Purpose

To report the role of radiotherapy as a second-line treatment in apical orbital tumors not amenable to safe surgical excision.

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Methods

We describe a recent case of a patient presenting with a symptomatic apical orbital mass, radiologically consistent with a cavernous hemangioma. Surgical excision was initially planned. However, during the procedure, the lesion appeared tightly adherent to the optic nerve. Intraoperatively, progressive pupillary dilation was observed, raising concern for optic nerve compromise. Therefore, complete excision was deemed unsafe, and only an incisional biopsy was performed. Histopathological analysis confirmed the diagnosis of cavernous hemangioma. The patient was subsequently referred for radiotherapy.

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Results

Following radiotherapy, imaging demonstrated a significant reduction in lesion size. Clinically, the patient experienced complete resolution of the presenting symptoms, with preservation of visual function and no evidence of treatment-related complications during follow-up.

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Conclusion

Radiotherapy represents a valid and effective second-line option in selected cases of apical orbital tumors where surgical resection carries a high risk of optic nerve damage. This approach may allow tumor control while preserving visual function, particularly in lesions with intimate adherence to critical neurovascular structures. Furthermore, this strategy could represent a potentially revolutionary frontier for the management of orbital apical lesions that are not safely approachable surgically. Additional similar cases are currently being collected in order to further validate the efficacy and reproducibility of this treatment approach.

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Additional Authors

First name	Last name	Base Hospital / Institution
Diego	Strianese	Azienda Ospedaliera Universitaria Federico II Napoli
Adriana	Iuliano	Azienda Ospedaliera Universitaria Federico II Napoli

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