Laskar Siddhartha, Gurram Lavanya, Laskar Sarbani Ghosh, Chaudhari Suresh, Khanna Nehal, Upreti Rituraj
Department of Radiation Oncology.
Department of Radiation Physics, Tata Memorial Hospital, Mumbai, Maharashtra, India.
J Contemp Brachytherapy. 2015 Oct;7(5):369-73. doi: 10.5114/jcb.2014.55003. Epub 2015 Oct 16.
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.
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.
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.
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.
结膜恶性肿瘤的发病率低于1%。尽管手术切除仍是主要的治疗方法，但手术切缘阳性率和局部复发率较高，切缘阴性者约为33%，切缘阳性者约为56%。放射治疗可降低这些病例的复发风险。使用锶-90（90Sr）等β发射体的近距离放射治疗是这些肿瘤的理想治疗技术，其优点是仅治疗几毫米的组织，同时保留眼内的正常组织。我们报告了使用90Sr敷贴器近距离放射治疗结膜恶性肿瘤患者的局部控制和晚期后遗症等长期结果。
分析1999年至2013年期间使用90Sr近距离放射治疗的13例结膜肿瘤患者。近距离放射治疗用于术后辅助治疗或复发情况。评估局部控制（LC）、无病生存期（DFS）、总生存期（OS）和晚期后遗症。
就诊时的中位年龄为47岁（范围：11 - 71岁）。13例患者共治疗15个肿瘤。最常见的组织学类型是鳞状细胞癌。中位剂量为44 Gy，分11次给予。所有患者的中位随访时间为51个月（范围：3 - 139个月）。仅患有癌的患者中位随访时间为64个月，5年时的局部控制率和无病生存率为90.9%。没有患者发生≥II级放射治疗肿瘤学组（RTOG）急性毒性反应。1例患者出现局部瘢痕，另1例患者在角膜缘出现角膜混浊。所有患者的视力均未受损。
锶-90近距离放射治疗用于早期浸润性结膜恶性肿瘤，作为原发性和复发性疾病手术的辅助治疗，可实现最佳的疾病控制和眼部功能预后。
