Topical 1% 5-fluoruracil as a sole treatment of corneoconjunctival ocular surface squamous neoplasia: long-term study

Abstract

AimsTo report long-term clinical outcome of topical 1% 5-fluoruracil (5-FU) as a sole treatment of ocular surface squamous neoplasia (OSSN).Methods41 patients affected by OSSN were included. Each patient underwent full ophthalmological examination at baseline, with cytological or histological confirmation. Patients were treated by topical chemotherapy with 1% 5-FU four times a day for 4 weeks. One course was defined as 4 weeks of topical chemotherapy. Adjunctive courses were administered after 1 month of chemotherapy-free interval.ResultsMean follow-up was 105±32 months (range 60–171 months). Complete tumour regression was achieved in 34 cases (83%) after a mean of 1.5 courses (range, 1–3 courses). Univariate analysis revealed that complete response was significantly related to tumour thickness <1.5 mm (p=0.005), lack of fornix or tarsal involvement (p=0.015 and p=0.009, respectively) and the absence of multifocality (p=0.002). Histopathological diagnosis (intraepithelial neoplasia vs squamous cell carcinoma, p=0.019) and American Joint Committee on Cancer (AJCC) classification (T1 vs T2 or T3) (p=0.028) were also related to incomplete tumour response. In a multivariate analysis, just tumour thickness >1.5 mm (p=0.045) and multifocality (p=0.023) were correlated with incomplete tumour response. Transient and reversible low-to-mild local side effects were documented in 19 (48%) eyes.ConclusionTopical 5-FU, as a sole therapy, is a long-term safe and effective treatment for patients affected by preinvasive OSSN and for a limited proportion (50%) of invasive OSSN.

Utility of high-resolution anterior segment optical coherence tomography in the diagnosis and management of sub-clinical ocular surface squamous neoplasia

“…This study found that sub-clinical OSSN was detected by HR-OCT in 17% of patients whose tumors were noted to have resolved clinically. While the clinical implications of sub-clinical disease are unknown, OSSN recurrences are noted in 0-28% of eyes treated with 5-FU and in 4-20% of eyes treated with IFN [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. It can be postulated that recurrences may be driving residual disease or sub-clinical disease, especially since most occurred within the first year after stopping treatment.…”

Management Issues in Conjunctival Tumours: Ocular Surface Squamous Neoplasia

“…Non-invasive pathological assessment consisting of impression or scrape cytology can identify the dysplastic epithelial cells characteristic of OSSN [7,[34][35][36]. Some features on impression cytology are suggestive of invasive disease, such as the presence of syncytial sheaths, macronucleoli and inflammatory cells [7,21]. But these features are not diagnostic of invasive disease and further investigations are required if they are present.…”

“…Topical MMC 0.04% is the preferred chemotherapeutic agent as SCC does not seem to respond to topical IFNa 2b [18]. Similarly, although it may regress in 50% of patients treated with topical 5-FU, it recurs in 75% of these [21]. By contrast, Shields et al reported a prospective series of patients with conjunctival SCC who demonstrated excellent response to topical MMC 0.04% [23].…”

“…intralesional versus topical interferon-a 2b , mitomycin C strength and regimen) that makes comparing these case series fraught with difficulty. Unsurprisingly, reported recurrence rates vary widely, from 0 to 56% with surgical excision alone [9][10][11][12][13], 0-28% with surgical excision followed by topical interferon-a 2b (IFNa 2b ) [12-20], 10-15% with surgical excision followed by topical 5-fluorouracil [16,21,22] and 0-30% with surgical excision followed by topical mitomycin C (MMC) [23][24][25][26][27][28]. From this potpourri of evidence, the clinician must formulate treatment strategies for a diverse patient population, often with many medical comorbidities.…”

Szemfelszíni laphám-neoplasia

“…Átlagosan másfél ciklust követően a betegek 83%-ánál alakult ki teljes rezolúció. Joag nemrégiben megjelent közleményében 44 pácienst kezeltek naponta 4 × 1 1%-os 5-FU-szemcseppel, amely során egy ciklusban a páciens egy hétig csepegtetett, majd három hétig nem használt 5-FU-t. Átlagosan négy ciklust követően az esetek 82%-ában alakult ki teljes rezolúció, a recidívaráta egy év után 6%, két év után pedig 15% volt [50].…”