title: The treatment of carcinoma in situ and squamous cell carcinoma of the conjunctiva with fractionated strontium-90 radiation in a population with a high prevalence of HIV.
abstract: BACKGROUND
  This study explores the safety and efficacy of strontium 90 (Sr-90) brachytherapy as the sole adjuvant therapy for carcinoma in situ (CIS) and squamous cell carcinoma (SCC) of the conjunctiva in a high HIV prevalent area.
  
  
  METHODS
  This is a retrospective case review of patients treated with 60 Gray Sr-90 brachytherapy in four divided doses after resection with a 2 mm margin and histological confirmation. Cryotherapy or alcohol debridement was not performed at the time of excision due to limited resources. Two plaque sizes, 8.5 mm and 18 mm, were used.
  
  
  RESULTS
  Sixty-nine patients were treated and had a median follow-up of 27 months (range 6-127). Thirty-three (47.8%) were HIV-positive. CIS was present in 40.6% and SCC in 59.4%. The surgical margins were positive in 39 (56.5%). Twenty patients (29.0%) were treated with the 18 mm plaque and 49 (71.0%) with the 8.5 mm plaque. Eight (11.6%) patients developed a recurrence at a median of 5 months (range 2-40). Recurrences only occurred in patients treated with the 8.5 mm plaque (p=0.094). There was no significant effect of HIV status, positive margins or staging on the number of recurrences. Treatment side effects were a dry eye in five patients which was successfully managed with topical lubricants, and induced astigmatism of 1 dioptre of cylinder in one patient.
  
  
  CONCLUSIONS
  Sr-90 brachytherapy is safe and effective in preventing recurrences in ocular surface squamous neoplasia in a high HIV prevalent setting. The 18 mm plaque size is superior to the 8.5 mm plaque size.
authors.affiliation: Department Ophthalmology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Karin
authors.initials: K
authors.lastname: Lecuona
authors.affiliation: Department Radiation Oncology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Clare
authors.initials: C
authors.lastname: Stannard
authors.affiliation: Department Radiation Oncology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Gregory
authors.initials: G
authors.lastname: Hart
authors.affiliation: Department Ophthalmology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: James
authors.initials: J
authors.lastname: Rice
authors.affiliation: Department Ophthalmology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Colin
authors.initials: C
authors.lastname: Cook
authors.affiliation: Department Radiation Oncology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Julie
authors.initials: J
authors.lastname: Wetter
authors.affiliation: Department of Anatomical Pathology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Maureen
authors.initials: M
authors.lastname: Duffield
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D002278:Carcinoma in Situ / Q000532:radiotherapy* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D003230:Conjunctival Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D013326:Strontium Radioisotopes / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D013326:Strontium Radioisotopes
keywords: Conjunctiva; Neoplasia; Treatment other