Bata Bashar M, Radatz Matthias W R, Salvi Sachin M
The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, United Kingdom.
The National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, S10 2JF, Sheffield, United Kingdom.
Ocul Oncol Pathol. 2021 Jun;7(3):206-214. doi: 10.1159/000514340. Epub 2021 Mar 31.
The aim of the study was to report our experience in the use of Gamma Knife Stereotactic Radiosurgery (GKSTRS) for conjunctival squamous cell carcinoma (SCC) invading the orbit, as an alternative to exenteration surgery.
Patients who had GKSTRS for conjunctival SCC invading the orbit but sparing the bone (AJCC eighth ed. T4a) with a minimum of 1-year follow-up were included. Treatment failure was defined as no decrease in tumour size 3 months post-treatment, or further growth during the follow-up period. Patients were followed up 3-monthly for 2 years and 6-monthly afterwards with a minimum of yearly MR Imaging of orbit.
Six patients met the inclusion criteria. MR imaging was used to identify the extent of orbital involvement of SCC. Stereotactic radiosurgery utilizing the Leksell Gamma Knife® Perfexion was delivered in a single session in which patients received 18-20 Gy to the 45-50% isodose. The median follow-up was 29 months. Four patients responded to the treatment and had no evidence of recurrence at their most recent follow-up. The treatment failed in 2 patients, in 1 of whom the tumour was larger and extended deeper into the orbit. The other patient developed a recurrence away from the treated area at 9 months, suggesting a multifocal disease. Both patients had poorly differentiated SCC.
GKSTRS is a potential alternative to orbital exenteration surgery for conjunctival SCC extending into the anterior orbit in a selected group of patients refusing orbital exenteration or has a second blind eye. Nevertheless, the disease is more likely to recur than with exenteration surgery, hence lifelong monitoring and low threshold for surgical intervention or retreatment is prudent.
本研究的目的是报告我们使用伽玛刀立体定向放射外科治疗（GKSTRS）侵袭眼眶的结膜鳞状细胞癌（SCC）的经验，作为眶内容剜除术的替代方法。
纳入接受GKSTRS治疗侵袭眼眶但未累及骨质（美国癌症联合委员会第八版T4a）的结膜SCC且随访至少1年的患者。治疗失败定义为治疗后3个月肿瘤大小未减小或随访期间进一步生长。患者在2年内每3个月随访一次，之后每6个月随访一次，至少每年进行一次眼眶磁共振成像（MRI）。
6例患者符合纳入标准。MRI用于确定SCC累及眼眶的范围。使用Leksell伽玛刀®Perfexion进行立体定向放射外科治疗，单次治疗，患者接受18 - 20 Gy的45 - 50%等剂量线照射。中位随访时间为29个月。4例患者对治疗有反应，在最近一次随访时无复发迹象。2例患者治疗失败，其中1例肿瘤较大且向眼眶深部扩展。另1例患者在9个月时在治疗区域外出现复发，提示为多灶性疾病。2例患者均为低分化SCC。
对于部分拒绝眶内容剜除术或有另一只盲眼的患者，GKSTRS是眼眶结膜SCC扩展至前眼眶时眶内容剜除术的潜在替代方法。然而，与眶内容剜除术相比，该疾病更易复发，因此进行终身监测并保持较低的手术干预或再治疗阈值是明智的。
