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X-ray brachytherapy 50kV (XRB 50) for carcinoma of the eyelid: a report of 29 cases. Bénézery K, Natale R, Courdi A, Chand ME, Lagier J, Marcie S, Gauthier M, Feuillade J, Dejean C, Gerard JP. Centre Antoine LACASSAGNE, Radiotherapy Department, 33 Avenue de Valombrose, NICE, France with Grant from ANR TecSan and Eurobiomed (France).
INTRODUCTION
Carinoma of the eyelid is treated by surgery and or radiotherapy. Irradiation can be given with electron, iridium 192 implant or XRB 50. The advantages of XRB 50 are : accuracy, small volume, good protection of organ at risk, simple and cheap.
MATERIALS AND METHODS
29 patients were treated from February 2009 to December 2011, using a RT 50 Philips or the new PAPILLON 50 unit delivering a 50-kV maximal energy X-ray beam.
Out of a total of 28 patients, one had two synchronous tumours.
Age ranged from 48 to 94 years (median: 77.3), with a male female ratio of 1.
Site: lateral canthus = 3 %, medial canthus = 31%, lower eyelid = 45 %, upper eyelid = 21 %. There were 80 % (23) basal cell carcinomas, 17% (5) squamous cell carcinoma, 3% (1) melanoma. No tumour exceeded T1b.
Five patients were referred for radical radiotherapy first line treatment and twenty-four patients for post surgical excision treatment: among them, R0 excision = 2 (1 first event, 1 recurrence), R1 excision = 22 (15 first events, 7 recurrences).
They were treated according to 2 schemes:
42 Gy in six fractions of 7 Gy (23 %) for radical treatment, 35 Gy in 5 fractions of 7 Gy (77 %) in case of post-operative treatment. 2 1
Papillon 50 tm
XRaySource : Re .50 kVp
Dose Rate :> 10 Gy/mn
PDD: 50%: 6mm
Ariane medical Systems
1- Applicator
2- Generator + x-ray tube
Eyelid and eye applicators
Eyelid irradiation
RESULTS
Follow-up ranged from 2 to 24 months.
Five patients were lost to follow-up. One local relapse occurred 2 months after treatment, outside the treated area. Local control was achieved in other patients after XRB alone or post excision.
Side effects: All patients had Grade I (55%) or II (45 %) erythema and loss of the eyelashes in the treated area during treatment. 17% had GI eye watering, 10% suffered from a GII conjunctivitis, and 3% had a G II pilo sebaceous gland infection.
Sequelae: persistent watering of the eye for 21%, xerosis for 14%, one ectropion, one definitive loss of eyelashes and one with slightly depigmented skin.
No cataract was observed.
Majority of patients assessed were more than satisfied with both the cosmetic and function that followed radiotherapy.
Basal cell carcinoma of the internal lower eyelid
Complete response assessed 3 months after contact x-ray
Complete response assessed (medial lower eyelid) 3 months after x-ray brachytherapy (notice the chalazion located in the upper eyelid)
Basal cell carcinoma of the medial lower eyelid
Grade 2 lower eyelid erythema during treatment
CONCLUSION
XR brachytherapy 50 kV of the eyelid for skin carcinoma is an efficient treatment, with good local control, and few significant side effects or sequelae in this selected population.
REFERENCES
Buatois F et al. J Fr Ophtalmo 1996;19:405
Gérard JP et al. Expert Rev Med Devices 2011;8:483.