Program Book

Purpose. Ocular surface squamous neoplasia (OSSN) refers to
precancerous and cancerous lesions of the conjunctiva ranging form
conjuctival intraepithelial neoplasia (CIN) to an invasive tumor with
destruction of the orbital tissues. OSSN used to affect elderly men, yet
this pattern has changed. In Africa the incidence is rising in younger
persons, mostly women around 35 years of age. This increasing
prevalence is probably due to HIV infection and HPV co-infections.
Methods. Clinical and immunological analysis including testing of
specific T cell interferon-gamma immune responses, and tissue HPV
type analysis.
Results. A 50 year-old female presented with complaints of chronical
blepharoconjunctivitis which had existed for a couple of years. She was
HIV positive and used antiretroviral medication infrequently. An eye
examination revealed extensive leukoplakia of the palpebral and bulbar
conjunctiva and cornea in the left eye. As a biopsy revealed squamous
cell carcinoma with infiltration of the tarsal and bulbar conjunctiva of
the left eye, exenteration of the left orbit was planned.
When admitted to the hospital after a patients delay of a couple of
months, the lesion of the conjunctival lesion had almost disappeared.
The patient mentioned that she had restarted to take her HAART
medication conscientiously.
Earlier biopsies showed the presence of HPV 16, and at the time of tumor
regression, anti-HPV16 T-cell responses were found to be present.
Conclusions. Meticulous use of antiretroviral medication may cause
regression of OSSN. It is unclear whether the medication targets the
underlying HIV or HPV infection, or indirectly led to healing by allowing
the recurrence of an anti-HPV16 T cell immune response. The lack of
compliance in the use of therapy could be added to the list of risk factors
for OSSN. Further research is needed to confirm this suggestion.
Financial disclosure. None
12 EC8
RUTHENIUM PLAQUE THERAPY IN THE MANAGEMENT
OF CONJUNCTIVAL SQUAMOUS CELL CARCINOMA
INVADING THE EYE
Priscilla L. Ballalai, Virginia L. Torres, Roberto Segretto (pbbordon@
terra.com.br)
Ocular Oncology Section - Federal University of Sao Paulo
Radiotherapy - Federal University of Sao Paulo
Purpose. To describe the outcome of patients with conjunctival
squamous cell carcinoma invading the eye treated with Ruthenium
(Ru106) plaque therapy.
Methods. Retrospective, non-comparative review of charts of patients
referred to the University and private office with conjunctival squamous
cell carcinoma (SCC) invading the eye, from January 2001 to July 2011.
Patients with focal invasions at the cornea, sclera or iris and ciliary body
were included. Patients with orbital infiltrations or extensive intraocular
infiltrations were excluded. All patients were submitted to Ru 106 plaque
therapy, and the treatment dose was 50 Gy. The duration of the treatment
was calculated according to the UBM measurements with a 1 mm safety
margin. The patients were followed with a complete ophthalmological
examination and systemic evaluation after the treatment.
Results. Twenty patients with conjunctival SCC invading the eye were
seen by the authors from January 2001 to July 2011. Six of them were
eligible for salvage therapy with ruthenium plaque therapy. One patient
was HIV positive. The mean age was 58 yo (range 29-82 yo), 4 were
females and 2 males. The mean follow up of was 31,5 mo (range 6 -108
EYELID, CONJUNTIVA & ORBIT
Abstracts
69
mo). All of them had been treated previously with surgery or surgery and
topical chemotherapy (Mitomycin C and/or Interferon). The mean number
of surgeries was 2,1 (range 1-4). The pathological evaluation confirmed
the diagnosis of SCC in all patients. Infiltration of the corneal stroma
was observed in 3 patients, deep scleral infiltration in 4 patients and
iris and ciliary body infiltration in 1 patient. All patients had regression
of the tumor after the treatment without recurrence in the treatment
site or elsewhere. None of them presented distant metastasis. The only
complication observed with this treatment was cataract, in 3 patients.
Conclusions. Ruthenium plaque therapy is safe and effective in the
management of eyes with focal infiltrations by conjunctival squamous
cell carcinoma.
Financial disclosure. None
1059 EC9
INVASIVE SQUAMOUS CELL CARCINOMA OF THE
CONJUNCTIVA TREATED BY PROTONS
W. Sauerwein1, J. Herault2, P. Chauvel2, H. Westekemper3, R.
Darawsha3, B. Zimmermann1, C. Maschi4, A. Wittig5, L. Brualla1, J.-P.
Caujolle4 (w.sauerwein@uni-due.de)
1. University Duisburg- Essen, University Hospital Essen, Department of
Radiation Oncology, Essen, Germany
2. Cyclotron Biomédicale, Centre Antoine-Lacassagne, Nice, France
3. University Duisburg- Essen, University Hospital Essen, Department of
Ophthalmology, Essen, Germany
4. Service d’Ophtalmologie, CHU Saint Roch, Nice, France
5. Klinikum der Philipps-Universität Marburg, Department of Radiation
Oncology Marburg, Germany
Purpose. Squamous cell carcinoma (SCC) of the conjunctiva is an
extremely rare disease. The disease is suspected to be associated
with atrophic dermatitis and HIV in young women. After local excision
the tumor often recurs instead of adjuvant therapies such as cryocoagulation,
local chemotherapy or radiotherapy. Conventional external
beam radiotherapy with electrons or photons is not conducive as the
dose needed to control the tumor will destroy the eye. A sufficient dose
can only be delivered by brachytherapy if the tumor is localized on the
eyeball and if the target volume can be covered by a radioactive plaque.
Therefore, exenteration is often the only curative approach. Protons
might offer an alternative as they can be collimated and modulated to
cover a complex area of the conjunctiva including fornix and tarsus while
protecting the inner part of the eye and radiosensitive structures in the
neighbourhood.
Methods. The irradiation technique was initially developed to treat
melanoma of the conjunctiva. The target volume to be considered is
large and individually shaped. It includes often more than half of the total
surface of the conjunctiva, with the goal to avoid further relapses at the
margin of the treated volume. Because of the large volume, the number of
fractions has been extended as compared to conventional proton therapy of
uveal melanoma. The dose applied is given in 6 fractions of 5.2 Gy (36 Gy
RBE) followed by a boost of 2 fractions of 7 Gy (16 Gy RBE). The technical
principles of the treatment are as follows: - the clips are inserted on the eye
for localization of the target volume and positioning. A bolus is set-up on the
lid to give a homogeneous flat entrance for the proton beam collimated to
the size of the tumor, - the beam passes through a semi-spherical acrylic
glass compensator to adapt the range of the proton beam to the shape
the inner sclera and let the protons irradiate the thickness of sclera and
conjunctiva. The compensator is individually customized from an acrylic
glass block by a computerized milling machine. The resulting dose distribution is