strontium-radioisotopes and Conjunctival-Neoplasms

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

Because of the high local recurrence rates after excision of conjunctival melanomas, adjuvant local chemotherapy or irradiation is recommended. Strontium-90 brachytherapy is one radiotherapeutic option due to its low penetration depth.. 15 patients with conjunctival melanoma were treated with adjuvant strontium-90 brachytherapy after tumour excision. The treatment was fractionated into 9 irradiation sessions with 6 Gy each. The mean follow-up was 35 months (12-60 months).. Seven patients (46%) had no recurrence during the follow-up. Three patients (20%) had a recurrence in the treated or adjacent area. Eight patients (53%) developed new tumours in non-treated areas.. Strontium-90 brachytherapy is a useful adjuvant in the treatment of conjunctival melanomas. Regular ophthalmoscopic controls are necessary because of the high rate of new tumours in non-irradiated areas, especially in cases with primary acquired melanosis.

Topics: Adult; Aged; Brachytherapy; Conjunctival Neoplasms; Female; Humans; Male; Melanoma; Middle Aged; Neoplasm Recurrence, Local; Radiopharmaceuticals; Radiotherapy, Adjuvant; Strontium Radioisotopes; Treatment Outcome

Treatment of conjunctival epithelial tumors is not standardized because it is difficult to compare large series in this rare disease. Surgical excision is usual, but the recurrence rate has led several authors to propose alternative therapies.. During the past 20 years, brachytherapy using ophthalmic applicators has been developed and the results of different studies have confirmed the usefulness of this therapy. We report a retrospective study of 13 patients presenting with a conjunctival epithelial tumor treated with ruthenium106 applicators and followed up in our department since 1987.. There was no recurrence during a mean follow-up of 48 months. Complications depended on the size of the area treated and the dose of radiation.

Topics: Adult; Age Distribution; Aged; Aged, 80 and over; Biopsy; Brachytherapy; Conjunctival Neoplasms; Female; France; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasms, Glandular and Epithelial; Postoperative Care; Radiotherapy Dosage; Radiotherapy, Adjuvant; Retrospective Studies; Ruthenium Radioisotopes; Sex Distribution; Strontium Radioisotopes; Treatment Outcome

We reviewed the outcome of the 10 patients (13 eyes) with localized, biopsy-proven, low-grade lymphoma of the conjunctiva treated at our Department between 1988 and 1997. All patients were treated by beta-ray brachytherapy using a bidirectional 90Sr-90Y ophthalmic applicator (Applicator SIA 2, Amersham plc). Total doses, prescribed at the surface of the applicator, varied between 40 Gy and 80 Gy. With a median follow-up of 78 months (range: 14 to 146 months), seven patients remained with no evidence of relapse (67.5% 10 year disease free survival). Local control was achieved in 10 out of 13 eyes (76.9%). Two of the three local relapses were marginal. One of these three patients also developed a metachronous lymphoma in the contralateral conjunctiva. These three patients underwent a second course of brachytherapy with 90Sr/90Y and remained free of second relapse 109, 68 and 33 months after salvage therapy. No cases of systemic relapse were observed. Late (LENT-SOMA) complications were of grade 2 in five eyes, of grade 3 in one eye and of grade 4 in one eye. Late complications of grade 2 or higher were observed in one out of five patients (20%) treated with doses lower or equal to 50 Gy and in six out of eight patients (75%) treated with doses higher than 50 Gy (P=0.086). Our data indicates that beta-ray brachytherapy was ultimately able to control most conjunctival lymphomas but carried a risk of late complications and marginal relapses that was possibly higher than the rates reported for other radiotherapy techniques.

Topics: Adult; Aged; Brachytherapy; Conjunctival Neoplasms; Disease-Free Survival; Female; Humans; Lymphoma; Male; Middle Aged; Radiation Injuries; Retrospective Studies; Risk Factors; Strontium Radioisotopes; Treatment Outcome; Yttrium Radioisotopes

Fractionated beta-radiation was applied on a conjunctival lymphangioma, which had been known for several years. Histological diagnosis was established 3 years previously. Excision was not possible because the tumor had involved a considerable part of the conjunctiva. Using a strontium-90 applicator a total dose of 30 Gy was applied in 6 fractions with 5 Gy each. The initial tolerance was satisfactory. No radiogenic damage occurred, an involution of the tumor could be observed. During a follow-up time of nearly 2 years no further progression was noted. We consider the beta-radiation as an interesting therapeutic alternative for conjunctival lymphangiomas which are difficult to treat surgically due to their size.

Topics: Beta Particles; Conjunctival Neoplasms; Follow-Up Studies; Humans; Lymphangioma; Male; Middle Aged; Radiation Dosage; Strontium Radioisotopes

Topics: Aged; Beta Particles; Conjunctival Neoplasms; Corneal Diseases; Cryosurgery; Epithelium; Eye Neoplasms; Humans; Male; Middle Aged; Recurrence; Strontium Radioisotopes; Treatment Outcome; Visual Acuity

AIDS-related Kaposi's sarcoma is often treated by local therapy for physically or cosmetically disabling symptoms. We present the first case of a bulbar conjunctival Kaposi's sarcoma lesion to be treated with a strontium-90 ophthalmic applicator. The treatment is simple, effective and well tolerated and we recommend that it should be considered for the management of superficial Kaposi's sarcoma lesions of the conjunctiva.

Topics: Acquired Immunodeficiency Syndrome; Administration, Topical; Adult; Conjunctival Neoplasms; Humans; Male; Sarcoma, Kaposi; Strontium Radioisotopes

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

Squamous cell carcinoma of the ocular conjunctiva is a relatively rare malignancy which is attended by a high rate of local recurrence following simple surgical excision. To date, the management of conjunctival squamous cell cancer has been controversial. From 1950 to 1985, 146 consecutive patients with superficial conjunctival squamous cell cancer were treated at the Queensland Radium Institute. All patients were treated by simple surgical excision of the visible conjunctival lesion followed by adjunctive radiotherapy. Of 140 patients with histologically confirmed squamous cell cancer, 123 were treated with a strontium-90 source, 10 with a radon "ring," and 7 with superficial X ray therapy. Standard policy since 1960 has been to deliver an incident dose of 30 Gy in a single fraction within the first 48 post-operative hours to the surgical bed using a strontium-90 source on a stand-off eye applicator. This report will largely focus on the 123 patients who were treated with a strontium-90 source, of whom 107 received 30 Gy, 14 received 40 Gy (pre 1960) and one patient each received 20 and 25 Gy incident dose. Of 131 evaluable patients, there were only 3 who developed local recurrence. All 3 local recurrences developed in elderly men who had presented with extensive superficial primary tumors. Two of the three recurrences occurred in the two patients who were treated with doses less than 30 Gy. Both early and late radiation-induced complications following ablative surgery and treatment with strontium-90 were very uncommon. Three patients developed unsightly conjunctival telangiectasia, 2 patients developed a persistent scleral ulcer and 2 patients developed clinically significant cataracts. This negligible degree of treatment-related side effects contrasts with the experience of 10 patients who had previously been treated with a radon ring, 8 of whom developed serious complications, although none developed local recurrence. On the basis of our excellent local control rates with minimal morbidity we would continue to advocate the use of simple surgical excision followed by 30 Gy beta radiation from a strontium-90 source as the definitive treatment for superficial conjunctival squamous cell cancer.

Topics: Adult; Aged; Aged, 80 and over; Brachytherapy; Carcinoma, Squamous Cell; Combined Modality Therapy; Conjunctival Neoplasms; Female; Humans; Male; Middle Aged; Strontium Radioisotopes

A 87-year-old female patient with a squamous cell carcinoma of the conjunctiva was treated with local strontium-90 irradiation (with a so-called 'Dermaplatte'). In spite of a relatively low dosage, radiotherapy was followed by a corneal ulcer with consecutive rupture of the cornea. The cause of this unexpected perforation was, besides the effect of low-dose irradiation, probably a metabolic disorder of the cornea and a disturbance of the tear film due to the carcinoma which had spread on Bowman's layer of the cornea in an exophytic manner and was accompanied by a dense lymphocytic infiltration. An exenteration was performed and, at the last examination (1 year later), no local recurrence could be detected.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Conjunctival Neoplasms; Cornea; Corneal Ulcer; Female; Humans; Rupture, Spontaneous; Strontium Radioisotopes

The author reports on a 43-year-old patient who, having been treated for a conjunctival melanoma by local resection, presented 6 years later with a recurrent melanoma of a superficial spreading type, having a nodular and a flat component. While lamellar corneal excision was performed on the nodular component, the flat portion was treated with beta-contact radiation. The results are described and the argument for this therapy discussed.

Topics: Combined Modality Therapy; Conjunctival Neoplasms; Humans; Melanoma; Neoplasm Recurrence, Local; Strontium Radioisotopes