“Comments on - Recurrence of Primary Synovial Sarcoma of the Lacrimal Gland”

Abstract

Madam I read with great interest the article by Yadav et al regarding “Recurrence of primary synovial sarcoma of the Lacrimal Gland.1 I applaud the effort made in describing the rare case, its management and review of literature. However certain aspect merit discussion and I would like to express my comments. Though the article describes the clinical presentation and management of this rare entity the authors have not mentioned about the role of adjuvant radiotherapy. Lacrimal gland tumours is a therapeutic challenge due to their complex orbital anatomy limiting complete surgical resection, more so when the case is advanced and is planned for neoadjuvant chemotherapy to down stage the tumour as in the case reported. As already reported by the authors the case is a recurrent tumour and the likelihood of survival and recurrence free rate will be superior with the addition of adjuvant radiotherapy after surgical excision.2 Skinner et al have emphasized the role of adjuvant radiation therapy to improve local control in malignant epithelial neoplasms of lacrimal gland.3 It was observed that patients who did not receive adjuvant radiation therapy developed local recurrence earlier as compared to the group who received radiation. It is also noteworthy to mention that in the present day practice of enhanced functional and cosmetic outcome, for appropriately selected patients, eye sparing surgery with adjuvant radiotherapy can achieve similar survival outcome to those treated with orbital exenteration. It may therefore be worthwhile to consider adjuvant radiotherapy after en bloc excision thus avoiding exenteration. References