title: Conjunctival autograft alone or combined with adjuvant beta-radiation? A randomized clinical trial.
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of postoperative low single-dose of beta-irradiation (β-RT) in pterygium comparing conjunctival autograft (CAG) surgery with CAG plus adjuvant β-RT in a randomized clinical trial.
  
  
  METHODS
  This trial was designed as a prospective, randomized, single-center study. Surgery was performed in all cases according to the CAG technique. One hundred and eight pterygia were postoperatively randomized to CAG + β-RT or CAG alone. In the case of β-RT, a (90) Sr eye applicator was used to deliver 10 Gy to the sclera surface at a dose rate of between 200 and 250 cGy/min. After treatment, both an ophthalmologist and a radiation oncologist performed the follow-up examinations. The accumulated data were analyzed using a group sequential test.
  
  
  RESULTS
  Between February 2008 and September 2008, 116 eyes with primary pterygium were operated on according to the trial protocol. Adjuvant treatment was performed within 24 h postoperatively. Eight patients were lost to follow-up, resulting in 108 patients who could be analyzed. At a mean follow-up of 18 months (range, 8-33), in the 54 eyes randomized to receive CAG + β-RT, 5 relapses occurred compared with 12 recurrences in the 54 eyes in CAG, for a crude control rate of 90.8 % vs. 78%; p = 0.032, respectively. The treatment complications as hyperemia, total dehiscence of the autograft and dellen were significantly more frequent in the CAG (p < 0.05). The arm of β-RT resulted in better cosmetic results and improves of symptoms than CAG.
  
  
  CONCLUSIONS
  A low single-dose of β-RT of 10 Gy after CAG surgery was a simple, effective, and safe treatment that reduced the risk of primary pterygium recurrence, improved symptoms after surgery, resulting in a better cosmetic effect than only CAG.
authors.affiliation: Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil. gusviani@gmail.com
authors.forename: Gustavo Arruda
authors.initials: GA
authors.lastname: Viani
authors.forename: Ellen Carrara
authors.initials: EC
authors.lastname: Fonseca
authors.forename: Ligia Issa
authors.initials: LI
authors.lastname: De Fendi
authors.forename: Eduardo Melani
authors.initials: EM
authors.lastname: Rocha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006940:Hyperemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011625:Pterygium / Q000532:radiotherapy* / Q000601:surgery*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D012008:Recurrence; D013326:Strontium Radioisotopes / Q000627:therapeutic use*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013326:Strontium Radioisotopes