{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:44:16Z","timestamp":1791967456378,"version":"4.3.4"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The management of locally advanced periorbital skin tumors with orbital invasion is challenging. Orbital exenteration historically provides reliable local control but causes major functional and cosmetic morbidity. We evaluated stereotactic body radiation therapy (SBRT) as an eye\u2010sparing alternative, focusing on local control, vision preservation, and toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective series includes 26 consecutive patients with locally advanced periorbital tumors treated prospectively with SBRT. Tumors involved the canthi (zones III\u2013IV) in 20 patients, with multi\u2010zone involvement in 18 and complete periorbital skin invasion (zone V) in 4. Eighteen tumors violated the orbital septum; anterior orbital invasion was observed in 16, and middle orbital invasion in 14. Extraconal violation occurred in 16 patients, and intraconal invasion in 15 patients. All patients were presented with intact ipsilateral vision at baseline. SBRT was delivered using VMAT\/IMRT with a simultaneous integrated boost of 35\u201340\u2009Gy to GTV and 25\u2009Gy to CTV\u2009+\u20092\u2009mm over five biweekly fractions. Optic apparatus constraints included Orbit PRV and Optic N PRV maximum point \u2264\u200930\u2009Gy and mean\u2009\u2264\u200920\u2009Gy; Lacrimal gland mean\u2009&lt;\u200926 Gy when feasible. OAR constraints were based on institutional treatment directives supported by AAPM TG\u2010101, QUANTEC, and Emami et\u00a0al. 50% received systemic therapy, including immunotherapy, targeted therapy, or chemotherapy, with some receiving combined approaches. Local and regional control and toxicities (CTCAE v5.0) were recorded; statistical analysis was primarily descriptive. Kaplan\u2013Meier methodology was used to estimate local control and overall survival. Given the limited cohort size and heterogeneous tumor histologies, no formal comparative statistical testing was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010four patients presented with primary cutaneous tumors and 2 had non\u2010cutaneous histologies (solitary fibrous tumor and metastatic breast carcinoma). SBRT was delivered as definitive therapy in 19 patients and as adjuvant therapy in 7. Median planning target volumes (PTVs) were 45\u2009cc (PTV25) and 9\u2009cc (PTV35\u201340\u2009Gy), with corresponding median D90 values of 29 and 34\/42\u2009Gy, respectively. At a median follow\u2010up of 18\u2009months (range 4\u201350\u2009months), all patients retained intact vision. Twenty\u2010one patients achieved complete response, one had stable disease, and three experienced locoregional recurrences\u2014one cavernous sinus failure and two local\u2010regional relapses. Acute toxicities were predominantly mild, including Grade 1 dermatitis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915), conjunctivitis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098), diplopia (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20097), orbital pain (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), and hyperpigmentation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092). Grade 2 dermatitis occurred in 6 patients, while Grade 3 dermatitis was rare (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092), both requiring reconstructive grafting. On follow\u2010up, late effects included blurred vision (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096), epiphora (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093), orbital pain (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092), and cataract progression (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092), with isolated cases of trichiasis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091) and post\u2010surgical ptosis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092). One of four patients with zone V involvement developed a chronic corneal ulcer requiring surgical management.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SBRT with a simultaneous integrated boost is a feasible eye\u2010sparing option for selected patients with locally advanced periorbital tumors, providing high rates of local control and vision preservation with acceptable toxicity. Prospective evaluation and longer follow\u2010up are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70508","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:44:36Z","timestamp":1791963876000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stereotactic Body Radiation Therapy for Management of Locally Advanced Periorbital Tumors: Efficacy and Toxicity Profile"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4376-4573","authenticated-orcid":false,"given":"Oluwatimileyin","family":"Ojo","sequence":"first","affiliation":[{"name":"Department of Radiation Medicine Northwell Health  Lake Success New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamaldeep","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine Northwell Health  Lake Success New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breanna","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine Northwell Health  Lake Success New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3217-0456","authenticated-orcid":false,"given":"Bin","family":"Gui","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine Northwell Health  Lake Success New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Antone","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine Northwell Health  Lake Success New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaheer","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology and Hematology, Northwell Health Cancer Institute Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell  Lake Success New York USA"},{"name":"Northwell Health Physician Partners Cancer Institute at Lake Success  Lake Success New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2290-1884","authenticated-orcid":false,"given":"Craig","family":"Devoe","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology and Hematology, Northwell Health Cancer Institute Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell  Lake Success New York USA"},{"name":"Northwell Health Physician Partners Cancer Institute at Lake Success  Lake Success New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3282-7622","authenticated-orcid":false,"given":"Nagashree","family":"Seetharamu","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology and Hematology, Northwell Health Cancer Institute Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell  Lake Success New York USA"},{"name":"Northwell Health Physician Partners Cancer Institute at Lake Success  Lake Success New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9007-3443","authenticated-orcid":false,"given":"Maged","family":"Ghaly","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine Northwell Health  Lake Success New York USA"},{"name":"Northwell Health Physician Partners Cancer Institute at Lake Success  Lake Success New York 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P.","year":"2008","journal-title":"International Journal of Radiation Oncology, Biology, Physics"},{"issue":"3","key":"e_1_2_8_14_1","first-page":"431","article-title":"Definitive and Adjuvant Radiotherapy for Eyelid Squamous Cell Carcinoma: Modern Outcomes and Immunotherapy Integration","volume":"68","author":"Shen Y.","year":"2024","journal-title":"Journal of Medical Imaging and Radiation Oncology"},{"issue":"6","key":"e_1_2_8_15_1","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.1016\/j.prro.2014.02.001","article-title":"A Contouring Guide for Head and Neck Cancers With Perineural Invasion","volume":"4","author":"Ko H. C.","year":"2014","journal-title":"Practical Radiation Oncology"},{"issue":"7","key":"e_1_2_8_16_1","first-page":"1308","article-title":"Perineural Invasion and Perineural Spread in Periocular Squamous Cell Carcinoma","volume":"37","author":"Tong J. 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M.","year":"1993","journal-title":"International Journal of Radiation Oncology, Biology, Physics"},{"issue":"3","key":"e_1_2_8_35_1","doi-asserted-by":"crossref","first-page":"S10","DOI":"10.1016\/j.ijrobp.2009.07.1754","article-title":"Use of Normal Tissue Complication Probability Models in the Clinic","volume":"76","author":"Marks L. B.","year":"2010","journal-title":"International Journal of Radiation Oncology, Biology, Physics"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70508","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hed.70508","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70508","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:44:40Z","timestamp":1791963880000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.70508"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":34,"alternative-id":["10.1002\/hed.70508"],"URL":"https:\/\/doi.org\/10.1002\/hed.70508","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]},"assertion":[{"value":"2025-12-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"hed.70508"}}