Orthovoltage radiotherapy in the management of medial canthal basal cell carcinoma

Abstract

Orthovoltage radiotherapy can be a reliable therapeutic alternative for selected medial canthal BCCs, which can be contained within the prescribed radiation field, with anticipated radiation-related toxicities.

What is New in the Treatment of Eyelid Tumors with Radiation Therapy?

“…Following orthovoltage radiotherapy of medial canthal BCC, 10-year tumor control rate was 94% with no recurrence rates. However, patients developed significant complications within the radiation field such as madarosis, epiphora, ocular surface disorders and conjunctival scarring [3]. When eyelid tumors (1-4 cm size) were treated by electron beam therapy at a dose of 45-70 Gy in daily fractions of 2-4 Gy, though there was reasonable local tumor regression, few cases had recurrences (11%) and few had local radiation side effects such as skin atrophy and mild deformities [4].…”

“…However, in cases with incompletely excised primary tumors, recurrent tumors, or inoperable large primary tumors and elderly patients who cannot tolerate general anesthesia with significant co-morbidities, radiation therapy (RT) is considered as an effective alternative/adjuvant treatment modality [2][3][4][5][6][7]. Different radiation therapeutic methods such as external beam radiotherapy (EBRT) with x-rays [superficial (45-100 Kv), orthovoltage (100-250 Kv)] or megavoltage photons & electrons and radionuclide plaque brachytherapy has been used to treat various eyelid tumors with good success [2][3][4][5][6][7][8][9]. However, acute and chronic radiation side-effects (skin reactions, eyelid telangiectasia, eyelid atrophy, eyelash loss (madarosis), epiphora (tearing), ocular surface disorders (dry eyes), cataract, radiation papillopathy, retinopathy & maculopathy and second malignant neoplasms) can lead to significant functional and visual disabilities.…”

Recent Advances in Ophthalmic Plastic Surgery

“…98 Kvannli and associates 99 looked at the percentage of cases of BCC in which further resections were needed beyond the boundaries of the initial excision for complete tumor clearance, using the en face frozen section technique. 98 Kvannli and associates 99 looked at the percentage of cases of BCC in which further resections were needed beyond the boundaries of the initial excision for complete tumor clearance, using the en face frozen section technique.…”

“…98 Kvannli and associates 99 looked at the percentage of cases of BCC in which further resections were needed beyond the boundaries of the initial excision for complete tumor clearance, using the en face frozen section technique. 98 One hundred twenty BCCs had a full-thickness eyelid ''wedge'' resection, of which 45% needed more than the standard 2 frozen sections taken to achieve clear margins. 98 One hundred twenty BCCs had a full-thickness eyelid ''wedge'' resection, of which 45% needed more than the standard 2 frozen sections taken to achieve clear margins.…”

“…98 They showed that a significant percentage of lesions needed further resection after the initial frozen section edge checks to achieve clear margins. 98 Orthovoltage external beam radiotherapy is another option for BCCs that are difficult to operate and reconstruct such as those located in the medial canthal area. Eighty-four BCCs were removed using ring resection, of which 35.7% needed more than the standard initial resections (peripheral annulus and deep disc) to achieve clear margins, thus emphasizing the role for a good clinical judgment of the extent of the tumor.…”