Single-Fraction Adjuvant Electronic Brachytherapy after Resection of Conjunctival Carcinoma.

Gustavo R Sarria,Diego Ramirez,Paola Fuentes Rivera,Gustavo J Sarria,Mario Buitrago,Frank A Giordano,Solon Serpa

doi:10.3390/cancers13030454

Abstract

Simple SummaryA centralized distribution of specialized oncologic facilities is a widely repeated situation in many latitudes around the globe, limiting the patient’s access options to specialized treatments. Strategies to alleviate the overpassed attention capacities in low- and middle-income countries, such as Peru, have driven the attention of practitioners towards hypofractionated treatments. In order to shorten treatment times and hospital visits, treating ocular conjunctival carcinoma with a single-fraction electronic brachytherapy approach arises as a novel option, which further increases the current therapeutic arsenal against this entity. We aim to report the clinical findings of this treatment modality, in terms of feasibility, oncological outcomes and toxicity profile, while opening a new possibility of diminishing patient- and health care-related financial impact.A retrospective study was performed to assess the outcomes of a single-fraction adjuvant electronic brachytherapy (e-BT) approach for patients with squamous cell conjunctival carcinoma (SCCC). Forty-seven patients with T1–T3 SCCC were included. All patients underwent surgery followed by a single-fraction adjuvant e-BT with a porTable 50-kV device. Depending on margins, e-BT doses ranged between 18 to 22 Gy prescribed at 2 mm depth, resembling equivalent doses in 2 Gy (EQD2) per fraction of 46–66 Gy (α/β ratio of 8–10 Gy and a relative biological effect (RBE) of 1.3). The median age was 69 (29–87) years. Most tumors were T1 (40.4%) or T2 (57.5%) with a median size of 7 mm (1.5–20). Margins were positive in 40.4% of cases. The median time from surgery to e-BT was nine weeks (0–37). After a median follow-up of 24 (17–40) months, recurrence occurred in only two patients (6 and 7 months after e-BT), yielding a median disease-free survival (DFS) of 24 (6–40) months and DFS at two years of 95.7%. Acute grade 2 conjunctivitis occurred in 25.5%. E-BT is a safe and effective for SCCC treatment, with clinical and logistic advantages compared to classical methods. Longer follow-up and prospective assessment are warranted.

Highlights

We report the outcomes of patients who received adjuvant electronic brachytherapy (e-BT), representing a low-cost alternative to standard brachytherapy or external beam radiotherapy (EBRT)
All patients from the two participating institutions underwent the same procedure consisting of wide local excision, whilst 12.8% had re-excision due to initial positive margins and according to further procedural feasibility
E-BT doses ranged between 18 Gy for negative margins (R0) and

Summary

Introduction

The key goal of cancer care for patients with excellent prognosis is to keep toxicity as low as possible, which in SCCC management is challenging due to the inherent location of the tumor [9,10]. The cornerstone treatment in the upfront management of these tumors is surgery [2,11]. Surgery alone is still potentially related to high recurrence rates (0–56%) [10,15,16,17] and different adjuvant treatment options, namely topical chemotherapy, external beam radiotherapy (EBRT) or brachytherapy might be necessary to reduce local failure rates [12,16,18,19,20]

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