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LETTER TO EDITOR
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 43-44

Intraorbital pulse dose rate brachytherapy for myoepithelial carcinoma ex pleomorphic adenoma


Department of Orbit and Oculoplasty, Sankara Eye Hospital, Bengaluru, Karnataka, India

Date of Web Publication6-Dec-2016

Correspondence Address:
Saptagirish Rambhatla
Sankara Eye Hospital, Old Airport Road, Near Kundalhalli Gate, Varthur Road, Munnenkolala, Bengaluru - 560 037, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3897.195310

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How to cite this article:
Chandak AN, Rambhatla S, Shambhu SK. Intraorbital pulse dose rate brachytherapy for myoepithelial carcinoma ex pleomorphic adenoma. J Clin Ophthalmol Res 2017;5:43-4

How to cite this URL:
Chandak AN, Rambhatla S, Shambhu SK. Intraorbital pulse dose rate brachytherapy for myoepithelial carcinoma ex pleomorphic adenoma. J Clin Ophthalmol Res [serial online] 2017 [cited 2022 Aug 12];5:43-4. Available from: https://www.jcor.in/text.asp?2017/5/1/43/195310

Sir,

Various modalities of treatment are available for recurrent lacrimal gland carcinoma. The incidence of neoplastic lesions of the lacrimal gland was estimated to be 0.7 lesions per million individuals per year in a Danish report. [1] Malignant transformation of recurrent pleomorphic adenoma is reported in 1.5%-23% of cases, and the risk appears to increase with time and number of recurrences [2] and the estimated rate of mortality at 5-year follow-up is 50% regardless of the form of local treatment. [3] We used pulse-dose rate (PDR) brachytherapy for a case of myoepithelial carcinoma ex pleomorphic adenoma.

A 76-year-old man presented to our hospital with fall in vision since 3 months in the left eye and swelling in the left lacrimal gland area. He gave a history of undergoing left-sided lateral orbitotomy for a lacrimal gland mass 7 years ago. The tumor was removed completely with the capsule. Histopathologically, it was diagnosed as a pleomorphic adenoma of the lacrimal gland.

He developed a swelling in the left temporal area after 3 years, for which he underwent left lateral craniotomy. The tumor was diagnosed as myoepithelial carcinoma of the lacrimal gland. He underwent external beam radiotherapy (60 Gy in thirty fractions) to the temporal fossa for the same. He was asymptomatic till 3 months ago when he noticed a fall in vision and an associated swelling in the left lacrimal gland area.

He was noted to have vitreous hemorrhage and radiation retinopathy in the left eye. Magnetic resonance imaging scan showed recurrence of tumor. It was a diffuse tumor and nonencapsulated. Mass debulking was done and specimen was sent for histopathology which confirmed a diagnosis of myoepithelial carcinoma. Intraorbital PDR brachytherapy was planned. With accurate mapping of the tumor, sterile intraorbital catheters [Figure 1] (sections of Ryles tube with (polymethylmethacrylate dummy rods, similar in dimension to brachytherapy rods) were placed in superotemporal orbit 1.5 cm from the anterior orbital rim. Catheter was anchored to periosteum of the orbital rim and the skin and subcutaneous structures. Dosimetry was done by a radiation oncologist and 34 Gy using a source of iridium 192 was given over 5 days followed by catheter removal.
Figure 1: Larger tube - polymethylmethacrylate rods; smaller tubes - Ryles tube

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Patient being followed up for recurrence (1-year postbrachytherapy), there was no recurrence of tumor. Interstitial brachytherapy is used extensively in cervical, vaginal, rectal, gallbladder, and breast malignancies. [4] PDR brachytherapy using plastic catheters has also been used for leiomyosarcoma of the orbit, [5] but PDR brachytherapy has not been used for myoepithelial carcinoma ex pleomorphic adenoma. Intraorbital brachytherapy can provide individualized location specific high-dose radiation with minimal damage to surrounding structures. This treatment is an added option in the armamentarium, and we suggest this option for recurrent lacrimal gland malignancy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Von Holstein SL, Therkildsen MH, Prause JU, Stenman G, Siersma VD, Heegaard S. Lacrimal gland lesions in Denmark between 1974 and 2007. Acta Ophthalmol 2013;91:349-54.  Back to cited text no. 1
    
2.
Bradley P. Recurrent salivary gland pleomorphic adenoma: Etiology, management, and results. Curr Opin Otolaryngol Head Neck Surg 2001;9:100-8.  Back to cited text no. 2
    
3.
Font RL, Gamel JW. Epithelial tumors of the lacrimal gland: An analysis of 265 cases. In: Jakobiec FA, editor. Ocular and Adnexal Tumors. Birmingham, Alabama: Aesculapius Publishing Co.; 1978. p. 787-805.  Back to cited text no. 3
    
4.
Amsbaugh MJ, Bhatt N, Hunter T. Computed tomography planned interstitial brachytherapy for recurrent gynecologic cancer. Brachytherapy Int Multidiscip J 2015;14:600-5.  Back to cited text no. 4
    
5.
Padrón-Pérez N, Mascaró-Zamora F, Gutiérrez-Miguelez C. Adjuvant pulse dose rate brachytherapy in a secondary leiomyosarcoma of the orbit. Can J Ophthalmol 2013;48:e65-7.  Back to cited text no. 5
    


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