Introduction: The aim of the study was to report our experience in the use of Gamma Knife Stereotactic Radiosurgery (GKSTRS) for conjunctival squamous cell carcinoma (SCC) invading the orbit, as an alternative to exenteration surgery. Patients and Methods: Patients who had GKSTRS for conjunctival SCC invading the orbit but sparing the bone (AJCC eighth ed. T4a) with a minimum of 1-year follow-up were included. Treatment failure was defined as no decrease in tumour size 3 months post-treatment, or further growth during the follow-up period. Patients were followed up 3-monthly for 2 years and 6-monthly afterwards with a minimum of yearly MR Imaging of orbit. Results: Six patients met the inclusion criteria. MR imaging was used to identify the extent of orbital involvement of SCC. Stereotactic radiosurgery utilizing the Leksell Gamma Knife® Perfexion was delivered in a single session in which patients received 18–20 Gy to the 45–50% isodose. The median follow-up was 29 months. Four patients responded to the treatment and had no evidence of recurrence at their most recent follow-up. The treatment failed in 2 patients, in 1 of whom the tumour was larger and extended deeper into the orbit. The other patient developed a recurrence away from the treated area at 9 months, suggesting a multifocal disease. Both patients had poorly differentiated SCC. Conclusion: GKSTRS is a potential alternative to orbital exenteration surgery for conjunctival SCC extending into the anterior orbit in a selected group of patients refusing orbital exenteration or has a second blind eye. Nevertheless, the disease is more likely to recur than with exenteration surgery, hence lifelong monitoring and low threshold for surgical intervention or retreatment is prudent.
Ocul Oncol Pathol

中文翻译：

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伽玛刀立体定向放射外科治疗侵犯前眶的结膜鳞状细胞癌：病例系列

简介：本研究的目的是报告我们在使用伽玛刀立体定向放射外科 (GKSTRS) 治疗侵入眼眶的结膜鳞状细胞癌 (SCC) 方面的经验，作为肠切除手术的替代方法。患者和方法：纳入 GKSTRS 治疗侵犯眼眶但保留骨骼的结膜 SCC（AJCC 第八版 T4a）并至少随访 1 年的患者。治疗失败被定义为治疗后 3 个月肿瘤大小没有减小，或在随访期间进一步生长。患者每 3 个月随访 2 年，之后每 6 个月随访一次，至少每年进行一次眼眶 MR 成像。结果：六名患者符合纳入标准。MR 成像用于确定 SCC 的眼眶受累程度。使用 Leksell Gamma Knife® Perfexion 的立体定向放射外科手术在一次治疗中进行，患者接受 18-20 Gy 至 45-50% 的等剂量。中位随访时间为 29 个月。四名患者对治疗有反应，在最近的随访中没有复发的证据。2 名患者的治疗失败，其中 1 名患者的肿瘤较大并延伸到眼眶更深处。另一名患者在 9 个月时出现远离治疗区域的复发，提示多灶性疾病。两名患者均患有低分化 SCC。结论：GKSTRS 是眼眶摘除手术的潜在替代方案，用于在选择的一组拒绝眼眶摘除或第二只眼失明的患者中延伸到前眼眶的结膜 SCC。然而，该疾病比肠切除手术更容易复发，因此终身监测和手术干预或再治疗的低阈值是谨慎的。
眼肿瘤病理