Topical chemotherapy for ocular surface squamous neoplasia: current status

Abstract

Although there are no randomised trials directly comparing topical chemotherapeutic agents mitomycin-C, 5-fluorouracil, and interferon-alpha2b, published studies indicate equal efficacy of these agents for treatment of non-invasive ocular surface squamous neoplasia (80%-88%). 5-Fluorouracil may be preferred, given low incidence of serious side effects and low cost to the patient.

Widespread Ocular Surface Squamous Neoplasia Treated with Topical Interferon Alpha-2b

“…Topical therapies with 5-fluorouracil [11], mitomycin-C [12], interferon alpha-2b (IFNα2b) [13], and cidofovir [8, 9] are alternatives that may be as effective as surgery for in situ disease (clinical stage Tis, American Joint Committee on Cancer Classification [14]). In select cases, topical pharmacotherapies offer several potential advantages over surgery or cryotherapy including minimizing injury to limbal stem cells [7]. Topical IFNα2b is well tolerated compared to topical antimetabolites.…”

Carcinoma de células escamosas de conjuntiva

“…La etiología de estas neoplasias deriva de una maduración anormal del epitelio conjuntival por distintos factores, incluyendo la exposición a radiación ultravioleta, y muchos estudios confirman que el virus del papiloma humano participa como un cofactor en pacientes susceptibles 3 . En el tratamiento inicial, en lesiones pequeñas, puede usarse quimioterapia tópica incluyendo mitomicina-C, 5-fluoracilo e interferón-2b, con el fin de reducir su tamaño, aunque puede requerir de escisión quirúrgica si no responde a tratamiento o si se trata de lesión más extensa o invasiva 2,4 . …”

Ocular Surface Squamous Neoplasia

“…IFN-2b is the least toxic, however, it is the costliest of the three agents. (Sepulveda et al 2010) The relative indications of using topical treatments in OSSN are: 1) >2 quadrants conjunctival involvement, 2) > 180 degree limbal involvement, 3) extension into the clear cornea involving the papillary axis, 4) positive margin after excision, and 5) patient unable to undergo surgery. (Sepulveda et al 2010) However, some clinicians prefer surgical excision as an initial treatment of invasive lesions if the extension is less than 6 clock hours of involvement, because this provides confirmation of the diagnosis with little cosmetic disfigurement if properly performed.…”

“…(Sepulveda et al 2010) The relative indications of using topical treatments in OSSN are: 1) >2 quadrants conjunctival involvement, 2) > 180 degree limbal involvement, 3) extension into the clear cornea involving the papillary axis, 4) positive margin after excision, and 5) patient unable to undergo surgery. (Sepulveda et al 2010) However, some clinicians prefer surgical excision as an initial treatment of invasive lesions if the extension is less than 6 clock hours of involvement, because this provides confirmation of the diagnosis with little cosmetic disfigurement if properly performed. (Shields et al 2002) When topical agents are considered as a treatment regimen of OSSN, they should be used with caution as long-term effects on the ocular surface of the eye, as well as the adjacent eyelids and nasolacrimal drainage system, have not yet been completely defined.…”