Interstitial brachytherapy for eyelid carcinoma. Outcome analysis in 60 patients.

BACKGROUND: Eyelid cancer is a therapeutic challenge due to the cosmetic and functional implications of this anatomical region and the objectives of therapy are tumor control, functional and cosmetic outcome. AIM: The present study was performed to analyze local control, toxicity, functional and cosmetic results in patients with eyelid carcinoma treated by interstitial brachytherapy. MATERIAL AND METHODS: In this study 60 patients with eyelid carcinoma were treated by interstitial brachytherapy using iridium ((192)Ir) wires with a linear activity of 1.2-1.7 mCi/cm. The prescription dose was 51-70 Gy (mean 65 Gy, median 66 Gy). RESULTS: Of the 60 patients 51 (85.0 %) had received no prior treatment, 4 (6.7 %) had received previous surgery with positive or close margins and 5 (8.3 %) had suffered local recurrence after surgery. Of the tumors 52 (86.7 %) were basal cell carcinoma, 7 (11.7 %) squamous cell carcinoma and 1 (1.7 %) Merkel cell carcinoma. Clinical stage of the 51 previously untreated tumors was 38 T1N0, 12 T2N0 and 1 T3N0. Mean follow-up was 92 months (range 6-253 months). Local control was maintained in 96.7 % of patients. Late effects higher than grade 2 were observed in 3.0 % of cases. Functional and cosmetic outcomes were optimal in 68.4 % of patients. CONCLUSION: Interstitial brachytherapy for carcinoma of the eyelid can achieve local control, cosmetic and functional results comparable to those of surgery.

Reassessment of the specificity of lens opacities in myotonic dystrophy.

Cataract has been considered for a long time one of the major indicators of the presence of the mutated myotonic dystrophy (DM) gene in asymptomatic relatives of DM patients. However, some recent studies show that not all cases of cataract typical of DM are associated with the disease even in members of DM families. In order to determine the frequency of lens opacities characteristic of DM in the general population and to evaluate the specificity of lens anomalies for detection of the DM premutation, we screened a sample of 1,400 random individuals for the presence of 'myotonic cataract'. Ten individuals were found with the typical lens opacities and no neuromuscular signs of DM; molecular analysis of the DM mutation showed that they all carried two normal alleles. Our data allow to conclude that bilateral cortical iridescent and posterior cortical lens opacities cannot be considered a marker of the presence of the DM premutation in the general population.