Neoadjuvant Intra-arterial Cytoreductive Chemotherapy for Lacrimal Gland Adenoid Cystic Carcinoma

Abstract

Adenoid cystic carcinoma (ACC) is the most common lacrimal gland malignancy. Despite poor prognosis, the advent of neoadjuvant intra-arterial cytoreductive chemotherapy (IACC) can improve survival. We report the first case of lacrimal gland ACC from the Indian subcontinent managed with IACC. A 45-year-old gentleman presented with painful proptosis with restricted ocular movements in right eye for 6 months. Imaging showed an ill-defined heterogeneous mass involving the right lacrimal gland with calcification and adjacent bony erosion. Incision biopsy confirmed the diagnosis of lacrimal gland ACC. He received 2 cycles of neoadjuvant intra-arterial cisplatin before tumour excision followed by adjuvant chemoradiation. He had no recurrence at 6 years of follow-up. IACC helps to reduce tumour size, thereby enabling complete tumour excision and globe salvage. IACC is a treatment option worth considering for patients presenting with a large lacrimal gland ACC.

Keywords

• adenoid cystic carcinoma
• intra-arterial chemotherapy
• lacrimal gland