Successful management of adenoid cystic carcinoma of the lacrimal sac with apatinib combined with concurrent chemoradiotherapy: a case report

Adenoid cystic carcinoma (ACC) of the lacrimal sac is an extremely rare disease with a poor prognosis. There is currently no standard treatment for this malignancy. Radical surgical excision followed by radiotherapy and chemotherapy is the preferred treatment for localized ACC of the lacrimal sac. Apatinib has shown efficacy in recurrent/metastatic ACC. The role of apatinib in combination with concurrent chemoradiotherapy in patients with non-operated localized advanced ACC is not clear. Here, we report a 30-year-old man with a 1-year history of epiphora of the left eye and nasal congestion who was diagnosed as ACC of the lacrimal sac. The computed tomography (CT) scan showed the tumor invading the left orbit and left maxillary sinus. He refused surgical resection and instead received combined apatinib and nedaplatinbased concurrent chemoradiotherapy. He experienced moderate adverse effects such as nausea, hypertension, myelosuppression that were well controlled after symptomatic supportive care. Complete response was observed 3 weeks following the treatment. The patient remained free of disease until the last follow up by December 2020, 22 months after the treatment. This case suggested that combined apatinib and concurrent chemoradiotherapy might be an option for locally advanced ACC patients who are ineligible for or rejective to surgical resection.