After determining a diagnosis and completing a full pre-treatment evaluation, doctors will recommend a course of treatment for their patients. For orbital cancers, the pretreatment evaluation should also involve examination by an ophthalmologist. In general, there are 3 different options for the treatment of orbital cancers that can be used alone or in combination.
Unlike other types of head and neck cancers, there are no comprehensive guidelines regarding the treatment of orbital cancers, for a variety of reasons:
- Orbital cancers are very rare, making it difficult for doctors to perform studies on the best treatment options.
- Orbital cancers are extremely varied and can be treated many different ways depending on the type of cancer and grade.
- Many orbital cancers do not have a clear staging system.
However, as more data on orbital cancers accumulates over time, doctors are beginning to gain a better understanding of the best treatment options for orbital cancers. Patients with orbital cancer should have an in-depth discussion with a doctor specializing in head and neck or orbital cancers.
Surgery
If surgery is determined to be the treatment of choice, options may include a craniofacial resection, evisceration, enucleation, or exenteration.
General Treatment Options for Orbital Cancer
Treatment recommendations will depend on the specific type of orbital cancer. The following are some general treatment guidelines.
Orbital Lymphomas
Surgery can be helpful in diagnosing an orbital lymphoma, but it does not play a major role in treatment. Studies have found success using radiotherapy alone to treat orbital lymphomas. Successful treatment will depend on the type of lymphoma and the stage. Additional treatment may be required in some cases.
Rhabdomyosarcomas
This is the most common orbital tumor in children. Most patients with rhabdomyosarcoma of the orbit are treated at major cancer hospitals using a combination of chemotherapy and radiation. Surgical removal may be indicated if there is tumor remaining after the initial treatment.
Lacrimal Apparatus Cancers
This includes cancers of the lacrimal gland, lacrimal duct and lacrimal sac. Many different types of cancer can arise in these regions, including adenoid cystic carcinoma, adenocarcinoma and squamous cell carcinoma. Whether all of the lacrimal structures should be grouped and treated together remains questionable. Studies that evaluate the effectiveness of different treatments are based on small groups of patients with a number of different types of tumors. Most existing studies have looked at adenoid cystic carcinoma. Patients should speak to their doctors about different treatment options for these specific types of cancers. Basic information regarding treatment options is as follows:
- Surgery
Surgery is the generally accepted first line treatment for lacrimal gland and lacrimal apparatus cancers, when possible. The cancer should be completely removed, which may or may not involve removal of the eye (orbital exenteration). - Radiation
Radiation is generally given after surgical removal of a lacrimal cancer, though some treatment centers use external beam radiation as an initial treatment. Other radiation treatment methods such as neutron beam, gamma knife radiosurgery, and brachytherapy have also been used. - Chemotherapy
Some treatments may use chemotherapy in an attempt to improve the prognosis of lacrimal cancer. In these cases, chemotherapy is often given in addition to radiation and surgery.
Metastatic Orbital Tumors
Some centers offer localized short-term radiation treatments for isolated orbital metastases. While this may not have a significant effect on the overall cure rate for the patient’s metastatic disease, it can provide local tumor control at the orbit, preservation of orbital function, and symptom relief.
- Orbital brachytherapy can also be used to treat orbital cancers in certain cases. Brachytherapy is a form of radiotherapy, and is discussed in more detail here.
