Journal Article

Survival After Orbital Exenteration for Primary Cutaneous Squamous Cell Carcinoma: A Retrospective Cohort Study

Hughes, Brett G. M., Fox, Carly, Dunn, Darryl, Lin, Charles, Hunt, Justin, Murray-Douglass, Alexander, Crawford, Lachlan

2025

Overview

Background Locally advanced periorbital cutaneous squamous cell carcinoma (cSCC) may require orbital exenteration, which is highly morbid. As immunotherapy develops, orbit preservation may become widespread, and data benchmarking survival with current standard-of-care surgery and radiotherapy are essential to the integration of this emerging method into modern treatment paradigms. This study aimed to determine the survival of patients after orbital exenteration for cSCC and investigate contributing factors. It was hypothesized that postoperative radiotherapy would be associated with improved survival. Methods This was a retrospective cohort study of patients with T3 and T4 cSCC undergoing orbital exenteration. Survival analysis was performed using Cox proportional hazards. Results The study enrolled 40 patients with a median age of 61.5 years who met the criteria. None of the patients had received preoperative radiotherapy. Age (hazard ratio [HR], 1.09; p = 0.019) and residual disease (HR, 9.00; p = 0.003) were associated with worse survival. Postoperative radiotherapy (HR, 0.003; p < 0.001) was associated with improved survival. Perineural, lymphovascular, and bony invasion and T and N stage were not associated with survival. Survival with postoperative radiotherapy was 94 % at 1 year, 87 % at 2 years, and 84 % at 5 years. Conclusions The oncologic outcomes of orbital exenteration with postoperative radiotherapy for locally advanced head and neck cSCC are good. However, amelioration of the morbidity caused by resection of the eye would be ideal. Data to support immunotherapy as a sole therapy are currently limited, but a combination of neoadjuvant immunotherapy and surgical treatment may facilitate orbit-preserving treatment in the future.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Carcinoma, Squamous Cell - mortality / Carcinoma, Squamous Cell - pathology / Carcinoma, Squamous Cell - surgery / Cohort analysis / Female / Follow-Up Studies / Head and Neck Oncology / Humans / Immunotherapy / Male / Medicine / Medicine & Public Health / Middle Aged / Morbidity / Oncology / Orbit Evisceration - mortality / Orbital Neoplasms - mortality / Orbital Neoplasms - pathology / Orbital Neoplasms - surgery / Patients / Prognosis / Radiation therapy / Radiotherapy, Adjuvant - mortality / Retrospective Studies / Skin Neoplasms - mortality / Skin Neoplasms - pathology / Skin Neoplasms - surgery / Squamous cell carcinoma / Surgery / Surgical Oncology / Survival analysis / Survival Rate