Post- operative Radiotherapy of Conjunctival Malignancies: A Series of 24 Cases

Asma Belaïd; Chiraz Nasr; Omar Jmour; Aziz Cherif; Hajer Kamoun; Khalil Mahjoubi; Rim Abidi; Safia Yahiaoui; Semia Zarraa; Amani Yousfi; Walid Gargouri; Hedi Bouguila; Mounir Besbes; Farouk Benna

doi:10.31557/apjcb.2017.2.1.3-8

Authors

Asma Belaïd Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia. Faculty of Medicine of Tunis, Tunis-el Manar University, Tunis, Tunisia.
Chiraz Nasr Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia. Faculty of Medicine of Tunis, Tunis-el Manar University, Tunis, Tunisia.
Omar Jmour Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia. Faculty of Medicine of Tunis, Tunis-el Manar University, Tunis, Tunisia.
Aziz Cherif Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia. Faculty of Medicine of Tunis, Tunis-el Manar University, Tunis, Tunisia.
Hajer Kamoun Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia.
Khalil Mahjoubi Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia. Faculty of Medicine of Tunis, Tunis-el Manar University, Tunis, Tunisia.
Rim Abidi Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia. Faculty of Medicine of Tunis, Tunis-el Manar University, Tunis, Tunisia.
Safia Yahiaoui Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia. Faculty of Medicine of Tunis, Tunis-el Manar University, Tunis, Tunisia.
Semia Zarraa Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia. Faculty of Medicine of Tunis, Tunis-el Manar University, Tunis, Tunisia.
Amani Yousfi Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia. Faculty of Medicine of Tunis, Tunis-el Manar University, Tunis, Tunisia.
Walid Gargouri Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia.
Hedi Bouguila Faculty of Medicine of Tunis, Tunis-el Manar University, Tunis, Tunisia. Ophthalmology Department, Hedi Raïs Institute, Tunis, Tunisia.
Mounir Besbes Radiation Oncology Department, Salah Azaïz Institute, Tunis, Tunisia.
Farouk Benna

DOI:

https://doi.org/10.31557/apjcb.2017.2.1.3-8

Keywords:

Radiotherapy- Conjunctival Malignancies- Malignant tumors

Abstract

Objective: To assess the results of post-operative radiation therapy in the management of incompletely resected conjunctival malignancies.
Methods: In this retrospective case series, we reviewed the clinical records of all cases of conjunctival tumors treated with post-operative radiotherapy in the radiation oncology department of Salah Azaïz Institute of Tunis, from January 1990 to December 2015. We focused on clinico-pathological characteristics, treatment modalities and patients’ outcome.
Results: Twenty four patients were enrolled in our study: 19 men and 5 women. The mean age of our patients was 54 years (range: 20 to 84). The mean basal diameter of the tumor was 11 mm (range 6 to 20 mm). The mean tumor thickness was 4 mm (range 1 to 15 mm). The most frequent histological type was squamous cell carcinoma in 23 cases. One patient had a malignant conjunctival fibrohistiocytoma. Radiation therapy was post-operative for positive or narrow surgical margins in all cases. Eighteen patients were treated with kilovoltage radiation therapy (KVRT). The mean delivered dose to the tumor bed was 64 Gy (range: 60 to 70 Gy). Four patients were treated with an association of KVRT and Strontium 90 plaque brachytherapy. Two patients were treated only with Strontium 90 plaque brachytherapy (2 fractions of 17 Gy). After a median follow-up of 110 months, 19 patients were alive with no evidence of local recurrence in 17 patients. Two patients had a local recurrence and were referred to surgery. Two patients were ost to follow up. The 5-year relapse free survival rate was 90.9%. Radiation-induced side effects were conjunctivitis, cataract, eye watering and glaucoma.
Conclusion: Post-operative radiation therapy allows good local control with acceptable toxicities in conjunctival malignancies. Management of these tumors needs a broad collaboration between ophthalmologists and radiation oncologists, to allow a conservative treatment with the lowest rates of local recurrence.