4
|
Nahon-Estève S, Bertolotto C, Picard-Gauci A, Gastaud L, Baillif S, Hofman P, Groulier A, Maschi C, Caujolle JP, Lassalle S, Martel A. Small but Challenging Conjunctival Melanoma: New Insights, Paradigms and Future Perspectives. Cancers (Basel) 2021; 13:5691. [PMID: 34830847 PMCID: PMC8616295 DOI: 10.3390/cancers13225691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Although its incidence has increased over the last decades, conjunctival melanoma (CM) remains a rare but challenging periocular malignancy. While there is currently no recognized standard of care, "no-touch" surgical excision followed by adjuvant treatments is usually recommended. Despite its small size, managing CM is challenging for clinicians. The first challenge is the high risk of tumour local recurrence that occurs in about one third of the patients. The management of locally advanced CM (≥T2) or multiple recurrences may require mutilating surgeries such as orbital exenteration (OE). The second challenge is the metastatic spread of CM that occurs in about one quarter of patients, regardless of whether complete surgical excision is performed or not. This highlights the infiltrative and highly aggressive behaviour of CM. Recently, attention has been directed towards the use of eye-sparing strategies to avoid OE. Initially, wide conservative surgeries followed by customized brachytherapy or radiotherapy have appeared as viable strategies. Nowadays, new biological insights into CM have revealed similarities with cutaneous melanoma. These new findings have allowed clinicians to reconsider the management of locally advanced CM with "medical" eye-sparing treatment as well as the management of metastatic spread. The aim of this review was to summarize the current and future perspectives of treatment for CM based on recent biological findings.
Collapse
Affiliation(s)
- Sacha Nahon-Estève
- Ophthalmology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (S.B.); (C.M.); (J.-P.C.); (A.M.)
- Department of Biology and Pathologies of Melanocytes, Team1, Equipe Labellisée Ligue 2020 and Equipe Labellisée ARC 2019, Centre Méditerranéen de Médecine Moléculaire, INSERM, 06200 Nice, France;
| | - Corine Bertolotto
- Department of Biology and Pathologies of Melanocytes, Team1, Equipe Labellisée Ligue 2020 and Equipe Labellisée ARC 2019, Centre Méditerranéen de Médecine Moléculaire, INSERM, 06200 Nice, France;
| | - Alexandra Picard-Gauci
- Dermatology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France;
| | - Lauris Gastaud
- Antoine Lacassagne Cancer Centre, Oncology Department, Université Côte d’Azur, 06000 Nice, France;
| | - Stéphanie Baillif
- Ophthalmology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (S.B.); (C.M.); (J.-P.C.); (A.M.)
| | - Paul Hofman
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Université Côte d’Azur, 06000 Nice, France; (P.H.); (S.L.)
- Biobank BB-0033-00025, Laboratory of Clinical and Experimental Pathology, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France
| | - Anaïs Groulier
- Antoine Lacassagne Cancer Center, Department of Radiation Oncology, Université Côte d’Azur, 06000 Nice, France;
| | - Célia Maschi
- Ophthalmology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (S.B.); (C.M.); (J.-P.C.); (A.M.)
| | - Jean-Pierre Caujolle
- Ophthalmology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (S.B.); (C.M.); (J.-P.C.); (A.M.)
| | - Sandra Lassalle
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Université Côte d’Azur, 06000 Nice, France; (P.H.); (S.L.)
- Biobank BB-0033-00025, Laboratory of Clinical and Experimental Pathology, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France
| | - Arnaud Martel
- Ophthalmology Department, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (S.B.); (C.M.); (J.-P.C.); (A.M.)
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Université Côte d’Azur, 06000 Nice, France; (P.H.); (S.L.)
| |
Collapse
|
5
|
Martel A, Lassalle S, Picard-Gauci A, Gastaud L, Montaudie H, Bertolotto C, Nahon-Esteve S, Poissonnet G, Hofman P, Baillif S. New Targeted Therapies and Immunotherapies for Locally Advanced Periocular Malignant Tumours: Towards a New 'Eye-Sparing' Paradigm? Cancers (Basel) 2021; 13:2822. [PMID: 34198863 PMCID: PMC8201354 DOI: 10.3390/cancers13112822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 12/26/2022] Open
Abstract
The management of periocular skin malignant tumours is challenging. Surgery remains the mainstay of treatment for localised eyelid cancers. For more locally advanced cancers, especially those invading the orbit, orbital exenteration has long been considered the gold standard; however, it is a highly disfiguring and traumatic surgery. The last two decades have been marked by the emergence of a new paradigm shift towards the use of 'eye-sparing' strategies. In the early 2000s, the first step consisted of performing wide conservative eyelid and orbital excisions. Multiple flaps and grafts were needed, as well as adjuvant radiotherapy in selected cases. Although being incredibly attractive, several limitations such as the inability to treat the more posteriorly located orbital lesions, as well as unbearable diplopia, eye pain and even secondary eye loss were identified. Therefore, surgeons should distinguish 'eye-sparing' from 'sight-sparing' strategies. The second step emerged over the last decade and was based on the development of targeted therapies and immunotherapies. Their advantages include their potential ability to treat almost all tumours, regardless of their locations, without performing complex surgeries. However, several limitations have been reported, including their side effects, the appearance of primary or secondary resistances, their price and the lack of consensus on treatment regimen and exact duration. The aim of this article was to review the evolution of the management of locally advanced periocular malignant tumours over the last three decades and highlight the new paradigm shift towards the use of 'eye-sparing' strategies.
Collapse
Affiliation(s)
- Arnaud Martel
- Department of Ophthalmology, University Hospital of Nice, Cote d’Azur University, 06000 Nice, France; (S.N.-E.); (S.B.)
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Cote d’Azur University, 06000 Nice, France; (S.L.); (P.H.)
| | - Sandra Lassalle
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Cote d’Azur University, 06000 Nice, France; (S.L.); (P.H.)
- Biobank BB-0033-00025, FHU OncoAge, IRCAN, Laboratory of Clinical and Experimental Pathology, University Hospital of Nice, 06000 Nice, France
| | - Alexandra Picard-Gauci
- Department of Dermatology, Archet 2 Hospital, 151 Route de Saint-Antoine, 06200 Nice, France; (A.P.-G.); (H.M.)
| | - Lauris Gastaud
- Department of Oncology, Antoine Lacassagne Cancer Centre, 06000 Nice, France;
| | - Henri Montaudie
- Department of Dermatology, Archet 2 Hospital, 151 Route de Saint-Antoine, 06200 Nice, France; (A.P.-G.); (H.M.)
| | - Corine Bertolotto
- Department of Biology and Pathologies of Melanocytes, Team1, Equipe Labellisée Ligue 2020 and Equipe Labellisée ARC 2019, Centre Méditerranéen de Médecine Moléculaire, Inserm, 06200 Nice, France;
| | - Sacha Nahon-Esteve
- Department of Ophthalmology, University Hospital of Nice, Cote d’Azur University, 06000 Nice, France; (S.N.-E.); (S.B.)
| | - Gilles Poissonnet
- Cervicofacial Surgery Department, Antoine Lacassagne Cancer Centre, 06000 Nice, France;
| | - Paul Hofman
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Cote d’Azur University, 06000 Nice, France; (S.L.); (P.H.)
- Biobank BB-0033-00025, FHU OncoAge, IRCAN, Laboratory of Clinical and Experimental Pathology, University Hospital of Nice, 06000 Nice, France
| | - Stephanie Baillif
- Department of Ophthalmology, University Hospital of Nice, Cote d’Azur University, 06000 Nice, France; (S.N.-E.); (S.B.)
| |
Collapse
|