Malignant melanoma of the eyelid and palpebral conjunctiva treated with iodine-125 brachytherapy.

OBJECTIVE: To evaluate the results on malignant melanomas of the eyelid and palpebral conjunctiva treated with iodine-125 (125I) brachytherapy with shielding of the eye. DESIGN: Noncomparative case series. PARTICIPANTS: Fourteen patients treated with 125I brachytherapy at an ocular oncology referral center from 1974 through 1996, all of whom had had previous debulking, incomplete resection, or recurrence after surgery. INTERVENTION: A stainless steel pericorneal ring eyeshield was attached to the extraocular muscles, over which a lid was fitted to protect the cornea without touching it. Iodine-125 seeds in polythene tubes were inserted into the eyelid and attached to the lid margin for a single plane implant. In five cases additional seeds were glued on to the shield as well for a volume implant. A median dose of 37 Gy (range, 17.3-67.6 Gy) was given over the course of 113 hours (range, 47-190 hours) to the outer surface of target volume. MAIN OUTCOME MEASURES: Local control is regarded as freedom from recurrence in those without measurable disease and complete clinical regression in those with measurable disease. Morbidity is assessed in terms of function and cosmesis. Survival is given from the time of the implant. RESULTS: There was local control in 13 patients maintained from 11 to 227 months (median, 39 months). There were two recurrences at 8 and 13 months in the first patient who received 17.3 Gy. Late complications consisted of mild eyelid telangiectasia, mild eyelid atrophy, and loss of eyelashes in most patients. Five patients, four of whom had upper eyelid tumors, experienced a dry eye, which was managed with tear supplements, and one of these patients developed a cataract. A corneal ulcer developed in one eye, which later perforated after treatment of a subsequent bulbar melanoma and was exenterated. Another eye was enucleated after treatment for a subsequent melanoma in the fornix. Cosmesis was acceptable to patient and doctor in the other 12 patients. Vision was maintained in seven patients, reduced in two, and not recorded in the remaining three patients. Three patients died of hematogenous metastases at 44, 62, and 79 months after implant, one of bronchial carcinoma at 46 months and one of an astrocytoma at 39 months. All patients were clear of local disease. The remainder survived for a median of 45 months (range, 18-227 months). CONCLUSIONS: Iodine-125 brachytherapy can be used as an alternative to wide excision or exenteration of these tumors. There was good local control, reasonable maintenance of vision, and good cosmesis.

Status report of the NAC particle therapy programme.

The 200 MeV cyclotron facility at the National Accelerator Centre has been operational since 1987. Between September 1988 and December 1997 a total of 973 patients (26,916 fields) had been treated on the 66 MeV p+Be isocentric neutron therapy system. Patients are currently being treated according to several protocols, including tumors of the head and neck, salivary gland and breast and soft tissue sarcomas, uterine sarcomas and paranasal sinuses. A multiblade post-collimator trimmer has recently being installed. This device provides improved neutron beam shaping capability. Between September 1993 and December 1997 a total of 243 patients (4008 fields) had been treated (mainly intracranial stereotactic irradiations) on the fixed horizontal 200 MeV proton therapy facility. The facility incorporates an innovative automatic patient positioning system. Two new fixed beam lines for proton therapy are presently being designed (horizontal and 30 degrees to the vertical) for an existing unused treatment vault. Spot scanning systems will be developed for both beam lines.

The neutron therapy clinical programme at the National Accelerator Centre (NAC).

A total of 721 patients were treated in the neutron therapy programme at NAC from February 1989-March 1995 with a p(66)/Be isocentric unit. The preliminary results showed: 3-year local control and survival probabilities of 57 and 79% respectively for advanced salivary gland tumours; increased local control for twice-daily neutron therapy for advanced head and neck cancer compared with photon therapy; local control rates of 68 and 83% for locally advanced breast cancer treated with 17 and 19 Gy respectively; complete response rates of 67% for macroscopic residual soft tissue sarcomas and those with irresectable disease of less than 10 cm; complete response rate of 56% for macroscopic residual uterine sarcoma with a median follow up of 38 months; 2-year local control rate and survival of 44 and 38% respectively for advanced squamous carcinoma of the maxillary antrum; complete response rate of 38% for advanced osteosarcomas and chondrosarcomas.

The role of suprahyoid block dissection in carcinoma of the floor of the mouth.

The efficacy of suprahyoid block dissection combined with radiotherapy, in the management of neck nodal disease was evaluated in 15 patients with carcinoma of the floor of mouth (abutting on the mandible) between 1983 and 1989. Ten males and 5 females had a mean age of 60.3 years. Suprahyoid block dissection was performed in 10 patients as initial treatment. Nine of these presented with a submandibular mass and one patient with a T4NO lesion had a prophylactic block performed. Suprahyoid block dissection was performed in five patients who developed a submandibular mass after completion of surgery and radiotherapy. Wound sepsis occurred in three patients, but resolved with conservative treatment. Clinical assessment of the suprahyoid mass was accurate in 65% of patients. Nodal recurrence occurred in one patient. Seven patients are alive and disease free after a mean of 64.5 months. Two other patients are alive, one with lung metastases, and one with a supraclavicular mass. Six patients have died, two of whom developed local recurrence, one who developed a supraclavicular mass, one after nodal recurrence, one with lung metastases, and one of an unrelated cause. Suprahyoid block dissection combined with radiotherapy is effective treatment for nodal control of patients with carcinoma of the floor of mouth. This procedure is associated with a low morbidity.

Treatment of malignant meningitis in retinoblastoma.

Six patients with meningitis due to retinoblastoma are described. The diagnosis may be suspected on clinical examination but is made by the demonstration of malignant cells in the CSF. These patients have been treated with cranial irradiation together with systemic and intrathecal cytotoxic drugs. There is one survivor. It is suggested that the CSF should be examined in all cases at risk so that the appropriate treatment can be started promptly and thus improve the prognosis.