I-125 eye-plaque seed economics: To re-use or to not re-use? A single institutional cost savings analysis of re-using I-125 radioactive seeds for eye-Plaque brachytherapy.

INTRODUCTION: Iodine-125 (I-125) seeds, commonly used in low-dose rate brachytherapy for ocular malignancies, are often discarded after a single use. This study examines the potential cost savings at an institution with high ocular melanoma referrals, by re-using I-125 seeds for eye-plaque brachytherapy. METHODS: In this single-institutional retrospective analysis, data was collected from I-125 seed orders from 8/2019 through 10/2022. Information including number of seeds ordered per lot, number of plaques built per lot, and number of seeds used per lot were collected. Cost per lot of seed was assumed to be the current cost from the most recent lot of 35 seeds. RESULTS: During the study, 72 I-125 seed lots were ordered bi-weekly, with a median of 35 seeds per lot (Range: 15-35). Each seed was used on average 2.26 times prior to being discarded. The average duration of each seed lot used was 62.2 days (Range: 21-126). Each seed lot contributed to the construction of an average of 8.4 eye plaques (Range: 2-20). With seed recycling, 2,475 seeds were used to construct 608 eye-plaques. Without re-using practice this would require 5,694 seeds. This resulted in a percentage cost savings of 56.5%, with a total seed cost reduction of $344,884, or $559 per eye-plaque on average. CONCLUSION: This is the first study to evaluate cost savings relative to re-using I-125 seeds for eye plaques. The data demonstrates how an institution can decrease costs associated with I-125 radiation seeds used for eye-plaque brachytherapy by re-using them.

Complicaciones tardías de la radioterapia ocular / Late complications of the ocular radiotherapy

La radioterapia es uno de los pilares terapéuticos utilizados en la oncología, no exenta de producir daño ocular, lo que constituye un fenómeno bien establecido. La aparición de complicaciones continúa siendo la principal preocupación de la aplicación de la radioterapia, a pesar del empleo de nuevas estrategias que buscan reducir las complicaciones y mejorar el índice terapéutico. Se presenta una paciente femenina de 63 años con diagnóstico de carcinoma epidermoide de la conjuntiva, moderadamente diferenciado G-II, invasor (T3N0M0) en ojo izquierdo, que llevó tratamiento quirúrgico y radioterapia superficial complementaria. Como complicación tardía, la paciente presentó catarata radiógena, que recibió tratamiento quirúrgico, además de aneurismas conjuntivales en el área tratada(AU)

Radiotherapy is one of the therapeutic pillars used in oncology, but ocular damage may occur and this is a well-established phenomenon. The occurrence of complications remains the main concern for the application of radiotherapy, despite the use of new strategies to reduce complications and to improve the therapeutic rate. Here is a 63 years old female patient, who was diagnosed with epidermoid carcinoma of the conjunctiva, moderately differentiated G-II invader (T3N0M0) in the left eye. She was surgically treated and received supplementary superficial radiotherapy As a late complication, the patient presented with radiogenic cataract treated by surgery, in addition to conjunctival aneurysms in the treated area as well(AU)

Asynchronous presentation of follicle center lymphoma and reactive lymphoid hyperplasia of the ocular adnexa.

Although ocular lymphoproliferative diseases may be rarely encountered by dermatopathologists, the frequency may increase particularly as more and more subspecialties rely on dermatopathology services. Emerging data suggest that there are some similarities between ocular and cutaneous lymphoproliferative diseases with respect to their clinical behavior, prognosis, and cytogenetics. In this case report, a patient with ocular follicle center lymphoma who subsequently developed ocular reactive lymphoid hyperplasia is presented with an accompanying review of the literature on the subjects. The encounter of both follicular center lymphoma and reactive lymphoid hyperplasia in the same patient provides a rare opportunity to compare and contrast the clinical, histological, and immunohistochemical findings of the respective lymphoproliferative diseases situated at opposite ends of the spectrum.

Episcleral brachytherapy for uveal melanoma: analysis of 136 cases.

PURPOSE: To assess the results of I-125 episcleral brachytherapy (EB) in uveal melanoma: tumour control, visual acuity (VA), eye preservation and survival. PATIENTS: Prospective and consecutive study of patients with a diagnosis of uveal melanoma at the Ocular Oncology Unit in the Valladolid University Teaching Hospital treated with EB between September 1997 and June 2008. Ocular examination and extraocular and systemic extension data were registered in a database at the time of the diagnosis and during the follow-up. RESULTS: Among a total of 310 patients diagnosed between September 1997 and June 2008, 136 were treated with EB (mean age, 58.3). Mean follow-up was 55.3 months. As for tumour type, 66.9% were nodular and 39% mushroom shaped. With respect to size, 80.9% were medium, 7.4% small and 11.8% large. After 4.6 years of follow-up, tumours were controlled in 97.1%, with a 55.1% reduction in mean height; only 2.9% of patients showed recurrence. VA was maintained in 16.2% of patients and 17.6% showed an increase; 33% had retinopathy and 14.6% optic neuropathy. Only 5.1% of patients underwent enucleation due to complications and there has been 1 melanoma-related death to date. CONCLUSIONS: I-125 EB is effective in tumour control, allowing preservation of the eye and useful visual function for the majority of patients.

Plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma: case report.

The authors present a rare case of plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma in a 42-year-old woman. The lesion was surgically removed and analyzed. Histopathological examination with immunostaining revealed it to be positive for immunoglobulin G and Kappa chains, demonstrating monoclonality. However, no abnormality was observed on serum electrophoresis, skeletal survey and bone marrow aspiration. Therefore, the tumor was diagnosed solitary plasmacytoma of bone. The patient was treated with external beam radiotherapy and has remained disease free for 5 years and 6 months until 2007, when she presented a pathological fracture due to multiple myeloma. Extensive medical work-up to rule out multiple myeloma or other malignant lymphoproliferative conditions involving orbit or ocular adnexa is needed when the diagnosis of solitary plasmacytoma of bone is suspected because treatment and prognosis are very different.

Plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma: case report / Plasmocitoma da órbita envolvendo glândula lacrimal com transformação secundária para mieloma múltiplo: relato de caso

The authors present a rare case of plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma in a 42-year-old woman. The lesion was surgically removed and analyzed. Histopathological examination with immunostaining revealed it to be positive for immunoglobulin G and Kappa chains, demonstrating monoclonality. However, no abnormality was observed on serum electrophoresis, skeletal survey and bone marrow aspiration. Therefore, the tumor was diagnosed solitary plasmacytoma of bone. The patient was treated with external beam radiotherapy and has remained disease free for 5 years and 6 months until 2007, when she presented a pathological fracture due to multiple myeloma. Extensive medical work-up to rule out multiple myeloma or other malignant lymphoproliferative conditions involving orbit or ocular adnexa is needed when the diagnosis of solitary plasmacytoma of bone is suspected because treatment and prognosis are very different.

Os autores relatam um raro caso de plasmocitoma da órbita envolvendo glândula lacrimal com transformação secundária para mieloma múltiplo em uma paciente de 42 anos. A lesão foi removida cirurgicamente e o exame anatomopatológico, aliado à imuno-histoquímica, revelou positividade para imunoglobulina G e cadeias leve tipo Kappa. Após extensa avaliação sistêmica, nenhuma anormalidade foi observada, sendo feito o diagnóstico de plasmocitoma solitário ósseo. A paciente foi submetida à radioterapia, permanecendo livre da doença por 5 anos e 6 meses até 2007, quando apresentou uma fratura patológica devido à infiltração plasmocitária na coluna lombar, sendo feito diagnóstico de mieloma múltiplo. Uma vez que o plasmocitoma solitário ósseo pode ser a primeira manifestação do mieloma múltiplo, esses pacientes necessitam de adequado diagnóstico e seguimento a longo prazo, pois o tratamento e prognóstico dessas duas condições é diferente.

Trilateral retinoblastoma.

BACKGROUND: Trilateral retinoblastoma (TRB) is a syndrome consisting of unilateral or bilateral hereditary retinoblastoma (Rb) associated with an intracranial neuroblastic tumor. Although its incidence is low, the prognosis is very poor. This article reports four cases of TRB and discusses the role of neuroimaging screening for early detection. PROCEDURE: From January 1986 to December 2003, 470 children with Rb were admitted to the Pediatrics and Ophthalmology Departments, A C Camargo Hospital, São Paulo, Brazil. RESULTS: There were four patients with pineoblastoma, two of whom had a positive familial history. The age at diagnosis of Rb was 4, 6, 10, and 24 months while the age of diagnosis of TRB was 10, 25, 57, and 72 months. One patient presented TRB at initial diagnosis of Rb. Three patients had bilateral disease and all of them had one eye enucleated, followed by chemotherapy and/or external beam radiation therapy (EBRT). One child with unilateral disease was only submitted to enucleation. In spite of intensive treatment, all patients died with progressive disease within 7, 8, 12, and 12 months after diagnosis of TRB. CONCLUSIONS: Early diagnosis as well as new therapeutic approaches are needed to achieve better results.

Retinoblastoma in children older than 5 years of age.

BACKGROUND: Retinoblastoma is a malignant tumor of the embryonic neural retina. About 80% of cases are diagnosed before age 4, with a median age at diagnosis of 2 years. OBJECTIVE: To determine characteristics and prognosis of retinoblastoma in children older than 5 years. PROCEDURES: From 1986 to 2002, medical records of 16 patients out of 453 cases referred to Hospital do Câncer AC Camargo, São Paulo, Brazil. RESULTS: Median age at diagnosis was 73.7 months (range 65-144) and there was an equal gender distribution. Fifteen patients presented with unilateral disease. The mean time between first symptoms and diagnosis was 9.6 months (range 0-48). Most cases were diagnosed in advanced stages and 15 eyes were enucleated. Eleven patients presented with intraocular tumor (1 Reese II and 10 Reese V) and five presented with extraocular disease (one CCG II and four CCG III). Twelve patients are still alive with a median follow-up of 92 months (range 65-199). CONCLUSIONS: Because of its low incidence at this age, diagnosis of retinoblastoma is usually delayed due to low level of suspicion. Therefore, it is important that physicians are aware of this disease in order to perform an earlier diagnosis, and decrease treatment-related morbidity.

[Ten year experience with ocular lymphomas and ocular adnexae lymphomas]. / Experiencia de 10 años en linfomas oculares y de anexos oculares.

BACKGROUND: Ocular lymphomas and ocular adnexae lymphomas (OL and OAL) constitute 7-8% of all extranodal lymphomas. OBJECTIVE: Describe the clinical, morphologic and immunophenotypic characteristics of OAL seen in our hospital. MATERIAL AND METHODS: Retrospective analysis of patient records with OL and OAL between July 1994 and July 2005. The following data was analyzed: Clinical presentation, therapy, treatment response, overall survival and disease free survival. RESULTS: Ten patients with OL and OAL were identified. Of these, 8 were women and 2 men. Median age was 50. Eight of 10 patients achieved complete remission, 6 of the 6 presenting MALT Lymphoma. Two patients with stage IV had refractory disease. CONCLUSIONS: In our series 0.02% of lymphomas were OL and OAL of a total 498 LNH. MALT lymphomas appear at a more advanced age, sixty percent of the cases were MALT lymphomas and were diagnosed during their early stages. Patients were followed during 21 months, global survival was 100%, free illness survival had a mean of 868 days and a survival median of 442 days.

Experiencia de 10 años en linfomas oculares y de anexos oculares / Ten year experience with ocular lymphomas and ocular adnexae lymphomas

Antecedentes. Los linfomas oculares (LO) y de los anexos oculares (LAO) tienen una incidencia de 7- 8% de todos los tumores extraganglionares. Objetivo. Describir las características clínicas, morfológicas e inmunofenotípicas de los LO y LAO atendidos en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Material y métodos. Se revisaron los expedientes de los pacientes con diagnóstico de LO y LAO de julio de 1994 a julio del 2005. Se analizaron los siguientes datos: presentación clínica, tratamiento, respuesta al tratamiento, supervivencia global, y supervivencia libre de enfermedad (SVLE). Resultados. Se analizaron 10 pacientes, 8 mujeres y 2 hombres. La media de edad fue de 50 años. La remisión completa (RC) se presentó en 8 de 10 pacientes y en los 6 pacientes con linfoma de tejido linfoide asociado a mucosas (MALT). Se encontraron dos con enfermedad refractaria, los cuales estaban en estadio IV. Conclusiones. En este estudio los LO y LAO correspondieron a 0.02% de todos los linfomas no Hodgkin (LNH) estudiados (498 casos). Los linfomas tipo MALT se presentan a edad más avanzada, se encontraron en estadios más tempranos y en todos hubo RC, con una SVLE promedio de 868 días y una media de supervivencia de 442 días.

BACKGROUND: Ocular lymphomas and ocular adnexae lymphomas (OL and OAL) constitute 7-8% of all extranodal lymphomas. OBJECTIVE: Describe the clinical, morphologic and immunophenotypic characteristics of OAL seen in our hospital. MATERIAL AND METHODS: Retrospective analysis of patient records with OL and OAL between July 1994 and July 2005. The following data was analyzed: Clinical presentation, therapy, treatment response, overall survival and disease free survival. RESULTS: Ten patients with OL and OAL were identified. Of these, 8 were women and 2 men. Median age was 50. Eight of 10 patients achieved complete remission, 6 of the 6 presenting MALT Lymphoma. Two patients with stage IV had refractory disease. CONCLUSIONS: In our series 0.02% of lymphomas were OL and OAL of a total 498 LNH. MALT lymphomas appear at a more advanced age, sixty percent of the cases were MALT lymphomas and were diagnosed during their early stages. Patients were followed during 21 months, global survival was 100%, free illness survival had a mean of 868 days and a survival median of 442 days.

Survival in extra-orbital metastatic retinoblastoma:treatment results.

INTRODUCTION: Retinoblastoma (RB) is the most frequent malignant eye tumor in childhood. In developing countries advanced stages are common. The purpose of this paper is to present our 21-year clinical experience with metastatic extra ocular RB patients treated with 5 different chemotherapy schemas at a single Mexican Pediatric referral center. MATERIALS AND METHODS: A retrospective analysis was carried out reviewing the clinical characteristics of patients with metastatic RB. The information analyzed included the delay in diagnosis after first symptoms, age, sex, ocular staging, and anatomic site of metastases, treatment scheme, initial response and status at the last contact or date of death. RESULTS: Eighty-one patients were included; age range was from 3 to 80 months. The most common site of metastasis was central nervous system (83.9%). From those patients treated with chemotherapy (n = 74), 89.2% presented a complete initial response (n = 66). Early mortality occurred in 7 cases before any treatment. Fifty-six received treatment and died with progressive disease. All patients without radiotherapy died with tumor activity (n = 15). The use of cisplatin was related with longer disease free intervals; no other variable was related with survival. Four patients were alive and disease free at 33 to 144.3 months of follow up from diagnosis. The prevalent cause of death was tumor progression. CONCLUSIONS: In our experience, metastatic RB has a very high mortality rate in spite of the use of different chemotherapy regimens.

Epithelial lacrimal gland tumors: a clinicopathological study of 18 cases.

OBJECTIVE: The aim of this study was to report the clinicopathological features of 18 epithelial tumors of the lacrimal gland treated in a single institution. STUDY DESIGN AND SETTING: Clinical data and treatment were recorded and histological features reviewed. RESULTS: Twelve tumors (66.7%) were adenoid cystic carcinoma (ACC), 5 (27.8%) pleomorphic adenoma (PA), and 1 (5.5%) carcinoma ex pleomorphic adenoma. All patients with ACC presented with advanced clinical stage, and most were treated by wide surgical resection followed by adjuvant radiotherapy. No recurrence was observed in 4 cases of ACC; however, 7 patients died from persistence of disease or by local and/or distant recurrence. All PA patients were successfully treated by surgical resection. CONCLUSIONS: Epithelial lacrimal gland tumors are mainly PA and ACC, and malignancies are more common than benign tumors. Although ACC presented typically with advanced clinical stage, 33% of the patients survived without tumor recurrence or metastasis.

Rehabilitación ocular de un niño de 2 años en el Centro de Rehabilitación de la Cara y Prótesis Bucomaxilofacial / A 2 years-old boy's ocular rehabilitation in the Face and Buccomaxillofacial Denture Rehabilitation Center

Se presenta el caso de un niño de 2 años, rehabilitado con prótesis ocular en el Centro de Rehabilitación de la Cara y Prótesis Bucomaxilofacial de la provincia Santiago de Cuba, donde fue operado y tratado con radioterapia por presentar retinoblastoma. La conducta terapéutica mejoró la apariencia física del paciente y contribuyó a su adecuado desarrollo biológico, psicológico y social

A new human eye model for ophthalmic brachytherapy dosimetry.

The present work proposes a new mathematical eye model for ophthalmic brachytherapy dosimetry. This new model includes detailed description of internal structures that were not treated in previous works, allowing dose determination in different regions of the eye for a more adequate clinical analysis. Dose calculations were determined with the MCNP-4C Monte Carlo particle transport code running n parallel environment using PVM. The Amersham CKA4 ophthalmic applicator has been chosen and the depth dose distribution has been determined and compared to those provide by the manufacturer. The results have shown excellent agreement. Besides, absorbed dose values due to both 125I seeds and 60Co plaques were obtained for each one of the different structures which compose the eye model and can give relevant information in eventual clinical analyses.

Cáncer de mama metastásico en ojo y órbita: tratamiento radiante. Nuestra experiencia / Breast carcinoma metastatic to the eye and orbit: our experience

Los tumores malignos más frecuentes en ojo y órbita son las metástasis. El cáncer de mama es el tumor que con más frecuencia metastatiza en ojo y órbita (40 por ciento-50 por ciento de los casos según las distintas series). El tratamiento tiene como uno de sus pilares a la radioterapia. Objetivos: evaluar la eficacia del tratamiento radiante en pacientes (ptes.) con cáncer de mama metastásico en ojo y órbita. Materiales y métodos: entre los años 1996-2002 recibieron tratamiento radiante 17 ptes. con tumores metastásicos en ojo y órbita, de ellos 9 ptes. (53 por ciento) tenían metástasis óculo-orbitarias de cáncer de mama. La edad media fue 54 años (R: 43-84 años). Todas las ptes. son de sexo femenino. La localización de las metástasis fue: ojo derecho, 2 ptes.; ojo izquierdo, 5 ptes.; compromiso orbitario bilateral, 2 ptes. De las 9 ptes., 3 presentaron metástasis en coroides y 6 en órbita...(AU)

Radioterapia estereotáxica fraccionada como tratamiento radiante en la metástasis orbital y ocular (reporte de tres casos) / Fraccionated stereotactic radiation therapy as treatment in retro-ocular and orbital metastasis: report of 3 cases

Tres pacientes, uno con metástasis ocular y dos con metástasis en órbita, fueron referidos para su tratamiento al CMPDF, Córdoba, Argentina. Todos ellos recibieron Radioterapia Estereotáxica Fraccionada (REF). En dos pacientes el tumor primario fue de mama y el restante de pulmón. La técnica de la REF es descripta en éste artículo, la dosis entregada fue de 50 Gy en 2 pacientes y de 58 Gy en 1 paciente. Este estudio analiza las características y los resultados obtenidos en éstos pacientes. Dos pacientes se hallan vivos y libres de enfermedad clínica en la órbita, al cierre del presente estudio; el paciente con metástasis ocular falleció por diseminación sistémica, con enfermedad ocular controlada. No se han observado complicaciones inmediatas o mediatas, referidas al tratamiento. Concluímos que la REF es una terapéutica muy efectiva para el tratamiento de lesiones metastásicas en órbita y sin evidencia de complicaciones severas (AU)

Critical analysis of methods of reconstruction of exenterated orbits.

Reconstructive procedures were used on 14 patients who had undergone orbital exenteration and radiotherapy for malignant tumours. All patients were tumour free after a follow-up of between 5 and 18 years. Reconstruction was carried out in 3 stages. In the first operation the orbit was filled, in the second the orbital rims and eyelids were shaped, and in the third a cavity for a static eye prosthesis was created. Critical assessment of results showed that the first stage alone produced a marked improvement in appearance and occluded existing fistulae. The subsequent procedures improved aesthetic results further. Difficulties were encountered from retraction of the tissues and insufficient tissue mobility.

Tumores intra-oculares / Intraocular tumours

O autor apresenta a sua casuística de tumores oculares demonstrando a possibilidade do tratamento conservador nos casos específicos. Em 13 pacientes foram usadas placas radioativas contendo cobalto e suturadas à esclera. O autor discute os resultados

Duplo padräo de regressäo no retinoblastoma / Double regression pattern in retinoblastoma

O retinoblastoma é suscetível de apresentar regressäo espontânea ou pós-terapia espontânea ocorre em 1-2% dos casos, sendo unilateral e unifocal geralmente. A regressäo após o uso de radioterapia classifica-se em quatro tipos diferentes conforme o aspecto morfológico. Apresentamos um paciente acompanhado no Serviço de Oftalmologia do Hospital de Clínicas de Porto Alegre, com 3 anos de idade, no qual foi diagnosticado retinoblastoma no olho esquerdo, aos quatro meses de idade, sendo enucleado neste momento. Juntamente, observou-se no olho contralateral duas massas tumorais, caracterizando o estagio Ia, de acordo com a classificaçäo de Howarth. Após dois ciclos de radioterapia e dois protocolos de quimioterapia realizados intercaladamente, no período de três anos, esses focos tumorais apresentaram sinais claros de regressäo diferentes entre si: massa tumoral periférica com padräo tipo I e outra, paramacular, com padräo tipo II de regressäo. Salientamos a coexistência de dois tipos distintos de regressäo tumoral pós-terapia no mesmo olho, fato raramente descrito na literatura pesquisada

Episcleral plaque radiotherapy for retinoblastoma.

The authors report their preliminary results of episcleral plaque radiotherapy (cobalt 60, iridium 192, ruthenium 106, and iodine 125 plaques) in 50 selected patients with retinoblastoma. There were 97 plaque applications to 51 affected eyes in these 50 patients. The plaque was used as primary treatment in 15 eyes and as secondary treatment after failure of external beam radiotherapy, photocoagulation, and/or cryotherapy in 36 eyes. Vitreous seeding of tumor cells was evident ophthalmoscopically in 49 of the 51 eyes, negating the possibility of ultimate success by further photocoagulation or cryotherapy. In 18 patients, the contralateral eye had been enucleated and the remaining eye was being considered for enucleation because all other treatment modalities had failed. In 2 of these 18 patients (11%), the remaining eye was salvaged with plaque radiotherapy and some vision was preserved. In 33 eyes with less advanced tumors, 31 had some degree of vitreous seeding by tumor cells. The eye has been retained in all 33 of these patients and useful vision preserved in most. On the basis of these preliminary observations, the authors conclude that plaque radiotherapy can be used successfully as a primary treatment for selected cases of unilateral or bilateral retinoblastoma or as a supplemental treatment after other treatment methods have failed. The current indications for plaque radiotherapy and its advantages over other therapeutic modalities are discussed.