5-Fluorouracil for the treatment of intraepithelial neoplasia of the conjunctiva and cornea.
OBJECTIVE
To evaluate the efficacy of pulse dosing of topical 5-fluorouracil (5-FU) in the treatment of conjunctival and corneal intraepithelial neoplasia.


METHODS
Prospective, noncomparative case series.


METHODS
Seven patients with histologic evidence of intraepithelial neoplasia were identified by conjunctival biopsy or tumor excision.


METHODS
Seven patients with a minimum of 7 months of follow-up were treated with pulsed dosing of 1% 5-FU. Topical 1% 5-FU was administered four times daily for 2 to 4 days for each cycle. The number of initial treatment cycles was two to six, with the time between cycles being 30 to 45 days.


METHODS
The presence or absence of clinically evident intraepithelial neoplasia was evaluated after each treatment interval. Patients were also monitored for adverse reactions to the use of topical 5-FU.


RESULTS
Four patients remain disease free with a mean follow-up of 18.5 months (range, 7-36 months) with no additional treatment after the initial treatment cycles (mean, 3.75 cycles; range, 2-5 cycles). Three patients had recurrence of disease after the initial treatment cycles. Two patients were treated with additional cycles for recurrent disease (six cycles in one patient and five cycles in the other patient) and are free of disease at 20 and 21 months after treatment, respectively. One patient had persistent disease despite treatment with topical 5-FU and was treated with topical mitomycin C with resolution of the disease without recurrence for 16.5 months. No adverse reactions to pulse dose treatment with topical 5-FU were noted.


CONCLUSIONS
Pulsed dosing with 1% topical 5-FU for the treatment of conjunctival and corneal intraepithelial neoplasia, alone or as an adjunct to excision of bulky disease, is a well-tolerated and effective method of treatment.
Yeatts
R P
RP
Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. pyeatts@wfubmc.edu
Engelbrecht
N E
NE
Curry
C D
CD
Ford
J G
JG
Walter
K A
KA
D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D002278:Carcinoma in Situ / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D003230:Conjunctival Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003316:Corneal Diseases / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D005134:Eye Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D011446:Prospective Studies
D000964:Antimetabolites, Antineoplastic; D009883:Ophthalmic Solutions; D005472:Fluorouracil