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Finger PT. High-Dose-Rate Yttrium-90 ( 90Y) Episcleral Plaque Brachytherapy for Iris and Iridociliary Melanoma. OPHTHALMOLOGY SCIENCE 2024; 4:100513. [PMID: 38840779 PMCID: PMC11152663 DOI: 10.1016/j.xops.2024.100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/20/2024] [Accepted: 03/11/2024] [Indexed: 06/07/2024]
Abstract
Purpose To describe a pilot study on the use of single-session, high-dose-rate, Food and Drug Administration-cleared, yttrium-90 (Y90) plaque brachytherapy for iris and iridociliary melanoma. Design A single-center, clinical case series. Participants Six consecutive patients were included in this study. Each was diagnosed with an iris or iridociliary melanoma based on clinical examination with or without biopsy. Methods Each tumor was staged according to the American Joint Committee on Cancer criteria and received Y90 eye plaque brachytherapy. The main variables were tumor size, patient age, sex, and method of diagnosis (clinical or biopsy). Surgical techniques, treatment durations, and ocular side effects were recorded. Local control was defined as a lack of tumor growth or regression determined by clinical examinations, including slit-lamp and gonio photography, as well as high-frequency ultrasound measurements. Toxicity parameters included acute and short-term corneal/scleral change, anterior segment inflammation, and cataract progression. Main Outcome Measures Local and systemic cancer control, tumor regression, visual acuity, as well as radiation-related normal tissue toxicity. Results High-dose-rate Y90 plaque brachytherapy was used to treat small (American Joint Committee on Cancer cT1) category melanomas. Single-surgery high-dose-rate irradiations were performed under anesthesia. Because of short treatment durations, high-dose-rate Y90 did not require the additional procedures used for low-dose-rate plaque (e.g., sutures, amniotic membrane epicorneal buffering, Gunderson flaps, and second surgeries for plaque removal). Only conjunctival recession was used to avoid normal tissue irradiation. High-dose-rate Y90 treatment durations averaged 8.8 minutes (median, 7.9; range, 5.8-12.9). High-dose-rate Y90 brachytherapy was associated with no periorbital, corneal (Descemet folds), or conjunctival edema. There was no acute or short-term anterior uveitis, secondary cataract, scleropathy, radiation retinopathy, maculopathy, or optic neuropathy. The follow-up was a mean of 16.0 (range 12-24) months. Evidence of local control included a lack of expansion of tumor borders (n = 6, 100%), darkening with or without atrophy of the tumor surface (n = 5/6, 83%), and a mean 24.5% reduction in ultrasonographically measured tumor thickness. There were no cases of metastatic disease. Conclusions High-dose-rate Y90 brachytherapy allowed for single-surgery, minimally invasive, outpatient irradiation of iris and iridociliary melanomas. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Paul T. Finger
- The Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, New York
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Carlà MM, Sammarco MG, Giannuzzi F, Savino G, Blasi MA, Fionda B, Tagliaferri L, Pagliara MM. Exclusive Ru-106 brachytherapy for the management of a recurrent corneo: Conjunctival squamous cell carcinoma. Brachytherapy 2024:S1538-4721(24)00018-7. [PMID: 38556408 DOI: 10.1016/j.brachy.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/18/2023] [Accepted: 02/12/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND We report a case of personalized exclusive brachytherapy treatment for the management of a highly recurrent squamous cell conjunctival carcinoma with corneal invasion. CASE DESCRIPTION This is a case of a Caucasian 81-years-old man who presented 10 years ago to our clinic with a pink-white para-limbal mass with dilated feeder arteries and mild leukoplakia. Excisional biopsy confirmed the presence of conjunctival intraepithelial neoplasia (CIN). Successively, he underwent two 4-weeks cycles of Mytomicin C topical therapy and a second excisional surgery, due to several recurrences of the lesion. At the last relapse, the pink-white peri-limbic mass which invaded the corneal limbus, determining corneal opacification from 5- to 7-clock hours, was confirmed by anterior segment optical coherence tomography (AS-OCT). Due to resistance to MMC therapy and chronic epitheliopathy, an AS-OCT guided exclusive radiotherapy plan was set: a Rhutenium-106 CCD plaque was applied directly over the afflicted corneal surface, the corneal limbus and the neighboring sclera for 24 hours. The remission of both conjunctival and corneal malignancy was complete 2 months after surgery and no signs of recurrence were highlighted at AS-OCT analysis at the 2-year follow up. CONCLUSION Brachytherapy treatment showed optimal management of both corneal and conjunctival involvement, with a free-of-disease follow-up of 24-months. This result suggests that, in specific conditions, Ru-106 brachytherapy could be an effective option of treatment even if not associated with surgical excision.
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Affiliation(s)
- Matteo Mario Carlà
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy.
| | - Maria Grazia Sammarco
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
| | - Federico Giannuzzi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
| | - Gustavo Savino
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
| | - Maria Antonietta Blasi
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
| | - Bruno Fionda
- Catholic University "Sacro Cuore", Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Gemelli ART (Advanced Radiation Therapy) - Interventional Oncology Center (IOC), Rome, Italy
| | - Luca Tagliaferri
- Catholic University "Sacro Cuore", Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Gemelli ART (Advanced Radiation Therapy) - Interventional Oncology Center (IOC), Rome, Italy
| | - Monica Maria Pagliara
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
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Finger PT. Yttrium-90 Episcleral Plaque Brachytherapy for Choroidal Melanoma. JOURNAL OF VITREORETINAL DISEASES 2024; 8:210-214. [PMID: 38465362 PMCID: PMC10924596 DOI: 10.1177/24741264241227684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose: To describe the first use of high-dose-rate yttrium-90 disc brachytherapy for choroidal melanoma. Methods: A 72-year-old patient had a cT1-category choroidal melanoma characterized by the presence of orange pigment, increasing subretinal fluid (SRF), and enlarging tumor thickness. It was treated with single-session, light-guided, light-defined yttrium-90-disc brachytherapy. Results: A specialized handheld applicator provided with 4 encircling lights was used to guide plaque placement and localize treatment. Unlike low-dose-rate plaques, high-dose-rate yttrium-90 required only 3 minutes 39 seconds. In this case, treatment did not require episcleral sutures, muscle relocation, outpatient dwell time, or a second surgery. High-dose-rate treatment improved radiation safety by eliminating perioperative exposure to health care personnel, the community, and the family. At the 13-month follow-up, the SRF and tumor thickness were diminished. There was no secondary cataract, radiation retinopathy, maculopathy, or optic neuropathy, and the visual acuity was 20/20. Conclusions: Yttrium-90 brachytherapy allowed for single-surgery, minimally invasive, outpatient irradiation of a choroidal melanoma.
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Lee B, Choi JH, Lee KR, Kang HW, Eom HJ, Shin K, Park HS. Evaluation of physicochemical characteristics and centerline temperatures of Sr ceramic waste form. Heliyon 2023; 9:e18406. [PMID: 37519639 PMCID: PMC10375857 DOI: 10.1016/j.heliyon.2023.e18406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023] Open
Abstract
When disposing of spent fuel, nuclides such as Cs-137 and Sr-90, which generate short-term decay heat, must be removed from the spent nuclear fuel for efficient storage facility utilization. The Korea Atomic Energy Research Institute (KAERI) has been developing a nuclide management process that can enhance disposal efficiency by sorting and collecting primary nuclides and a technology for separating Sr nuclides from the spent nuclear fuels using precipitation and distillation. In this study, we prepared Sr ceramic waste form, SrTiO3, using the solid-state reaction method to immobilize the Sr nuclides, and its physicochemical properties were evaluated. Moreover, the radiological and thermal characteristics of the Sr waste form were evaluated by estimating the composition of Sr nuclides considering the spent nuclear fuel history such as burn-up and cooling period. The waste form was found to be stable with good mechanical strength and leaching properties in addition to a low coefficient of thermal expansion, which would be advantageous for intermediate storage. Based on the experimental and radiological results, the centerline temperature of the waste form caused by Sr-90 nuclide was estimated using the steady-state conduction equation. The centerline temperature increased with increasing diameter of the waste form. When generating the SrTiO3 waste form using the Sr nuclide recovered after a cooling period of 10 years, the centerline temperature was estimated to exceed the melting point of SrTiO3 at a diameter of 0.275 m, under all burn-up conditions. These results provide fundamental data for the management and intermediate storage of Sr waste.
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Affiliation(s)
- Byeonggwan Lee
- Korea Atomic Energy Research Institute, 111 Daedeok-daero 989, Yuseong-gu, Daejeon, 34057, Republic of Korea
- Department of Hydrogen & Renewable Energy, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea
| | - Jung-Hoon Choi
- Korea Atomic Energy Research Institute, 111 Daedeok-daero 989, Yuseong-gu, Daejeon, 34057, Republic of Korea
| | - Ki Rak Lee
- Korea Atomic Energy Research Institute, 111 Daedeok-daero 989, Yuseong-gu, Daejeon, 34057, Republic of Korea
| | - Hyun Woo Kang
- Korea Atomic Energy Research Institute, 111 Daedeok-daero 989, Yuseong-gu, Daejeon, 34057, Republic of Korea
| | - Hyeon Jin Eom
- Department of Applied Chemistry, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea
| | - Kyuchul Shin
- Department of Hydrogen & Renewable Energy, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea
- Department of Applied Chemistry, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea
| | - Hwan-Seo Park
- Korea Atomic Energy Research Institute, 111 Daedeok-daero 989, Yuseong-gu, Daejeon, 34057, Republic of Korea
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Finger PT, Stewart R, Rivard MJ, Beers RJ, Kamen J, Lama S, Chin KJ, Mohney K, Welles TS, Sauerwein WAG, Rosenzweig K. First clinical implementation of Yttrium-90 Disc Brachytherapy after FDA clearance. Brachytherapy 2023; 22:416-427. [PMID: 36948988 DOI: 10.1016/j.brachy.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/04/2023] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Herein, we study if high-dose-rate (HDR) yttrium-90 (90Y) brachytherapy could be utilized by medical physicists, radiation oncologists, and ophthalmic surgeons. METHODS AND MATERIALS Yttrium-90 (90Y) beta-emitting brachytherapy sources received United States Food and Drug Administration clearance for episcleral treatment of ocular tumors and benign growths. Dose calibration traceable to the National Institute of Standards and Technology as well as treatment planning and target delineation methods were established. Single-use systems included a 90Y-disc affixed within specialized, multifunction, handheld applicator. Low-dose-rate to high-dose-rate prescription conversions and depth-dose determinations were performed. Radiation safety was evaluated based on live exposure rates during assembly and surgeries. Clinical data for radiation safety, treatment tolerability, and local control was collected. RESULTS Practice parameters for the medical physicist, radiation oncologist, and ophthalmic surgeon were defined. Device sterilizations, calibrations, assemblies, surgical methods, and disposals were reproducible and effective. Treated tumors included iris melanoma, iridociliary melanoma, choroidal melanoma, and a locally invasive squamous carcinoma. Mean calculated 90Y disc activity was 14.33 mCi (range 8.8-16.6), prescription dose 27.8 Gy (range 22-30), delivered to depth of 2.3 mm (range 1.6-2.6), at treatment durations of 420 s (7.0 min, range 219 s-773 s). Both insertion and removal were performed during one surgical session. After surgery, each disc-applicator- system was contained for decay in storage. Treatments were well-tolerated. CONCLUSIONS HDR 90Y episcleral brachytherapy devices were created, implementation methods developed, and treatments performed on 6 patients. Treatments were single-surgery, rapid, and well-tolerated with short-term follow up.
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Affiliation(s)
- Paul T Finger
- The Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, NY; The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY; Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH.
| | - Robert Stewart
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mark J Rivard
- Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | - Raymond J Beers
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob Kamen
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shyam Lama
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kimberly J Chin
- The Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, NY; Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | - Kyle Mohney
- Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | - Toby S Welles
- Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | | | - Kenneth Rosenzweig
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
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Houlihan OA, Workman G, Hounsell AR, Prise KM, Jain S. In vivo dosimetry in pelvic brachytherapy. Br J Radiol 2022; 95:20220046. [PMID: 35635803 PMCID: PMC10996950 DOI: 10.1259/bjr.20220046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/05/2022] Open
Abstract
ADVANCES IN KNOWLEDGE This paper describes the potential role for in vivo dosimetry in the reduction of uncertainties in pelvic brachytherapy, the pertinent factors for consideration in clinical practice, and the future potential for in vivo dosimetry in the personalisation of brachytherapy.
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Affiliation(s)
- Orla Anne Houlihan
- Department of Clinical Oncology, Northern Ireland Cancer
Centre, Belfast Health and Social Care Trust,
Belfast, UK
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
| | - Geraldine Workman
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast
Health and Social Care Trust,
Belfast, UK
| | - Alan R Hounsell
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast
Health and Social Care Trust,
Belfast, UK
| | - Kevin M Prise
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
| | - Suneil Jain
- Department of Clinical Oncology, Northern Ireland Cancer
Centre, Belfast Health and Social Care Trust,
Belfast, UK
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
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Blumberg M, Al-Ameed K, Eiselt E, Luber S, Mamat C. Synthesis of Ionizable Calix[4]arenes for Chelation of Selected Divalent Cations. Molecules 2022; 27:molecules27051478. [PMID: 35268577 PMCID: PMC8911665 DOI: 10.3390/molecules27051478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Two sets of functionalised calix[4]arenes, either with a 1,3-crown ether bridge or with an open-chain oligo ether moiety in 1,3-position were prepared and further equipped with additional deprotonisable sulfonamide groups to establish chelating systems for selected cations Sr2+, Ba2+, and Pb2+ ions. To improve the complexation behaviour towards these cations, calix[4]arenes with oligo ether groups and modified crowns of different sizes were synthesized. Association constants were determined by UV/Vis titration in acetonitrile using the respective perchlorate salts and logK values between 3.2 and 8.0 were obtained. These findings were supported by the calculation of the binding energies exemplarily for selected complexes with Ba2+.
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Affiliation(s)
- Markus Blumberg
- Helmholtz-Zentrum Dresden-Rossendorf, Institut für Radiopharmazeutische Krebsforschung, Bautzner Landstraße 400, D-01328 Dresden, Germany; (M.B.); (E.E.)
- Fakultät Chemie und Lebensmittelchemie, Technische Universität Dresden, D-01062 Dresden, Germany
| | - Karrar Al-Ameed
- Department of Chemistry, University of Zurich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland; (K.A.-A.); (S.L.)
| | - Erik Eiselt
- Helmholtz-Zentrum Dresden-Rossendorf, Institut für Radiopharmazeutische Krebsforschung, Bautzner Landstraße 400, D-01328 Dresden, Germany; (M.B.); (E.E.)
| | - Sandra Luber
- Department of Chemistry, University of Zurich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland; (K.A.-A.); (S.L.)
| | - Constantin Mamat
- Helmholtz-Zentrum Dresden-Rossendorf, Institut für Radiopharmazeutische Krebsforschung, Bautzner Landstraße 400, D-01328 Dresden, Germany; (M.B.); (E.E.)
- Fakultät Chemie und Lebensmittelchemie, Technische Universität Dresden, D-01062 Dresden, Germany
- Correspondence:
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Separation and purification of Sr-90 nuclide from a waste mixture. J Radioanal Nucl Chem 2021. [DOI: 10.1007/s10967-021-08082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Meel R, Dhiman R, Kashyap S, Agrawal S, Pushker N, Bakhshi S. Systemic neoadjuvant chemotherapy in non-resectable invasive squamous cell carcinoma of ocular surface. Eur J Ophthalmol 2021; 32:11206721211014376. [PMID: 33926247 DOI: 10.1177/11206721211014376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVES The conventional modality for management of advanced invasive ocular surface squamous neoplasia (OSSN) (AJCC grade T4 and T3 with fornicial involvement) is surgical excision which is not only challenging in terms of ability to achieve tumor free margins and tissue reconstruction but also has high morbidity. We describe the use of systemic neoadjuvant chemotherapy (NAC) in cases of advanced invasive OSSN. SUBJECTS/METHODS This is a retrospective case series. Five cases of histopathologically proven advanced OSSN that were challenging to manage with surgical excision or required exenteration were treated with NAC. Demographic details, previous treatment history, location and extent of tumor, imaging findings, number of cycles and duration of NAC, response to treatment, and final outcome on follow-up were noted. RESULTS A remarkable response to NAC was seen in 4/5(80%) cases. Complete regression was seen in 2/5, partial regression in 2/5, and no response in 1/5 cases. In 75% (3/4) cases who showed response to NAC, minimal or no surgery was required. Exenteration was avoided in 2/3 cases with orbital extension. CONCLUSION NAC appears to be an exciting option for management of surgically challenging cases of invasive OSSN and may be helpful in avoiding orbital exenteration. However, more studies are required to explore this treatment option.
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Affiliation(s)
- Rachna Meel
- Oculoplasty and Ocular Oncology Services, All India Institute of Medical Sciences, New Delhi, India
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rebika Dhiman
- Oculoplasty and Ocular Oncology Services, All India Institute of Medical Sciences, New Delhi, India
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
- Ocular Pathology Services, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Agrawal
- Oculoplasty and Ocular Oncology Services, All India Institute of Medical Sciences, New Delhi, India
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Oculoplasty and Ocular Oncology Services, All India Institute of Medical Sciences, New Delhi, India
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
- Dr. B.R.A Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Fagerberg PS, Ramberg IMS, Toft PB. Combining Brachytherapy and Cryotherapy as Adjuvant Therapy for Squamous Cell Carcinoma of the Conjunctiva: Literature Review and Case Reports. Ocul Oncol Pathol 2021; 7:77-84. [PMID: 33981690 DOI: 10.1159/000512029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
Background Separately, cryotherapy and brachytherapy have shown promising results when adjuvating the excision of squamous cell carcinoma of the conjunctiva (SCCC). The aim of this paper is to assess the combined effect in terms of complications and recurrence rate. Summary We describe 2 patients suffering from SCCC, and we review the current literature on adjuvant cryotherapy and brachytherapy. Both patients, one of whom suffered from recurrent SCCC, underwent surgical excision followed by combined cryotherapy and brachytherapy. Cryotherapy was performed using a retinal cryoprobe, and 2 rounds each of 5 s with N2O as a cryogen were applied. Brachytherapy was performed using a ruthenium-106 plaque, delivering a dosage of 100 Gy at 2-mm depth. Key Messages By reviewing the current literature and describing 2 case reports, this paper illustrates the use of combined cryotherapy and brachytherapy after surgical excision of SCCC. The current literature presents promising results of each treatment, and the 2 cases showed promising results by combining the 2 adjuvant therapies showing no signs of recurrence or complications during a follow-up period of 26 and 38 months.
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Affiliation(s)
- Peter S Fagerberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ingvild M S Ramberg
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter B Toft
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Brachytherapy in India: Learning from the past and looking into the future. Brachytherapy 2020; 19:861-873. [PMID: 32948463 DOI: 10.1016/j.brachy.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/05/2020] [Accepted: 08/25/2020] [Indexed: 11/23/2022]
Abstract
India has a longstanding tradition in the practice of brachytherapy and has actively contributed to the scientific literature by conducting prospective studies, clinical audits, developing innovative techniques, and performing randomized studies. Indian investigators have also contributed to international collaborative research, education, training programs along with guideline development for brachytherapy in cervix and head and neck cancers. The present article summarizes the key contributions to scientific literature, current infrastructure, skill set for brachytherapy, existing challenges, and strategy to further strengthen brachytherapy practice in the next decade.
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Single-fraction low-energy electronic brachytherapy for conjunctival lymphoma. J Contemp Brachytherapy 2020; 12:267-272. [PMID: 32695199 PMCID: PMC7366022 DOI: 10.5114/jcb.2020.96869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/12/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose Conjunctival lymphoma represents an uncommon tumor, accounting for 5-10% of total extranodal lymphomas. Although radiotherapy is a frequent treatment option, limited capacities and lack of specialized centers are common problems in Peru, forcing radiation oncologists to apply short courses of radiotherapy. Here, we report a case series of patients treated with a novel single-shot scheme. Additionally, we present a literature review of the current short-course irradiation strategies. Cases presentation Three cases of conjunctival marginal zone (B-cell) lymphoma (marginal zone lymphoma [MZL]/mucosa-associated lymphoid tissue [MALT]) of the fornix are presented. Following biopsy and sonographic assessment of the lesion thickness, we applied a focused single dose of 14 Gy kilovoltage brachytherapy (prescribed to the maximum thickness of the lesion). Follow-up was scheduled in quarterly intervals. After 28, 31, and 40 months of follow-up, none of the three patients treated exhibited acute or chronic toxicities and remained local or distant disease-free. Conclusions Single dose kilovoltage brachytherapy was effective and safe in this small cohort of patients. Based on the literature, there is an evidence that local treatment in short-course radiotherapy is effective and should be considered amongst therapeutic options for these patients; however, this novel approach should be evaluated prospectively in a larger cohort.
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Sinharoy P, Banerjee D, Manohar S, Kaushik CP. Separation of radio-chemically pure 106Ru from radioactive waste for the preparation of brachytherapy sources: an insight of process development study. SEP SCI TECHNOL 2020. [DOI: 10.1080/01496395.2020.1774779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Prithwish Sinharoy
- Process Development Division, Nuclear Recycle Group, Bhabha Atomic Research Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Dayamoy Banerjee
- Process Development Division, Nuclear Recycle Group, Bhabha Atomic Research Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Smitha Manohar
- Process Development Division, Nuclear Recycle Group, Bhabha Atomic Research Centre, Mumbai, India
| | - Chetan Prakash Kaushik
- Process Development Division, Nuclear Recycle Group, Bhabha Atomic Research Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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14
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Management Issues in Conjunctival Tumours: Ocular Surface Squamous Neoplasia. Ophthalmol Ther 2019; 9:181-190. [PMID: 31760597 PMCID: PMC7054503 DOI: 10.1007/s40123-019-00225-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Indexed: 11/11/2022] Open
Abstract
Ocular surface squamous neoplasia is the most common tumour of the ocular surface. It is a spectrum of disease from intraepithelial dysplasia to invasive squamous cell carcinoma. Recent years have seen an increase in the use of topical chemotherapeutic agents to treat this condition, often as primary treatment without full-thickness biopsy. This practical approach provides a critical appraisal of the evidence base with the goal being to aid the clinician in the management of these patients.
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15
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Santoni A, Thariat J, Maschi C, Herault J, Baillif S, Lassalle S, Peyrichon ML, Salleron J, Caujolle JP. Management of Invasive Squamous Cell Carcinomas of the Conjunctiva. Am J Ophthalmol 2019; 200:1-9. [PMID: 30552889 DOI: 10.1016/j.ajo.2018.11.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Ocular surface squamous neoplasia includes a spectrum of diseases from dysplasia to invasive squamous cell carcinoma (SCC) of the conjunctiva. Whether the degree of invasion influences outcomes is debated. We evaluated the outcomes and management of conjunctival carcinomas defined as ≤0.2 mm invasion of the chorion (microinvasive; miSCC) or over (SCC). DESIGN Retrospective case series. METHODS Clinical, tumor, and therapeutic characteristics and outcomes were collected for consecutive patients with histology-proven invasive conjunctival miSCC/SCC treated between 2002 and 2017. RESULTS Patients were 70% men, ≥70 years old (56%), with carcinomas of the bulbar conjunctiva (83.0%). Limbal, corneal, and/or scleral involvement were present in 70.4%, 42.6%, and 27.8%, respectively. Patient characteristics, tumor characteristics, and no-touch surgery rates were similar between the 39 SCC and 15 miSCC. However, mitomycin was performed in 93.3% and 20.5% of miSCC and SCC, respectively (P < .001). Proton therapy was performed in 0% and 92.0% of miSCC and SCC, respectively (P < .001). SCC received mitomycin in case of tumoral resection margins, respectively (P = .018). The 24-month incidence of local relapse was 14.8%, including 20% and 12% for miSCC and SCC, respectively (P = .079). Irradiation was the only prognostic factor associated with a lower risk for local relapse (hazard ratio [0.25]; P = .045). There were 2 cancer-related deaths (2%). Mild/moderate anterior segment complications occurred in one third of the patients. CONCLUSIONS miSCC had slightly worse relapse rates compared with SCC. Postoperative proton therapy, performed in SCC only, was associated with a lower risk for relapse.
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Affiliation(s)
- Alexandra Santoni
- Department of Ophthalmology, Pasteur 2 Teaching Hospital, Nice, France
| | - Juliette Thariat
- Department of Radiation Oncology, Francois Baclesse Cancer ARCHADE Center, Normandie Universite-Unicaen, Caen, France.
| | - Célia Maschi
- Department of Ophthalmology, Pasteur 2 Teaching Hospital, Nice, France
| | - Joel Herault
- Department of Radiation Oncology, Antoine-Lacassagne Cancer Center, Nice, France
| | - Stéphanie Baillif
- Department of Ophthalmology, Pasteur 2 Teaching Hospital, Nice, France
| | - Sandra Lassalle
- Department of Biopathology, Pasteur 2 Teaching Hospital, Nice, France
| | | | - Julia Salleron
- Department of Biostatistics, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandœuvre-lès-Nancy, France
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16
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Edgar A, Crutchfield G, Anderson N. Superficial radiotherapy as a treatment alternative for recurrent conjunctival squamous cell carcinoma: a case study. J Med Radiat Sci 2018; 65:240-244. [PMID: 29577676 PMCID: PMC6119735 DOI: 10.1002/jmrs.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/18/2018] [Indexed: 12/02/2022] Open
Abstract
This case study discusses the use of superficial radiotherapy (SXRT) in the treatment of recurrent conjunctival squamous cell carcinoma (SCC). Conjunctival SCC is often an aggressive cancer, with surgery the current standard of care. There is currently limited literature on alternative treatment options to treat conjunctival SCC recurrences that enable ocular function preservation. Furthermore, the use of SXRT in this setting is not well-reported. Technical feasibility, practical limitations and potential side effects of SXRT (in comparison to other treatment options) are discussed in this case study. This case describes a 62 years old male with limited treatment options following multiple recurrences of conjunctival SCC. He was prescribed a therapeutic SXRT dose of 48.4 Gy in 22 fractions (5 fractions/week). At 6-month follow-up, there was no evidence of residual or recurrent disease, or any significant objective or patient reported treatment induced side effects. This case study provides preliminary evidence for the potential application of SXRT for conjunctival SCC. The benefits reported in this case study warrant further investigation of the applicability of SXRT in a larger patient cohort, with the potential to provide patients with a less invasive treatment alternative for recurrent conjunctival SCC.
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Affiliation(s)
- Amanda Edgar
- Department of Radiation Oncology and Cancer ImagingPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Gretel Crutchfield
- Department of Radiation Oncology and Cancer ImagingPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Nigel Anderson
- Department of Radiation Oncology and Cancer ImagingPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
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17
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Bauer D, Gott M, Steinbach J, Mamat C. Chelation of heavy group 2 (radio)metals by p-tert-butylcalix[4]arene-1,3-crown-6 and logK determination via NMR. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2018; 199:50-56. [PMID: 29567522 DOI: 10.1016/j.saa.2018.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/09/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Affiliation(s)
- David Bauer
- Helmholtz-Zentrum Dresden-Rossendorf, Institut für Radiopharmazeutische Krebsforschung, Bautzner Landstraße 400, D-01328 Dresden, Germany; Technische Universität Dresden, Fakultät Chemie und Lebensmittelchemie, D-01062 Dresden, Germany
| | - Matthew Gott
- Helmholtz-Zentrum Dresden-Rossendorf, Institut für Radiopharmazeutische Krebsforschung, Bautzner Landstraße 400, D-01328 Dresden, Germany
| | - Jörg Steinbach
- Helmholtz-Zentrum Dresden-Rossendorf, Institut für Radiopharmazeutische Krebsforschung, Bautzner Landstraße 400, D-01328 Dresden, Germany; Technische Universität Dresden, Fakultät Chemie und Lebensmittelchemie, D-01062 Dresden, Germany
| | - Constantin Mamat
- Helmholtz-Zentrum Dresden-Rossendorf, Institut für Radiopharmazeutische Krebsforschung, Bautzner Landstraße 400, D-01328 Dresden, Germany; Technische Universität Dresden, Fakultät Chemie und Lebensmittelchemie, D-01062 Dresden, Germany.
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18
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Sarria GR, Sarria GJ, Rivera PF, Zaharia M, Serpa S, Buitrago M. Phase I/II study on kilovoltage surface brachytherapy in conjunctival cancer: preliminary results. Ecancermedicalscience 2018; 12:835. [PMID: 29910832 PMCID: PMC5985750 DOI: 10.3332/ecancer.2018.835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION In ocular conjunctival carcinoma after surgery, adjuvant treatment has a role and kilovoltage surface brachytherapy opens a new door for the range of therapeutic options. MATERIALS AND METHODS Between October 2014 and June 2017, at the National Institute of Neoplastic Diseases (INEN) from Peru, 39 patients with squamous cell carcinoma of ocular conjunctiva, T1-T3, resected, were selected to receive adjuvant treatment. The portable accelerator of 50-kV INTRABEAM (Carl Zeiss Meditec) was used, after local anaesthesia and blocking of ocular muscles movement. The doses used were 18 Gy for patients with free margins and 22 Gy for positive edges, according to calculation of equivalent dose of 2Gy per fraction of 46 and 66 Gy, respectively, assuming a tumoural α/β ratio of 8 Gy. The prescription was done to 2 mm depth. RESULTS The median age was 69 years, distributed evenly between both genders, with a median follow-up of 12 months. The surgical margins were 59% free and 41% committed, with no difference between the institutions where the surgery was performed (P = 0.069). The median tumour size was 7 mm with 2 mm of invasion, 61.5% was T2 and 35.9% T1. The mean time between surgery and irradiation was 1.5 months, 23.1% of patients developed grade I toxicity of spontaneous resolution, without evidence of greater degree in any case. The dose had no statistical relationship with toxicity (P = 0.533). One-year disease-free survival was 96.7%. CONCLUSIONS Kilovoltage surface brachytherapy is an applicable and reproducible tool in the treatment of squamous cell carcinoma of ocular conjunctiva. The administered doses are well tolerated by patients with low levels of acute toxicity. Longer follow-up is needed to establish disease control rates and late toxicities.
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Affiliation(s)
- Gustavo R Sarria
- Radiotherapy Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
| | - Gustavo J Sarria
- Radiotherapy Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
| | - Paola Fuentes Rivera
- Radiotherapy Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
| | - Mayer Zaharia
- Radiotherapy Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
| | - Solón Serpa
- Ophthalmic Oncology Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
| | - Mario Buitrago
- Ophthalmic Oncology Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
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19
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Coquard R, N'Guyen AM, Mathis T, Josserand-Pietri F, Khodri M, Largeron G, Barbet N, Grange JD. [Adjuvant contact radiotherapy for conjunctival malignancies: Preliminary results of a series of 14 patients treated with the Papillon 50 machine]. Cancer Radiother 2018; 22:107-111. [PMID: 29475731 DOI: 10.1016/j.canrad.2017.08.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/07/2017] [Accepted: 08/02/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the results of an adjuvant contact irradiation using 50kV photons after resection of conjunctival malignancies. MATERIALS AND METHOD From 2012 to 2014, 14 patients (male: nine; female: five) have been treated by contact irradiation after resection of a malignant tumor of the conjunctiva (melanoma: five patients; malignant fibrous histiocytoma: one patient; carcinoma: eight patients) The treatment was performed using the Papillon 50 machine (Ariane). Three to four sessions were delivered, each giving a dose of 10Gy. The median follow-up in survivors was 33 months. RESULTS The tolerance was good. A cataract was seen in one patient, and a moderate eye dryness in one. There was no corneal ulcer. One patient died of intercurrent disease. One patient with carcinoma recurred locally. CONCLUSION Adjuvant contact radiotherapy provides a good local control after resection of conjunctival malignancies (melanoma, malignant histiocytofibroma, carcinoma). Thanks to its precision, this technique is well tolerated with a low rate of complications. Furthermore, it is delivered on an ambulatory basis.
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Affiliation(s)
- R Coquard
- Centre de radiothérapie Bayard, 44, avenue Condorcet, 69100 Villeurbanne, France.
| | - A M N'Guyen
- Service d'ophtalmologie, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - T Mathis
- Service d'ophtalmologie, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - F Josserand-Pietri
- Centre de radiothérapie Bayard, 44, avenue Condorcet, 69100 Villeurbanne, France
| | - M Khodri
- Centre de radiothérapie Bayard, 44, avenue Condorcet, 69100 Villeurbanne, France
| | - G Largeron
- Centre de radiothérapie Bayard, 44, avenue Condorcet, 69100 Villeurbanne, France
| | - N Barbet
- Centre de radiothérapie Bayard, 44, avenue Condorcet, 69100 Villeurbanne, France
| | - J D Grange
- Service d'ophtalmologie, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
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