title: Intraoperative high-dose rate of radioactive phosphorus 32 brachytherapy for diffuse recalcitrant conjunctival neoplasms: a retrospective case series and report of toxicity.
abstract: OBJECTIVE
  Adjunct treatments for conjunctival malignancies are needed when standard therapy provides limited benefits or fails.
  
  
  OBJECTIVE
  To describe the results of patients with diffuse conjunctival neoplasms treated with radioactive phosphorus 32 (32P)-impregnated flexible film.
  
  
  METHODS
  This retrospective case series between January 1, 2010, and January 1, 2013, was conducted at Memorial Sloan-Kettering Cancer Center, a tertiary referral center. The study was conducted on 7 eyes of 6 patients treated for diffuse conjunctival squamous cell carcinoma, sebaceous carcinoma, or lymphoma that had recurrent or residual disease after primary treatment.
  
  
  METHODS
  Patients underwent mapping biopsies and detailed conjunctival drawings to delineate the pathologic extent of the disease. The brachytherapy film used for treatment was the RIC Conformal Source Model 100 (RIC-100, RI Consultants). The RIC-100 is a flexible, thin (approximately 0.5-mm) film made of a polymer chemically bound to 32P. The radioactive 32P film was placed intraoperatively, allowed to stay in place until the prescription dose was reached, and then removed. The median dose at the prescription point (1 mm from the surface of the film) was 15 Gy (range, 5-17 Gy).
  
  
  METHODS
  Patients were tested for best-corrected visual acuity, recurrence-free survival, and adverse events scored by using the Adult Comorbidity Evaluation-27 scale.
  
  
  RESULTS
  Between 2010 and 2013, 7 eyes of 6 patients were treated. The median age of patients was 70 years. All patients had a recurrent or persistent neoplasm. Four patients with squamous cell carcinoma, 1 with sebaceous carcinoma, and 1 with metachronous bilateral lymphomas were treated. The median treatment time was 19 minutes (range, 10-52 minutes). The median follow-up was 24.9 months (range, 3.1-38.2 months). Recurrence-free survival 24 months after brachytherapy was 75% (95% CI, 19-89.1). Two moderate adverse events and 1 severe adverse event occurred. Visual acuity was stable or improved in 5 of the 7 eyes (ie, better than 20/70 in the 5 patients who retained their treated eye).
  
  
  CONCLUSIONS
  Our results show the use of an intraoperative high-dose rate of 32P brachytherapy in selected cases of recalcitrant diffuse conjunctival neoplasms. This technique offers a novel adjunct in the treatment of these cancers. Further follow-up and study are warranted.
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York2Department of Ophthalmology, Weill-Cornell Medical School, New York, New York.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marr
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York2Department of Ophthalmology, Weill-Cornell Medical School, New York, New York.
authors.forename: David H
authors.initials: DH
authors.lastname: Abramson
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Gil'ad N
authors.initials: GN
authors.lastname: Cohen
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Williamson
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Beryl
authors.initials: B
authors.lastname: McCormick
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Barker
mesh_terms: D018266:Adenocarcinoma, Sebaceous / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D003230:Conjunctival Neoplasms / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D016399:Lymphoma, T-Cell / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010761:Phosphorus Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology
chemical_list: D010761:Phosphorus Radioisotopes