Postoperative interstitial brachytherapy in eyelid cancer: long term results and assessment of Cosmesis After Interstitial Brachytherapy scale

Abstract

PurposeTo analyse feasibility and safety of postoperative interstitial brachytherapy (IBRT) in patients of eyelid cancer treated primarily by surgical excision.Material and methodsIn this series, 8 patients with eyelid cancer were treated using postoperative interstitial brachytherapy. Patients were followed up for local control, cosmetic outcome, and acute and late toxicities. Cosmetic outcome was measured using a 6 point indigenous Cosmesis After Interstitial Brachytherapy (CAIB) scale.ResultsThe patients were between 23-82 years (median: 71 years). There were 3 females and 5 males, and 3 patients had lesions in upper eyelid. Postoperative high-dose-rate brachytherapy was used in all with 2 catheters implanted in most of them (6 out of 8). Local control was calculated from end of treatment to last follow-up. At last follow-up, all patients remained locally controlled. Two patients had nodal recurrence 6 months after interstitial brachytherapy and were salvaged effectively by external beam radiotherapy. At last follow-up, 7 patients were loco-regionally controlled and one was lost to follow up. All patients had Radiation Therapy Oncology Group (RTOG) grade 1 acute toxicity and 2 had grade 1 Common Terminology Criteria for Adverse Events (CTCAE) version.3 late toxicities. The cosmesis score for the whole group ranged between 0-1 indicating excellent to very good cosmesis.ConclusionsPostoperative high-dose-rate brachytherapy resulted in excellent disease control and cosmesis without significant acute or late toxicities. It is an effective modality for treatment of eyelid cancers in selected patients. Future prospective studies with the validation of CAIB scale would give us more insight to this effective yet often ignored modality of IBRT.

Brachytherapy in non melanoma skin cancer of eyelid: a systematic review

“…Through a process of screening the title and the abstract, 9 articles were identified [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. The flowchart of systematic literature search process is shown in Figure 1 .…”

High‐dose‐rate interstitial brachytherapy for a bulky sebaceous carcinoma of the eyelid: A case report

“…11 Laskar et al reported eight patients with eyelid cancer (four patients with a sebaceous carcinoma) treated with postoperative adjuvant HDR-ISBT (3-3.5 Gy per fraction, 7-10 fractions) and a local control rate of 100%; however, two of the patients experienced a nodal relapse. 13 In the present case, we considered EBRT alone as insufficient to control the bulky eyelid tumor and therefore planned HDR-ISBT.…”

“…Interstitial LDR BT for eyelid carcinomas was reported by several authors and is known to be a good option as definitive treatment for postoperative positive surgical margins or as adjuvant therapy for the early stages of eyelid cancer. However, there are few previous reports of HDR‐ISBT for eyelid carcinomas, and the sample sizes in these reports are small . Azad et al reported eight patients with sebaceous carcinoma of the eyelid treated with radical HDR‐ISBT (39 Gy/6 fr) and a 5‐year local control rate of 57.4% .…”

“…However, there are few previous reports of HDR-ISBT for eyelid carcinomas, and the sample sizes in these reports are small. [10][11][12][13][14] Azad et al reported eight patients with sebaceous carcinoma of the eyelid treated with radical HDR-ISBT (39 Gy/6 fr) and a 5-year local control rate of 57.4%. 11 Laskar et al reported eight patients with eyelid cancer (four patients with a sebaceous carcinoma) treated with postoperative adjuvant HDR-ISBT (3-3.5 Gy per fraction, 7-10 fractions) and a local control rate of 100%; however, two of the patients experienced a nodal relapse.…”

“…Some patients may be treated with radiotherapy if they are unsuitable candidates for surgery or refuse surgical intervention. Previous reports of interstitial low‐dose‐rate (LDR) and high‐dose‐rate (HDR) brachytherapy (BT) for eyelid cancer are few …”