Adjuvant treatment or primary topical monotherapy for ocular surface squamous neoplasia: a systematic review

Abstract

In this systematic review, we evaluated studies involving adjuvant and primary topical treatment for ocular surface squamous neoplasia (OSSN). The findings were: (i) adjuvant 5-fluorouracil (5-FU) reduces the risk of relapse after surgical excision with mild side effects [level Ib, grade of recommendation (GR) A]. (ii) Primary topical mitomycin (MMC) produces a high rate of complete response, low recurrence rate, and mild side effects (level Ib, GR A). (iii) Primary chemotherapy versus adjuvant chemotherapy produce similar rates of recurrence, with no significant difference (level IIb, GR B). (iv) Adjuvant 5-FU versus MMC showed no significant differences, with mild side effects in both groups and a better toxicity profile for MMC (level III, GR C). (v) Primary topical 5-FU versus MMC versus interferon (IFN) showed similar rates of tumor recurrence, mild side effects for all drugs, and more severe side effects in the 5-FU arm, followed successively by MMC and IFN (level III, GR C).

Single-Fraction Adjuvant Electronic Brachytherapy after Resection of Conjunctival Carcinoma

“…Probably, due to the low incidence of this malignancy, its standard management is still to be defined [29]. Despite the relationship of this entity to low regional-or distant-failure rates when promptly treated [7,8], the local failure rates after a pure surgical approach could remain elevated, according to various publications [14,30,31].…”

“…With a varying range of prices between 37-75 USD per 1-2 cycles, this would result in being unaffordable for many patients in developing countries if not covered by an insurance [19,37,38], in comparison to an average 90 USD e-BT cost entirely assumed by the Peruvian public health system. Toxicity rates might represent an additional fact for treatment declining, as the rate of overall adverse events and in particular conjunctivitis of this strategy reaches as high as 48-69%, which could greatly impair the patient's life quality [29,35,[39][40][41].…”

Cost-effective treatment of ocular surface squamous neoplasia for an undocumented and uninsured New York City patient: a case report

“…The standard of care for OSSN is currently evolving. Numerous studies have tested topical chemotherapy, such as 5-fluorouracil (5-FU), mitomycin C (MMC), and interferon α-2b (IFNα2b), for OSSN [ 5 , 30 ]. Joag et al identified that 82% of cases of OSSN had a complete response to 5-FU as the primary treatment without long-term complications [ 31 ].…”

Update on pharmacotherapy for ocular surface squamous neoplasia

“…If pathological evaluation of the specimen reveals tumor cells at the conjunctival margin, additional surgery or postoperative adjunctive chemotherapeutic drugs may be used after surgery, including interferon alpha 2b (IFNα-2b), 5-fluorouracil (5-FU) 1%, and mitomycin C (MMC) 0.02–0.04%. MMC has also been used as an adjuvant agent intraoperatively [15, 46, 47]. Adjuvant therapies are used both pre- and post-operatively as recurrence rates are higher when margins have residual disease (> 50% in some studies [48]), as compared to when margins are negative for tumor (5 to 33% recurrence frequency with follow-up of 15 years [48]).…”

“…Alternative regimens have been reported in the literature, including continuous administration of 5-FU 3 to 4 times a day for 4 weeks or administration of 5-FU for only 2 to 4 days with a 30 to 45 day drug-holiday. [45, 47, 70, 72–74]. 5-FU is preferably kept in refrigeration [69].…”