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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) Kaposi sarcoma infiltration of bulbar and palpebral conjunctiva before treatment. (b) Six months after 4 intralesional bleomycin treatments. Slight injection but no tumor visible biomicroscopically
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Figure 4: (a) Kaposi sarcoma infiltration of bulbar and palpebral conjunctiva before treatment. (b) Six months after 4 intralesional bleomycin treatments. Slight injection but no tumor visible biomicroscopically

Mentions: In 2013, a 35-year-old non-Caucasian male presented with a periocular tumor, localized to the subconjunctival bulbar and fornix. This lesion was detected 3 weeks prior to the presentation. Submental lymphadenopathy was present with oral candidiasis and a single dark purple lesion on the hard palate. He had hyperpigmented pruritic papular eruptive skin lesions in keeping with the retroviral disease. He tested positive for human immunodeficiency virus (HIV), and the CD4 lymphocyte cell count was 25/mm3 confirming a diagnosis of HIV/acquired immunodeficiency syndrome. Histological examination of the periocular lesion confirmed Kaposi sarcoma with immunohistochemistry positive for human herpes virus 8. The visual acuity in the affected eye was 20/20 and external beam radiotherapy would result in unacceptable side effects to the globe. We offered IBI treatments. Four injections with monthly intervals into all four quadrants of the tumor area were administered with a complete clinical resolution of the tumor after 6 months [Figure 4a 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) Kaposi sarcoma infiltration of bulbar and palpebral conjunctiva before treatment. (b) Six months after 4 intralesional bleomycin treatments. Slight injection but no tumor visible biomicroscopically
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: (a) Kaposi sarcoma infiltration of bulbar and palpebral conjunctiva before treatment. (b) Six months after 4 intralesional bleomycin treatments. Slight injection but no tumor visible biomicroscopically
Mentions: In 2013, a 35-year-old non-Caucasian male presented with a periocular tumor, localized to the subconjunctival bulbar and fornix. This lesion was detected 3 weeks prior to the presentation. Submental lymphadenopathy was present with oral candidiasis and a single dark purple lesion on the hard palate. He had hyperpigmented pruritic papular eruptive skin lesions in keeping with the retroviral disease. He tested positive for human immunodeficiency virus (HIV), and the CD4 lymphocyte cell count was 25/mm3 confirming a diagnosis of HIV/acquired immunodeficiency syndrome. Histological examination of the periocular lesion confirmed Kaposi sarcoma with immunohistochemistry positive for human herpes virus 8. The visual acuity in the affected eye was 20/20 and external beam radiotherapy would result in unacceptable side effects to the globe. We offered IBI treatments. Four injections with monthly intervals into all four quadrants of the tumor area were administered with a complete clinical resolution of the tumor after 6 months [Figure 4a 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