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Histopathology-guided management of ocular surface squamous neoplasia with corneal stromal or scleral invasion using ruthenium-106 plaque brachytherapy
  1. Raksha Rao1,
  2. Santosh G Honavar1,
  3. Sumeet Lahane1,
  4. Kaustubh Mulay2,
  5. Vijayanand Palkonda Reddy1
  1. 1Ocular Oncology Service, Centre for Sight, Hyderabad, Telangana, India
  2. 2Ocular Pathology Service, Centre for Sight, Hyderabad, Telangana, India
  1. Correspondence to Dr Santosh G Honavar, Ophthalmic Plastic Surgery, Orbit, Ocular Oncology, Centre for Sight, Hyderabad 500034, Telangana, India; santosh.honavar{at}gmail.com

Abstract

Background/aim To evaluate the safety and efficacy of ruthenium-106 (Ru-106) plaque brachytherapy in managing invasive ocular surface squamous neoplasia (OSSN).

Methods This is a retrospective, non-comparative, interventional case series of 42 eyes with OSSN with histopathologically-proven corneal stromal and/or scleral invasion that underwent Ru-106 plaque brachytherapy. Main outcome measures were tumour regression, eye salvage, final visual acuity, treatment complications and metastasis.

Results At presentation, the mean tumour basal diameter was 9.3 mm (range 5–26 mm) and thickness 3.1 mm (range 1.5–11 mm). Prior treatment included excision biopsy in two patients (5%), incision biopsy and topical interferon in one each (2%). Following excision with 4 mm clinically clear margins, corneal stromal and/or scleral invasion of OSSN was confirmed in all 42 cases, with the excised base showing invasive squamous cell carcinoma. A total dose of 5000 cGy over a mean duration of 19.7 hours (range 7–41 hours) was provided to an axial depth of 2 mm using Ru-106 surface plaque. Over a mean follow-up of 36.9 months (range 22.3–72 months), complete tumour regression was achieved in all eyes (100%). Two eyes (5%) showed conjunctival tumour growth remote from the site of prior treatment. Visual acuity was maintained at ≥20/200 in 35 eyes (83%), with a loss of >2 Snellen lines in 1 eye (2%). There was no evidence of regional lymph node or systemic metastasis.

Conclusion Histopathology-guided use of Ru-106 surface plaque brachytherapy is a safe and an effective adjuvant therapy in the management of corneal stromal and/or scleral invasion of OSSN.

  • eye (globe)
  • conjunctiva
  • sclera and episclera
  • pathology

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. NA.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. NA.

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Footnotes

  • Contributors All authors have participated in the assessment of the data and compilation of the manuscript. SGH accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.