Michael Zimbelmann1, Birte Neppert2, Roya Piria2, Neele Babst2, Katharina A Ponto3, Salvatore Grisanti2, Ludwig M Heindl4,5, Vinodh Kakkassery2. 1. Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. m.w.zimbelmann@gmail.com. 2. Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. 3. Universitäts-Augenklinik, Unversitätsmedizin Mainz, Mainz, Deutschland. 4. Klinik für Augenheilkunde, Universitätsklinikum Köln, Köln, Deutschland. 5. Center for Integrated Oncology (CIO) Aachen-Bonn-Köln-Düsseldorf, Aachen-Bonn-Köln-Düsseldorf, Deutschland.
Abstract
BACKGROUND: There are various options for the conservative treatment of the most frequent orbital tumors. These can delay, complement or be superior to the surgical approach, which is often prone to complications. OBJECTIVE: This article gives a summary of the possible treatment options for the most common orbital tumors in childhood and adulthood. METHODS: A literature search was carried out and the possible treatment pathways are presented. RESULTS: 1. Frequent orbital tumors in childhood: a systemic treatment with noncardioselective beta blockers is the primary treatment for capillary orbital hemangiomas. In cases of no response, steroids, interferon alpha or cyclophosphamide are treatment options. Observation is a possible option for smaller dermoid cysts, in cases of progression excision can become necessary. Symptomatic optic nerve gliomas can also be observed and in cases of progression treated with chemotherapy, mTOR/MEK inhibitors or radiotherapy (children > 5 years). Rhabdomyosarcomas are biopsied and subsequently treated by radiotherapy and chemotherapy. 2. Frequent orbital tumors in adulthood: asymptomatic cases of cavernous hemangiomas of the orbit can just be observed. Symptomatic hemangiomas can be surgically excised or treated with radiotherapy. For meningiomas of the optic nerve sheath radiotherapy is a very effective treatment. Surgical excision should be reserved for cases with no prognosis of visual acuity. There is also the option to treat with antiprogesterone. Orbital lymphomas with purely orbital involvement can be treated with radiotherapy, chemotherapy or the application of rituximab. CONCLUSION: There are now very effective conservative treatment options for many orbital tumors. In some cases a surgical procedure can be avoided and a good visual function can be retained.
BACKGROUND: There are various options for the conservative treatment of the most frequent orbital tumors. These can delay, complement or be superior to the surgical approach, which is often prone to complications. OBJECTIVE: This article gives a summary of the possible treatment options for the most common orbital tumors in childhood and adulthood. METHODS: A literature search was carried out and the possible treatment pathways are presented. RESULTS: 1. Frequent orbital tumors in childhood: a systemic treatment with noncardioselective beta blockers is the primary treatment for capillary orbital hemangiomas. In cases of no response, steroids, interferon alpha or cyclophosphamide are treatment options. Observation is a possible option for smaller dermoid cysts, in cases of progression excision can become necessary. Symptomatic optic nerve gliomas can also be observed and in cases of progression treated with chemotherapy, mTOR/MEK inhibitors or radiotherapy (children > 5 years). Rhabdomyosarcomas are biopsied and subsequently treated by radiotherapy and chemotherapy. 2. Frequent orbital tumors in adulthood: asymptomatic cases of cavernous hemangiomas of the orbit can just be observed. Symptomatic hemangiomas can be surgically excised or treated with radiotherapy. For meningiomas of the optic nerve sheath radiotherapy is a very effective treatment. Surgical excision should be reserved for cases with no prognosis of visual acuity. There is also the option to treat with antiprogesterone. Orbital lymphomas with purely orbital involvement can be treated with radiotherapy, chemotherapy or the application of rituximab. CONCLUSION: There are now very effective conservative treatment options for many orbital tumors. In some cases a surgical procedure can be avoided and a good visual function can be retained.
Authors: Christine Léauté-Labrèze; Eric Dumas de la Roque; Thomas Hubiche; Franck Boralevi; Jean-Benoît Thambo; Alain Taïeb Journal: N Engl J Med Date: 2008-06-12 Impact factor: 91.245
Authors: Beth A Drolet; Peter C Frommelt; Sarah L Chamlin; Anita Haggstrom; Nancy M Bauman; Yvonne E Chiu; Robert H Chun; Maria C Garzon; Kristen E Holland; Leonardo Liberman; Susan MacLellan-Tobert; Anthony J Mancini; Denise Metry; Katherine B Puttgen; Marcia Seefeldt; Robert Sidbury; Kendra M Ward; Francine Blei; Eulalia Baselga; Laura Cassidy; David H Darrow; Shawna Joachim; Eun-Kyung M Kwon; Kari Martin; Jonathan Perkins; Dawn H Siegel; Robert J Boucek; Ilona J Frieden Journal: Pediatrics Date: 2012-12-24 Impact factor: 7.124
Authors: David K Coats; James W O'Neil; Vincent J D'Elia; Kathryn M Brady-McCreery; Evelyn A Paysse Journal: Ophthalmology Date: 2003-06 Impact factor: 12.079