Orbital Oncology & Ophthalmic Plastic Surgery
Orbital Oncology and Ophthalmic Plastic Surgery is a subspecialty that focuses on the surgical treatment of tumors of the eye, orbit, eyelid, conjunctiva and other ocular adnexal structures, as well as reconstructive surgery in the periocular region in cancer patients. At MD Anderson, the primary goals of this subspecialty are surgical elimination of ocular and orbital cancers while preserving the eye and vision, and restoring function and cosmesis in the periocular region.
In this subspecialty within the Plastic Surgery departmetnt, Bita Esmaeli, M.D., professor of Ophthalmology, sees approximately 350 new patients and consultations each year. Among these are patients with rare cancers of the ocular and orbital area that require multidisciplinary expertise offered by departments across MD Anderson. Specific diseases and cancers treated by physicians in this subspecialty include conjunctival tumors, eyelid cancers, lacrimal gland tumors, orbital tumors and uveal melanoma.
Dr. Esmaeli sees patients in the Ophthalmology Clinic at MD Anderson. For new patient referrals please contact: 713-792-4457.
There are several clinical trials and protocols that are currently underway which are focused on cancers of the eye, orbit, and ocular adnexa are actively recruiting patients. These include:
- Sentinel lymph node biopsy for Conjunctival and Eyelid Melanoma (GSP00-106)
- Blood and Tumor Banking for Uveal Melanoma (Lab 02-693)
- Sentinel lymph node biopsy for sebaceous carcinoma of eyelid and conjunctiva (2008-0266)
- In vivo confocal microscopy for conjunctival melanoma (2010-0330)
- Low-dose radiation therapy for orbital and ocular adnexal lymphoma.
Other research efforts include the use of genomic testing to explore personalized targeted treatments for patients with orbital and ocular cancers; adjuvant radiation therapy for eyelid and orbital cancers after globe preserving surgery; sentinel lymph node biopsy for eyelid and conjunctival tumors to detect early metastasis; and the development of multi-institutional clinical databases for rare cancers of the ocular and orbital region.
Until recently, the treatment of lacrimal gland carcinoma almost
always required removal of the eye. But for some patients with these
tumors, globe-sparing surgery followed by radiation therapy can
preserve vision and decrease ocular morbidity and facial
Carcinomas of the lacrimal gland, although rare, are associated with a high risk of recurrence, perineural invasion, and distant metastasis. About half of patients eventually die of their disease despite treatment.
Treatment for lacrimal gland carcinoma historically entailed orbital exenteration (removal of the eye and all orbital contents), usually followed by high-dose radiation therapy to address perineural invasion or close surgical margins. Surgeons were reluctant to preserve the eye because of concerns that the eye would be severely damaged by the radiation therapy.
In recent years, however, the routine use of orbital exenteration for lacrimal gland carcinoma has been called into question by efforts led by Bita Esmaeli, M.D., a professor of ophthalmology and the director of orbital oncology and ophthalmic plastic surgery at The University of Texas MD Anderson Cancer Center. Retrospective reports from MD Anderson and other centers found poor survival outcomes despite local control of the tumors in patients who underwent orbital exenteration. “Orbital exenteration has not shown any survival benefit,” Dr. Esmaeli said.
The globe-sparing approach
MD Anderson physicians led by Dr. Esmaeli and Steven Frank, M.D., an associate professor in the Department of Radiation Oncology and the medical director of the Proton Therapy Center, use a multidisciplinary globe-sparing approach to manage lacrimal gland carcinoma in selected patients while striving to preserve vision and cosmesis.
This approach involves globe-sparing surgery followed by high-dose adjuvant radiation therapy. Chemotherapy may be given along with radiation to patients with positive surgical margins or recurrent disease.
Dr. Frank said, “With exenteration, a functioning organ is removed because of an adjacent tumor. Our goal is to preserve the eye and its function through surgery and radiation therapy.”
The extent of surgery depends upon the tumor’s location in the lacrimal gland, which comprises the orbital lobe and the palpebral lobe, and the involvement of the orbital soft tissue. For most patients, a significant amount of the orbital lobe must be removed; some patients must also undergo resection of the palpebral part of the gland, which is closest to the eye. Dr. Esmaeli said, “To achieve the goal of resecting the lacrimal gland cancer but preserving the eye and functionally important tissues in the orbit as much as possible, the orbital surgeon must have experience with meticulous oncologic resection.”
The globe-sparing approach requires close collaboration among the orbital surgeon, medical oncologist, and radiation oncologist. This collaboration is especially important in radiation treatment planning, as the treatment field must cover the postoperative surgical bed and often must extend to the base of the skull, toward the brain stem, to prevent perineural invasion and disease recurrence.