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Intralesional Bleomycin as an Adjunct Therapeutic Modality in Eyelid and Extraocular Malignancies and Tumors.

Meyer D, Gooding C - Middle East Afr J Ophthalmol (2015 Oct-Dec)

Bottom Line: Cases are presented to illustrate that IBI induced significant regression and reduction in tumor size and marked clinical improvement of the eyelid and orbital basal cell carcinomas, Kaposi sarcoma, and mycosis fungoides.Based on clinical experience we propose that IBI should be considered a treatment modality in select cases of the malignant eyelid and ophthalmic vascular tumors where the conventional standard of care is not possible.IBI is a reasonable alternative or adjunct to consider in such cases.

View Article: PubMed Central - PubMed

Affiliation: Division of Ophthalmology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.

ABSTRACT
To present our recent experience with intralesional bleomycin (IBI) in nonmelanoma extraocular tumors, and present previous experience on periocular capillary hemangiomas and orbital lymphangiomas in a tertiary referral hospital. This was a retrospective descriptive study of patients with eyelid and extraocular malignancies where conventional therapies failed, or surgery was contraindicated or refused and were offered IBI as an alternate therapy. All patients were recruited from the Oculoplastics Clinic at Tygerberg Academic Hospital, Cape Town, South Africa. A solution containing 1 international unit of bleomycin per milliliter saline was injected intralesionally together with 2% lignocaine in a ratio of 4:1. The injected volume was calculated to be equivalent to the estimated volume of the lesion. A multipuncture technique with a 29-gauge needle was used. Patients requiring retreatment were injected every 4-8 weeks until satisfactory clinical endpoints were achieved. Our previous experience with IBI in extensive capillary hemangiomas and orbital lymphangiomas is reviewed. Cases are presented to illustrate that IBI induced significant regression and reduction in tumor size and marked clinical improvement of the eyelid and orbital basal cell carcinomas, Kaposi sarcoma, and mycosis fungoides. The improvements obviated the need for further surgical intervention in most cases. Based on clinical experience we propose that IBI should be considered a treatment modality in select cases of the malignant eyelid and ophthalmic vascular tumors where the conventional standard of care is not possible. IBI is a reasonable alternative or adjunct to consider in such cases.

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(a) Pretreatment right lower lid histologically proven basal cell carcinoma. (b) One year after 4 intralesional bleomycin treatments
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Figure 2: (a) Pretreatment right lower lid histologically proven basal cell carcinoma. (b) One year after 4 intralesional bleomycin treatments

Mentions: In 2012, an 81-year-old female Caucasian female was referred to our tertiary eye center with a right lower lid biopsy-proven BCC. On examination, the lesion was located on the medial third of the lower lid adjacent to the lacrimal apparatus. She was frail, wheelchair-bound and was reluctant to undergo surgery. IBI was offered. After each injection, there was demonstrable tumor reduction. Four treatments of IBI were required over the duration of a year. The bleomycin was successful in shrinking the tumor to the point where no tumor was visible biomicroscopically. A totally acceptable posttreatment lid anatomy was obtained without having to intervene surgically. Currently, at 84 years of age she still has no signs of recurrence [Figure 2a and b].


Intralesional Bleomycin as an Adjunct Therapeutic Modality in Eyelid and Extraocular Malignancies and Tumors.

Meyer D, Gooding C - Middle East Afr J Ophthalmol (2015 Oct-Dec)

(a) Pretreatment right lower lid histologically proven basal cell carcinoma. (b) One year after 4 intralesional bleomycin treatments
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660524&req=5

Figure 2: (a) Pretreatment right lower lid histologically proven basal cell carcinoma. (b) One year after 4 intralesional bleomycin treatments
Mentions: In 2012, an 81-year-old female Caucasian female was referred to our tertiary eye center with a right lower lid biopsy-proven BCC. On examination, the lesion was located on the medial third of the lower lid adjacent to the lacrimal apparatus. She was frail, wheelchair-bound and was reluctant to undergo surgery. IBI was offered. After each injection, there was demonstrable tumor reduction. Four treatments of IBI were required over the duration of a year. The bleomycin was successful in shrinking the tumor to the point where no tumor was visible biomicroscopically. A totally acceptable posttreatment lid anatomy was obtained without having to intervene surgically. Currently, at 84 years of age she still has no signs of recurrence [Figure 2a and b].

Bottom Line: Cases are presented to illustrate that IBI induced significant regression and reduction in tumor size and marked clinical improvement of the eyelid and orbital basal cell carcinomas, Kaposi sarcoma, and mycosis fungoides.Based on clinical experience we propose that IBI should be considered a treatment modality in select cases of the malignant eyelid and ophthalmic vascular tumors where the conventional standard of care is not possible.IBI is a reasonable alternative or adjunct to consider in such cases.

View Article: PubMed Central - PubMed

Affiliation: Division of Ophthalmology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.

ABSTRACT
To present our recent experience with intralesional bleomycin (IBI) in nonmelanoma extraocular tumors, and present previous experience on periocular capillary hemangiomas and orbital lymphangiomas in a tertiary referral hospital. This was a retrospective descriptive study of patients with eyelid and extraocular malignancies where conventional therapies failed, or surgery was contraindicated or refused and were offered IBI as an alternate therapy. All patients were recruited from the Oculoplastics Clinic at Tygerberg Academic Hospital, Cape Town, South Africa. A solution containing 1 international unit of bleomycin per milliliter saline was injected intralesionally together with 2% lignocaine in a ratio of 4:1. The injected volume was calculated to be equivalent to the estimated volume of the lesion. A multipuncture technique with a 29-gauge needle was used. Patients requiring retreatment were injected every 4-8 weeks until satisfactory clinical endpoints were achieved. Our previous experience with IBI in extensive capillary hemangiomas and orbital lymphangiomas is reviewed. Cases are presented to illustrate that IBI induced significant regression and reduction in tumor size and marked clinical improvement of the eyelid and orbital basal cell carcinomas, Kaposi sarcoma, and mycosis fungoides. The improvements obviated the need for further surgical intervention in most cases. Based on clinical experience we propose that IBI should be considered a treatment modality in select cases of the malignant eyelid and ophthalmic vascular tumors where the conventional standard of care is not possible. IBI is a reasonable alternative or adjunct to consider in such cases.

Show MeSH
Related in: MedlinePlus