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Superficial ocular malignancies treated with strontium-90 brachytherapy: long term outcomes.

Laskar S, Gurram L, Laskar SG, Chaudhari S, Khanna N, Upreti R - J Contemp Brachytherapy (2015)

Bottom Line: Radiotherapy reduces the risk of recurrence in these cases.Vision was not impaired in any of the patients.Strontium-90 brachytherapy used in early invasive conjunctival malignancies as an adjunct to surgery in primary and recurrent settings, results in optimal disease control and ocular functional outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: The incidence of conjunctival malignancies is less than 1%. Though surgical excision remains the mainstay of treatment, the incidence of positive surgical margins and local recurrence rates are high, which is approximately up to 33% in negative margins and 56% in positive margins. Radiotherapy reduces the risk of recurrence in these cases. Brachytherapy using β emitters such as strontium-90 ((90)Sr) is an ideal treatment technique for these tumors with the advantage of treating only a few millimeters of tissue while sparing the underlying normal eye. We report the long term outcomes in the form of local control and late sequelae of patients with conjunctival malignancies treated with (90)Sr applicator brachytherapy.

Material and methods: During 1999-2013, 13 patients with conjunctival tumors, treated using (90)Sr brachytherapy were analyzed. Brachytherapy was either in a post-operative adjuvant or in a recurrent setting. Local control (LC), disease free survival (DFS), overall survival (OS), and late sequelae were evaluated.

Results: The median age at presentation was 47 years (range: 11-71 years). Thirteen patients with 15 tumors were treated. The commonest histology was squamous cell carcinoma. The median dose was 44 Gy over 11 fractions. The median follow up of all the patients was 51 months (range: 3-139 months). The median follow up of patients with carcinoma only was 64 months with a LC and DFS of 90.9% at 5 years. None of the patients developed ≥ grade II Radiation Therapy Oncology Group (RTOG) acute toxicities. One patient developed a focal scar and another developed corneal opacification at the limbus. Vision was not impaired in any of the patients.

Conclusions: Strontium-90 brachytherapy used in early invasive conjunctival malignancies as an adjunct to surgery in primary and recurrent settings, results in optimal disease control and ocular functional outcomes.

No MeSH data available.


Related in: MedlinePlus

A) Fixation of gaze towards opposite side prior to treatment. B) Applicator in direct contact with the affected area during treatment. C) Kaplan Meier Curve depicting local control at 5 years
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Figure 0001: A) Fixation of gaze towards opposite side prior to treatment. B) Applicator in direct contact with the affected area during treatment. C) Kaplan Meier Curve depicting local control at 5 years

Mentions: Patients were explained the treatment process in detail prior to the application. The target volume was determined by pre-excision clinical details, which included pictorial representation. A single field was applied in the area involved with the 90Sr applicator of 12 mm active diameter. The procedure was performed after application of topical anesthesia. The eye gaze was fixed to the opposite side of the treatment area in order to completely visualize the target volume (Figure 1A). The hand held applicator was then placed over the target area by the radiation oncologist for the treatment duration, which was calculated based on the source activity and prescribed dose (Figure 1B). Dose was prescribed to the surface of the conjunctiva. The treatment time was checked by the physicist with a timer. Quality assurance was ensured at every step of the procedure, including strict documentation of individual patient treatment record.


Superficial ocular malignancies treated with strontium-90 brachytherapy: long term outcomes.

Laskar S, Gurram L, Laskar SG, Chaudhari S, Khanna N, Upreti R - J Contemp Brachytherapy (2015)

A) Fixation of gaze towards opposite side prior to treatment. B) Applicator in direct contact with the affected area during treatment. C) Kaplan Meier Curve depicting local control at 5 years
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663211&req=5

Figure 0001: A) Fixation of gaze towards opposite side prior to treatment. B) Applicator in direct contact with the affected area during treatment. C) Kaplan Meier Curve depicting local control at 5 years
Mentions: Patients were explained the treatment process in detail prior to the application. The target volume was determined by pre-excision clinical details, which included pictorial representation. A single field was applied in the area involved with the 90Sr applicator of 12 mm active diameter. The procedure was performed after application of topical anesthesia. The eye gaze was fixed to the opposite side of the treatment area in order to completely visualize the target volume (Figure 1A). The hand held applicator was then placed over the target area by the radiation oncologist for the treatment duration, which was calculated based on the source activity and prescribed dose (Figure 1B). Dose was prescribed to the surface of the conjunctiva. The treatment time was checked by the physicist with a timer. Quality assurance was ensured at every step of the procedure, including strict documentation of individual patient treatment record.

Bottom Line: Radiotherapy reduces the risk of recurrence in these cases.Vision was not impaired in any of the patients.Strontium-90 brachytherapy used in early invasive conjunctival malignancies as an adjunct to surgery in primary and recurrent settings, results in optimal disease control and ocular functional outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: The incidence of conjunctival malignancies is less than 1%. Though surgical excision remains the mainstay of treatment, the incidence of positive surgical margins and local recurrence rates are high, which is approximately up to 33% in negative margins and 56% in positive margins. Radiotherapy reduces the risk of recurrence in these cases. Brachytherapy using β emitters such as strontium-90 ((90)Sr) is an ideal treatment technique for these tumors with the advantage of treating only a few millimeters of tissue while sparing the underlying normal eye. We report the long term outcomes in the form of local control and late sequelae of patients with conjunctival malignancies treated with (90)Sr applicator brachytherapy.

Material and methods: During 1999-2013, 13 patients with conjunctival tumors, treated using (90)Sr brachytherapy were analyzed. Brachytherapy was either in a post-operative adjuvant or in a recurrent setting. Local control (LC), disease free survival (DFS), overall survival (OS), and late sequelae were evaluated.

Results: The median age at presentation was 47 years (range: 11-71 years). Thirteen patients with 15 tumors were treated. The commonest histology was squamous cell carcinoma. The median dose was 44 Gy over 11 fractions. The median follow up of all the patients was 51 months (range: 3-139 months). The median follow up of patients with carcinoma only was 64 months with a LC and DFS of 90.9% at 5 years. None of the patients developed ≥ grade II Radiation Therapy Oncology Group (RTOG) acute toxicities. One patient developed a focal scar and another developed corneal opacification at the limbus. Vision was not impaired in any of the patients.

Conclusions: Strontium-90 brachytherapy used in early invasive conjunctival malignancies as an adjunct to surgery in primary and recurrent settings, results in optimal disease control and ocular functional outcomes.

No MeSH data available.


Related in: MedlinePlus