strontium-radioisotopes and Carcinoma-in-Situ

Fifteen patients with malignant epithelial tumors of the conjunctiva were treated with beta-ray ocular applicators filled with radioactive strontium and yttrium (90Sr/90Y). Histologic examination confirmed the diagnosis. There were ten squamous cell carcinomas, four carcinomas in situ, and one case of epidermidalization. In one patient, who may have received an insufficient dose, recurrence led to enucleation. Radiogenic complications-secondary glaucoma and corneal degeneration-caused visual loss in two other patients. All of the other tumors disappeared completely without seriously affecting the eyes. Beta-ray irradiation with 90Sr/90Y applicators was effective if a sufficient dose (15,000 to 18,000 rads) was applied to the tumor surface and if the height of the tumor did not exceed 5 mm.

Topics: Adult; Aged; Carcinoma in Situ; Carcinoma, Squamous Cell; Conjunctiva; Epithelium; Eye Neoplasms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Radiotherapy; Radiotherapy Dosage; Strontium Radioisotopes; X-Rays; Yttrium Radioisotopes

This study explores the safety and efficacy of strontium 90 (Sr-90) brachytherapy as the sole adjuvant therapy for carcinoma in situ (CIS) and squamous cell carcinoma (SCC) of the conjunctiva in a high HIV prevalent area.. This is a retrospective case review of patients treated with 60 Gray Sr-90 brachytherapy in four divided doses after resection with a 2 mm margin and histological confirmation. Cryotherapy or alcohol debridement was not performed at the time of excision due to limited resources. Two plaque sizes, 8.5 mm and 18 mm, were used.. Sixty-nine patients were treated and had a median follow-up of 27 months (range 6-127). Thirty-three (47.8%) were HIV-positive. CIS was present in 40.6% and SCC in 59.4%. The surgical margins were positive in 39 (56.5%). Twenty patients (29.0%) were treated with the 18 mm plaque and 49 (71.0%) with the 8.5 mm plaque. Eight (11.6%) patients developed a recurrence at a median of 5 months (range 2-40). Recurrences only occurred in patients treated with the 8.5 mm plaque (p=0.094). There was no significant effect of HIV status, positive margins or staging on the number of recurrences. Treatment side effects were a dry eye in five patients which was successfully managed with topical lubricants, and induced astigmatism of 1 dioptre of cylinder in one patient.. Sr-90 brachytherapy is safe and effective in preventing recurrences in ocular surface squamous neoplasia in a high HIV prevalent setting. The 18 mm plaque size is superior to the 8.5 mm plaque size.

Topics: Adult; Aged; Aged, 80 and over; Brachytherapy; Carcinoma in Situ; Carcinoma, Squamous Cell; Combined Modality Therapy; Conjunctival Neoplasms; Dose Fractionation, Radiation; Female; Follow-Up Studies; HIV Infections; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Strontium Radioisotopes; Young Adult

Twenty-seven patients with malignant epithelial tumors of the conjunctiva were treated between 1967 and 1987. Histological diagnosis was intraepithelial epithelioma in 15 cases (56%) and squamous cell carcinoma in 12 (44%). All patients were treated with a strontium-90 source on cup-shaped applicators of different sizes according to the extension of the tumor. Surface dose ranged from 60 Gy in a single treatment to 140 Gy in 7 fractions, depending on the thickness of the lesion. Fifteen patients were previously untreated, 7 were irradiated after some type of surgical treatment and 5 were treated for recurrence after multiple surgical excisions. Follow-up period ranged from 2 to 15 years. No patient died of his tumor. There were four local recurrences, three of them in patients with intraepithelial carcinoma. Two of the recurrences were salvaged with a new beta-ray treatment and the other two with enucleation. Since 1981, standard policy was to irradiate the entire conjunctiva in patients with diagnosis of intraepithelial epithelioma. Five patients developed cataracts. Considering the high primary control rate and minimal morbidity, strontium irradiation should be considered as a first-choice treatment for conjunctival tumors.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma in Situ; Carcinoma, Squamous Cell; Conjunctival Neoplasms; Eye Enucleation; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Radiotherapy Dosage; Strontium Radioisotopes

Four patients with carcinoma in situ were treated with strontium-90 beta ray application. The dose used was 4,500 rads after surgical removal or with small recurrent tumor and 7,000 rads for primary treatment. All patients were disease-free at follow-up periods of 48 to 320 months after treatment. One patient required superficial x-ray treatment for recurrent disease. No serious complications developed with the treatment and no progressive cataracts have occurred.

Topics: Aged; Carcinoma in Situ; Conjunctiva; Eye Neoplasms; Follow-Up Studies; Humans; Male; Neoplasm Recurrence, Local; Radiotherapy Dosage; Strontium Radioisotopes; Time Factors