Management of diffuse ocular surface squamous neoplasia: efficacy and complications of topical chemotherapy

Rudkin, Adam K; Dempster, Lucy; Muecke, James

doi:10.1111/ceo.12377

Cited by 47 publications

(45 citation statements)

References 17 publications

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“…This qualification may get lost in the discussion of OSSN, since some clinical series do not report clinical staging or depth of tumor invasion [18]. Some studies also erroneously define OSSN as in situ neoplasia, further confounding comparisons of clinical studies that include squamous cell carcinoma under the umbrella of OSSN [19]. Finally, some studies blur the role of topical treatment as an adjuvant to surgery for squamous cell carcinoma, leading some to employ it as lone therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Although there may be willingness to diagnose OSSN based solely on clinical examination or with impression cytology, these are less sensitive means of detecting squamous cell carcinoma than biopsy [19, 22]. Surface lesions with generous conjunctival thickening, lesions fixed to underlying tissues, symblepharon formation, or lesions with surface dimpling suggest invasive disease and call for diagnostic biopsy.…”

Section: Discussionmentioning

confidence: 99%

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Widespread Ocular Surface Squamous Neoplasia Treated with Topical Interferon Alpha-2b

et al. 2018

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Purpose: To emphasize the importance of staging ocular surface squamous neoplasia when contemplating use of topical interferon alpha-2b alone. Cases: Two patients with 360 degrees of limbal involvement. Results: Two patients with in situ squamous cell carcinoma of the conjunctiva and clinical involvement of the entire limbus were treated with topical interferon alpha-2b. Thorough examination and multiple biopsies excluded invasive disease. The patients had complete response to therapy. Conclusion: Widespread intraepithelial squamous neoplasia involving the entire limbus can be successfully treated with topical therapies. Biopsy plays a role in excluding invasive disease. Interferon alpha-2b is a preferable agent to start with because it is well tolerated. Since long-term risks of recurrence are unknown, appropriate monitoring is essential.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Widespread Ocular Surface Squamous Neoplasia Treated with Topical Interferon Alpha-2b

et al. 2018

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“…It is interesting, that although the response frequencies appear similar between the 3 topical agents, there are some patients who respond to one agent and not the other. 46, 47 As these agents have different mechanisms of action, more research is needed to predict which patient is most likely to respond to which treatment modality.…”

Section: Discussionmentioning

confidence: 99%

Topical 5-Fluorouracil 1% as Primary Treatment for Ocular Surface Squamous Neoplasia

et al. 2016

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Purpose To determine the efficacy of topical 5-fluorouracil 1% (5FU) as a primary treatment of ocular surface squamous neoplasia (OSSN). Design Retrospective study. Participants Topical 5FU was used as primary therapy in 44 patients with OSSN. Methods 5FU 1% administered topically four times a day for a week followed by a drug holiday of 3 weeks. Patients were identified through pharmacy database. Patients were excluded if 5FU was used as adjuvant therapy, did not complete therapy, or were still in active treatment for their OSSN at the time of last follow up. Main outcome measure The primary outcome measures were the frequency of complete resolution with topical 5FU treatment and the rate of OSSN recurrence. Results Of the 44 patients identified, 32 were males and 12 were females. The mean age was 68 years. Complete resolution of OSSN was noted in 82% (36/44) patients; and, 18% (8/44) were considered treatment non-responders. Patients were treated a median of 4 cycles (range 2-9). Nasal location was the only risk factor identified for nonresponse to therapy (p=0.04). The median follow up after resolution was 10 months (range 2-77). In the 36 patients with complete resolution, 4 had tumor recurrence. Recurrence rates at 1 and 2 years were 6% and 15% respectively using Kaplan-Meier survival analysis. At least one side effect from the medication was reported by 61% (21/44) of patients, but only 1 patient discontinued the medication due to intolerance. The most common side effect was pain (n=17, 39%) followed by tearing (n=10, 23%), photophobia (n=6, 14%), itching (n=4, 9%), swelling (n=2, 5%), and infection (n=1, 2%). No long-term complications were reported. Conclusion 5-fluorouracil is efficacious and well tolerated as a primary treatment for OSSN, with 82% of tumors completely responding to therapy.

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“…Considering that multivariate analysis did not show statistical correlations between incomplete tumour response and other clinical parameters related to tumour burden (fornix and tarsal involvement, clock hours of limbus involvement, LBD and AJCC classification), the reduced activity of 5-FU in multifocal lesions, more than a sort of indirect measure of chemoresistance related to tumour burden, may be better interpreted by the presence of different biological behaviours in different parts of a multifocal tumour. Rudkin et al 17 have recently reported that diffuse OSSN is often recalcitrant to initial treatment with either 1% 5-FU or 0.04% MMC, suggesting to use them as a debulking procedure. Nevertheless, in our study, a complete response was obtained in 44% of multifocal lesions.…”

Section: Discussionmentioning

confidence: 99%

Topical 1% 5-fluoruracil as a sole treatment of corneoconjunctival ocular surface squamous neoplasia: long-term study

et al. 2016

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AimsTo report long-term clinical outcome of topical 1% 5-fluoruracil (5-FU) as a sole treatment of ocular surface squamous neoplasia (OSSN).Methods41 patients affected by OSSN were included. Each patient underwent full ophthalmological examination at baseline, with cytological or histological confirmation. Patients were treated by topical chemotherapy with 1% 5-FU four times a day for 4 weeks. One course was defined as 4 weeks of topical chemotherapy. Adjunctive courses were administered after 1 month of chemotherapy-free interval.ResultsMean follow-up was 105±32 months (range 60–171 months). Complete tumour regression was achieved in 34 cases (83%) after a mean of 1.5 courses (range, 1–3 courses). Univariate analysis revealed that complete response was significantly related to tumour thickness <1.5 mm (p=0.005), lack of fornix or tarsal involvement (p=0.015 and p=0.009, respectively) and the absence of multifocality (p=0.002). Histopathological diagnosis (intraepithelial neoplasia vs squamous cell carcinoma, p=0.019) and American Joint Committee on Cancer (AJCC) classification (T1 vs T2 or T3) (p=0.028) were also related to incomplete tumour response. In a multivariate analysis, just tumour thickness >1.5 mm (p=0.045) and multifocality (p=0.023) were correlated with incomplete tumour response. Transient and reversible low-to-mild local side effects were documented in 19 (48%) eyes.ConclusionTopical 5-FU, as a sole therapy, is a long-term safe and effective treatment for patients affected by preinvasive OSSN and for a limited proportion (50%) of invasive OSSN.

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Management of diffuse ocular surface squamous neoplasia: efficacy and complications of topical chemotherapy

Abstract: Diffuse OSSN is often recalcitrant to initial treatment with either 5-FU 1% or MMC 0.04%, and a pragmatic and vigilant approach to this heterogenous disease is required. Compared to localized disease, diffuse disease often requires multiple treatment efforts.

Cited by 47 publications

References 17 publications

Widespread Ocular Surface Squamous Neoplasia Treated with Topical Interferon Alpha-2b

Widespread Ocular Surface Squamous Neoplasia Treated with Topical Interferon Alpha-2b

Topical 5-Fluorouracil 1% as Primary Treatment for Ocular Surface Squamous Neoplasia

Topical 1% 5-fluoruracil as a sole treatment of corneoconjunctival ocular surface squamous neoplasia: long-term study

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