New combined treatments, surgery and high-dose-rate interventional radiotherapy (brachytherapy), in advanced ocular surface and eyelid cancers

Bruno Fionda; Monica Maria Pagliara; Maria Grazia Sammarco; Francesco Pastore; Federico Giannuzzi; Giovanni Cuffaro; Flavia Quaranta Leoni; Luca Tagliaferri; Gustavo Savino

doi:10.1016/j.tranon.2024.102160

New combined treatments, surgery and high-dose-rate interventional radiotherapy (brachytherapy), in advanced ocular surface and eyelid cancers

Transl Oncol. 2024 Nov 5:51:102160. doi: 10.1016/j.tranon.2024.102160. Online ahead of print.

Authors

Bruno Fionda¹, Monica Maria Pagliara², Maria Grazia Sammarco², Francesco Pastore¹, Federico Giannuzzi³, Giovanni Cuffaro², Flavia Quaranta Leoni⁴, Luca Tagliaferri⁵, Gustavo Savino⁶

Affiliations

¹ Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
² Ocular Oncology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
³ Ophthalmology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, 00168, Rome Italy. Electronic address: federico.giannuzzi@gmail.com.
⁴ Università Cattolica del Sacro Cuore, 00168, Rome Italy.
⁵ Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, 00168, Rome Italy.
⁶ Ocular Oncology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, 00168, Rome Italy.

Abstract

Purpose: To evaluate the clinicopathological characteristics and the effectiveness of post-operative high-dose-rate (HDR) interventional radiotherapy (IRT - brachytherapy) in managing advanced ocular surface squamous neoplasia (OSSN) and eyelid tumors.

Methods: Nineteen patients with advanced malignancies affecting the ocular surface (stage ≥ T2) and eyelids (staging ≥ T3) were enrolled. Post-operative HDR-IRT treatment followed surgery after multidisciplinary discussion. In our series a total dose of 49 Gy was administered in 14 fractions of 3.5 Gy each, 2 doses per day. Local disease control is the study's main outcome. Death rate, total survival, disease-free survival, and toxicity are secondary outcomes.

Results: Local recurrence was observed in 4 cases, 2 were conjunctival melanomas and 2 were conjunctival squamous cell carcinoma. The median OS was 56.3 months. The 12, 24 and 36 months survival rate was respectively 100.00% (IQR: 100.00% - 100.00%), 100.00% (IQR: 100.00% - 100.00%), 100.00% (IQR: 100.00% - 100.00%) respectively . The median DFS was 56.3 months. The 12, 24 and 36 months disease survival rate was respectively 85.71% (IQR: 69.21% - 100.00%), 68.57% (IQR: 42.11% - 100.00%), 68.57% (IQR: 42.11% - 100.00%) respectively. In eyelid tumors, madarosis and eyelid abnormalities are the main side effects, while in OSSNs, dry eye symptoms are frequently reported.

Conclusion: Postoperative HDR-IRT has been effective in advanced eyelid cancers control. More challenging appears instead an effective treatment of advanced OSSNs, particularly conjunctival melanomas. Multicenter studies are needed to get a larger patient sample and to evaluate different radiotherapy dosages by different histologic and T types of tumors.

Keywords: Brachytherapy; Eyelid tumors; Eyelid tumors treatments; Interventional radiotherapy; Ocular surface tumors; Ocular surface tumors treatments.