Pasha Tanvir, Radhakrishna Nikhila, Poojar Sushma, Shivananjappa Rashmi, Krishnamoorthy Bharathi, Thimmaiah Naveen
Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.
Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Bangalore, India.
J Contemp Brachytherapy. 2025 Jun;17(3):191-196. doi: 10.5114/jcb.2025.152542. Epub 2025 Jun 30.
Eyelid tumors are uncommon malignancies, where 75% of cases are cutaneous basal cell carcinoma (BCC), and sebaceous cell carcinoma, squamous, adenocarcinoma from meibomian glands are diagnosed in 25%. Post-excision adjuvant radiotherapy (ART) is indicated in high-grade tumors with positive margins and lymphovascular space or perineural invasion. The ideal technique for delivering ART for eyelid tumors is interstitial brachytherapy (ISBT). However, its use is limited by steep learning curve. Here, we described the stepwise procedure of ISBT performed in eyelid tumors with reported outcomes.
Four patients with sebaceous carcinoma of the upper eyelid underwent ART, and 2 of the 4 patients had positive margins. Tumor bed was delineated with a 0.5-1 cm margin circumferentially. Under short general anesthesia, 2-3 hollow ISBT needles were inserted in a single-plane into tumor bed, 1 cm apart. Tarsal margin was avoided by > 2 mm to prevent eyelid contractures. Needles were replaced with 6 Fr flexible nylon catheters and fixed with buttons, ensuring a 5 mm gap from the skin to allow post-procedural edema. 3.5 Gy in 12-14 fractions were planned to achieve EQD dose of 60 Gy for R0 resection and 66 Gy for R1 resection, delivered twice a day with more than 6 hours interval. A wax-coated lead shield was placed to protect the cornea and lens using 0.4% paracaine eye drops. dosimetry was performed using metal-oxide-semiconductor field-effect transistor (MOSFET).
The mean clinical target volume (CTV) was 2.1 cc, the target D was 3.37 Gy/fraction. The target V100% was 86.27%, V150% was 31%, and V200% was 11.33%. The lens D (TPS) was 1.28 Gy/fraction, while the mean dose recorded by MOSFET was 0.7 Gy/fraction. No conjunctival acute toxicities were observed. Grade 1 skin reaction (hyperpigmentation) was noted, with no local recurrences at 1 year median follow-up.
ART delivered by ISBT in eyelid tumors is a simple and efficient brachytherapy procedure, providing excellent cosmesis and local control.
眼睑肿瘤是罕见的恶性肿瘤，其中75%的病例为皮肤基底细胞癌（BCC），25%为皮脂腺癌、鳞状细胞癌、睑板腺癌。切除术后辅助放疗（ART）适用于切缘阳性、存在淋巴管间隙或神经周围浸润的高级别肿瘤。用于眼睑肿瘤ART的理想技术是组织间近距离放疗（ISBT）。然而，其应用受到陡峭学习曲线的限制。在此，我们描述了在眼睑肿瘤中进行ISBT的分步操作过程及报告的结果。
4例上睑皮脂腺癌患者接受了ART，其中4例中有2例切缘阳性。肿瘤床周围以0.5 - 1 cm的边界划定。在短暂全身麻醉下，将2 - 3根中空的ISBT针单平面插入肿瘤床，针间距为1 cm。距睑缘> 2 mm以避免眼睑挛缩。将针换成6 Fr柔性尼龙导管并用纽扣固定，确保与皮肤有5 mm的间隙以允许术后水肿。计划分12 - 14次给予3.5 Gy，R0切除的等效剂量为60 Gy，R1切除的等效剂量为66 Gy，每天照射2次，间隔超过6小时。使用0.4%丙美卡因滴眼液并放置涂蜡铅屏蔽以保护角膜和晶状体。使用金属氧化物半导体场效应晶体管（MOSFET）进行剂量测定。
平均临床靶体积（CTV）为2.1 cc，靶区剂量D为3.37 Gy/分次。靶区V100%为86.27%，V150%为31%，V200%为11.33%。晶状体剂量D（TPS）为1.28 Gy/分次，而MOSFET记录的平均剂量为
