Intraoperative High-Dose Rate of Radioactive Phosphorus 32 Brachytherapy for Diffuse Recalcitrant Conjunctival Neoplasms: A Retrospective Case Series and Report of Toxicity | Clinical Pharmacy and Pharmacology | JAMA Ophthalmology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.173.234.169. Please contact the publisher to request reinstatement.
1.
Galor  A, Karp  CL, Oellers  P,  et al.  Predictors of ocular surface squamous neoplasia recurrence after excisional surgery.  Ophthalmology. 2012;119(10):1974-1981.PubMedGoogle ScholarCrossref
2.
Russell  HC, Chadha  V, Lockington  D, Kemp  EG.  Topical mitomycin C chemotherapy in the management of ocular surface neoplasia: a 10-year review of treatment outcomes and complications.  Br J Ophthalmol. 2010;94(10):1316-1321.PubMedGoogle ScholarCrossref
3.
Yeatts  RP, Engelbrecht  NE, Curry  CD, Ford  JG, Walter  KA.  5-Fluorouracil for the treatment of intraepithelial neoplasia of the conjunctiva and cornea.  Ophthalmology. 2000;107(12):2190-2195.PubMedGoogle ScholarCrossref
4.
Kim  HJ, Shields  CL, Shah  SU, Kaliki  S, Lally  SE.  Giant ocular surface squamous neoplasia managed with interferon alpha-2b as immunotherapy or immunoreduction.  Ophthalmology. 2012;119(5):938-944.PubMedGoogle ScholarCrossref
5.
Boehm  MD, Huang  AJ.  Treatment of recurrent corneal and conjunctival intraepithelial neoplasia with topical interferon alfa 2b.  Ophthalmology. 2004;111(9):1755-1761.PubMedGoogle ScholarCrossref
6.
Putterman  AM.  Conjunctival map biopsy to determine pagetoid spread.  Am J Ophthalmol. 1986;102(1):87-90.PubMedGoogle ScholarCrossref
7.
Cohen  GN, Munro  JJ  III, Kirov  A,  et al.  32P brachytherapy conformal source model RIC-100 for high-dose-rate treatment of superficial disease: Monte Carlo calculations, diode measurements, and clinical implementation.  Int J Radiat Oncol Biol Phys. 2014;88(3):746-752.PubMedGoogle ScholarCrossref
8.
Stannard  C, Sauerwein  W, Maree  G, Lecuona  K.  Radiotherapy for ocular tumours.  Eye (Lond). 2013;27(2):119-127.PubMedGoogle ScholarCrossref
9.
Hsu  A, Frank  SJ, Ballo  MT,  et al.  Postoperative adjuvant external-beam radiation therapy for cancers of the eyelid and conjunctiva.  Ophthal Plast Reconstr Surg. 2008;24(6):444-449.PubMedGoogle ScholarCrossref
10.
Moore  RF.  Choroidal sarcoma treated by the intraocular insertion of radon seeds.  Br J Ophthalmol. 1930;14(4):145-152.PubMedGoogle ScholarCrossref
11.
Kearsley  JH, Fitchew  RS, Taylor  RG.  Adjunctive radiotherapy with strontium-90 in the treatment of conjunctival squamous cell carcinoma.  Int J Radiat Oncol Biol Phys. 1988;14(3):435-443.PubMedGoogle ScholarCrossref
12.
Buc  D, Pilon  F, Donnarieix  D, Kemeny  JL, Bacin  F, Rigal  D.  Treatment of conjunctival epithelial tumors: brachytherapy with ruthenium-106 [in French].  J Fr Ophtalmol. 2003;26(9):929-939.PubMedGoogle Scholar
13.
Regueiro  CA, Valcárcel  FJ, Romero  J, de la Torre  A.  Treatment of conjunctival lymphomas by beta-ray brachytherapy using a strontium-90-yttrium-90 applicator.  Clin Oncol (R Coll Radiol). 2002;14(6):459-463.PubMedGoogle ScholarCrossref
14.
Jones  DB, Wilhelmus  KR, Font  RL.  Beta radiation of recurrent corneal intraepithelial neoplasia.  Trans Am Ophthalmol Soc. 1991;89:285-298.PubMedGoogle Scholar
15.
Graue  GF, Tena  LB, Finger  PT.  Electron beam radiation for conjunctival squamous carcinoma.  Ophthal Plast Reconstr Surg. 2011;27(4):277-281.PubMedGoogle ScholarCrossref
16.
Ramonas  KM, Conway  RM, Daftari  IK, Crawford  JB, O’Brien  JM.  Successful treatment of intraocularly invasive conjunctival squamous cell carcinoma with proton beam therapy.  Arch Ophthalmol. 2006;124(1):126-128.PubMedGoogle ScholarCrossref
17.
Hughes  WF.  Beta radiation sources, uses, and dangers in treatment of the eye.  J Am Med Assoc. 1959;170(17):2096-2101.PubMedGoogle ScholarCrossref
18.
Folkert  MR, Bilsky  MH, Cohen  GN,  et al.  Intraoperative 32P high-dose rate brachytherapy of the dura for recurrent primary and metastatic intracranial and spinal tumors.  Neurosurgery. 2012;71(5):1003-1010.PubMedGoogle ScholarCrossref
19.
Mourits  MP, Wyrdeman  HK, Jurgenliemk-Schulz  IM, Bidlot  E.  Favorable long-term results of primary pterygium removal by bare sclera extirpation followed by a single 90Strontium application.  Eur J Ophthalmol. 2008;18(3):327-331.PubMedGoogle Scholar
Original Investigation
March 2015

Intraoperative High-Dose Rate of Radioactive Phosphorus 32 Brachytherapy for Diffuse Recalcitrant Conjunctival Neoplasms: A Retrospective Case Series and Report of Toxicity

Author Affiliations
  • 1Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
  • 2Department of Ophthalmology, Weill-Cornell Medical School, New York, New York
  • 3Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
  • 4Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
JAMA Ophthalmol. 2015;133(3):283-289. doi:10.1001/jamaophthalmol.2014.5079
Abstract

Importance  Adjunct treatments for conjunctival malignancies are needed when standard therapy provides limited benefits or fails.

Objective  To describe the results of patients with diffuse conjunctival neoplasms treated with radioactive phosphorus 32 (32P)–impregnated flexible film.

Design, Setting, and Participants  This retrospective case series between January 1, 2010, and January 1, 2013, was conducted at Memorial Sloan-Kettering Cancer Center, a tertiary referral center. The study was conducted on 7 eyes of 6 patients treated for diffuse conjunctival squamous cell carcinoma, sebaceous carcinoma, or lymphoma that had recurrent or residual disease after primary treatment.

Interventions  Patients underwent mapping biopsies and detailed conjunctival drawings to delineate the pathologic extent of the disease. The brachytherapy film used for treatment was the RIC Conformal Source Model 100 (RIC-100, RI Consultants). The RIC-100 is a flexible, thin (approximately 0.5-mm) film made of a polymer chemically bound to 32P. The radioactive 32P film was placed intraoperatively, allowed to stay in place until the prescription dose was reached, and then removed. The median dose at the prescription point (1 mm from the surface of the film) was 15 Gy (range, 5-17 Gy).

Main Outcomes and Measures  Patients were tested for best-corrected visual acuity, recurrence-free survival, and adverse events scored by using the Adult Comorbidity Evaluation–27 scale.

Results  Between 2010 and 2013, 7 eyes of 6 patients were treated. The median age of patients was 70 years. All patients had a recurrent or persistent neoplasm. Four patients with squamous cell carcinoma, 1 with sebaceous carcinoma, and 1 with metachronous bilateral lymphomas were treated. The median treatment time was 19 minutes (range, 10-52 minutes). The median follow-up was 24.9 months (range, 3.1-38.2 months). Recurrence-free survival 24 months after brachytherapy was 75% (95% CI, 19-89.1). Two moderate adverse events and 1 severe adverse event occurred. Visual acuity was stable or improved in 5 of the 7 eyes (ie, better than 20/70 in the 5 patients who retained their treated eye).

Conclusions and Relevance  Our results show the use of an intraoperative high-dose rate of 32P brachytherapy in selected cases of recalcitrant diffuse conjunctival neoplasms. This technique offers a novel adjunct in the treatment of these cancers. Further follow-up and study are warranted.

×