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Brian Marr, David H Abramson, Gil’ad Cohen, Christopher Barker; Intraoperative High Dose Rate 32P Brachytherapy for Diffuse Conjunctival Neoplasms. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5436.
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: Malignancies occurring near the eye are often effectively managed with radiation therapy. However, the sensitivity and small size of the eye often limit options with teletherapy. For this reason, we have employed a novel brachytherapy system for ophthalmic malignancies in recent years. This study was conducted to assess the outcome of treatment with this modality.
: With permission of the IRB, medical records of patients treated with 32P brachytherapy for ophthalmic malignancies were reviewed. Demographic, comorbidity, cancer and treatment related factors were recorded. Visual acuity, intraocular pressure, grade >2 adverse events (defined and graded per CTCAE) and tumor control were noted.
: 5 patients (2 women, 3 men) underwent 6 courses of 32P ophthalmic brachytherapy. Median age was 63 (range 51-80). Median ACE-27 comorbidity score was 1 (range 1-2). Four of 5 patients (80%) had recurrent cancer, which had failed a median of 1 prior therapy (range 1-3), including surgical excision, and topical chemotherapy and immunotherapy. No patients had evidence of regional or distant metastases at presentation for brachytherapy. Doses were prescribed to 1 mm from the surface of the applicator, and ranged from 5-17 Gy (median 15 Gy), at dose rates of 0.325-0.770 Gy/minute (median 0.450), from 32P sources with activities of 1.35-6.00 mCi (median 5.60), using custom designed applicators 1.0-6.7 cm2 (median 4.5). With a median follow-up of 17 months, 2 patients developed clinical evidence of local recurrence 11 and 4 months after brachytherapy; biopsy confirmed recurrence in only one patient. One patient required enucleation for extensive local tumor recurrence. No patient developed regional or distant recurrence, or has died since brachytherapy. One grade 4 corneal ulcer occurred 1 month after brachytherapy, and one grade 3 cataract occurred 30 months after brachytherapy. Visual acuity >20/200 was preserved in 4 of 5 patients. Glaucoma was not noted in any
: Intraoperative high dose rate 32P brachytherapy is feasible for ophthalmic malignancies. We have not noted major complications with doses of ≤15 Gy. Further study with a larger group of patients will be necessary to validate these preliminary findings.
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