https://doi.org/10.31288/oftalmolzh201452833

Step-wise (radiocryogenic) treatment of patients with primary malignant epithelial tumors of the eyelid skin

Safronenkova I. A., Yelagina V. A.

State Institution The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine; Odessa, (Ukraine)

Introduction. Among all malignant tumors of the organ of malignant epithelial tumors (Theo) eyelid skin make up 68—75 %. Treatment of tumors of the eyelid skin has certain peculiarities. Along with the basic principles of oncology — and radical ablation, is necessary to preserve the basic functions of the age — protective, lac­rimal and cosmetics. Neglect of these principles leads to inappropriate treatment and, as a consequence — to relapse and the need for excision.

Purpose. Study of immediate and long-term results radiokriogennogo treatment (radiotherapy + cryosurgery) patients Theo eyelid skin stage T2b-3a N0 MO.Material and methods. Radiokriogennoe treatment was performed in 358pa­tients with primary Theo eyelid skin stage T2a-3a NOMO. There were 177 men (49.5 %) aged 33 to 85 years (median = 63.4), women — 181 (50.5 %) aged 28 to 89 years (median = 67.3). In 246 (68.7 %) had a basal cell carcinoma, in 73 (20.4 %) — squamous, 16 (4.5 %) — metatipichesky and 23 (6.4 %) — adeno­carcinoma. RTwas applied in the form of 'y — RD therapy 2—2.2 Gy, SOD (34.6 ± 5,8) Gy and brachytherapy, RD 40 GR, SOD (288 ± 61,3) Gy. Immediate results. Of358patients after one course of treatment radiokriogennogo complete tumor occurred in 290 (81.0 %) patients: all 24 patients with tumor stage T2a, 122 (84.7 %) patients with T2B and 144 (76.2 %) c T3a stage. Partial re­sorption — in 68 (19.0 %) cases: T2b stage in 22 (15.3 %) and in 46 (23.8 %) with stage T3a. In 43 (67.2 %) patients with partial resorption of the tumor (19 — and 24 T2B stage — with stage T3a) complete recovery occurred after additional CD held in the period from 3 to 11 months (median 4.7).

Long-term results. Tumor recurrence appeared in 23patients (6.4 %). When tumors T2b N0 M0 stage recurrences appeared in 6 (4.2 %) cases in the period from 11 to 152 months (median = 36.9 months), and in tumors T3a stage — in 17(8.9 %) during the period from 19 to 68.9 months (median 37months).

Conclusion. Application of the first stage of treatment RT reduces tumor volume and the CD — to preserve healthy tissue, skeleton structures century and tearful way. The method allows to reduce the total radiation dose is 1.5—2 times as compared with RT in pure form, expand the indications for treatment of patients with organ-running Theo eyelid skin T2a-bN0M0 stage and get a good functional and cosmetic result. 

Key words: malignant epithelial, tumor's 0f the eyelid skin cryosurgery, radiation therapy 

 

References

1.     Buiko AS, Karpovskii EYa, Safronenkova IA et al. Epithelial tumors of the eyelids: cryosurgery or scalpel? Oftalmol Zh. 1991;6:338- 44. Russian.

2.     Paches tumors of the head and neck. M.: Praknicheskaia meditsina; 2013. 478 p.

3.     Pustynskii IN, Lyubaiev VL, Tkachev SI et al. The combination of cryogenic and radiation effects in the treatment of locally advanced cancer of the skin. Ross. Onkologicheskii zhurnal. 2006;6:23-8. Russian.

4.     Safronenkova IA. The structure and nature of the lesion of the eyelid skin and periorbital region in patients with malignant epithelial tumors (MET) in the refer­ral data at the Filatov Institute of Eye Diseases and Tis­sue Therapy. Tavricheskii medico-biologicheskii vestnik. 2012;15(3(59)):170- 4. Russian.

5.     Smirnov A. Low fertility and aging of population: causes, consequences, policy options. Prognosis. 2004;1:185- 98. Russian.

6.     Asilian A, Tamizifar B. Aggressive and neglected basal cell carcinoma. Dermatol. Surg. 2005;31(11):1468- 71.
Crossref

7.     AJCC Cancer Staging Manual. 7-th editions of the American Joint Committee on Cancer. 2010. New York: Spring­er Science + Business Media, 2010.X(48):523.

8.     Bushmann W. A reappraisal of cryosurgery for eyelid basalcell carcinomas. Br. J. Ophthalmol. 2002;86:453-7.
Crossref

9.     Cook BE, Bartley GB. Treatment options and future prospects for the management of eyelid malignancies: an evi­dence-based update. Ophthalmology. 2001;108:2088-98.
Crossref

10.  Conway RM, Themel S, Holbach LM. Surgery for primary basal cell carcinoma including the eyelid margins with in­traoperative frozen section control: comparative interven-tional study with a minimum clinical follow up of 5 years.Br. J. Ophthalm. 2004;88:236-8.
Crossref

11. Eyelid basal cell carcinoma: non-Mohs excision, repair,and outcome. Br. J. Ophthalm. 2005;89:992- 4.
Crossref

12.  Lear W, Dahlke E, Murray CA. Basal cell carcinoma: review of epidemiology, pathogenesis, and associated risk factors. J. Cutan. Med. and Surg. 2007;1:19-30.
Crossref

13.  Leibovitch I, Huilgol SC, Selva D et al. Basosquamous carcinoma: treatment with Mohs micrographic surgery.Cancer. 2005;104:170-5.
Crossref

14.  Murchison AP, Walrath JD, Washington CV. Nonsurgical treatments of primary, non-melanoma eyelid ma­lignancies: a review. Clin. Experiment. Ophthalmol. 2011;39:65- 83.
Crossref

15.  Pompucci A, Rea G, Farallo E et al. Combined treatment of advanced stages of recurrent skin cancer of the head. J. Neurosurg. 2004;100(4):652- 8.
Crossref

16.  Ridky TW. Nonmelanoma skin cancer. Am. Acad. Dermatol. 2007;57:484-501.

17.  Rubin AI, Chen EH, Ratner D. Basal-Cell Carcinoma.N. Engl. J. Med. 2005;353(21):2262-9.

18.  Sartore L, Lancerotto L, Salmaso M et al. Facial basal cell carcinoma: analysis of recurrence and follow-up strategies. Oncol. Rep. 2011;26(6):1423- 9.

19.  Fattah A, Pollock J, Maheshwar A et al. Big Bad BCCs: craniofacial resection and reconstruction for atypical basal cell carcinoma. J. Plastic, Reconstructive and Aesthetic Surgery. 2009;63:433-41.

20.  Varga E, Korom I, Rasky Z et al. Neglected Basal Cell Carcinomas in the 21st Century, Case Report. J. Skin Cancer.2011;2011:3921-51.

21.  Zimmermann AC, Klauss V. Predictors of recurrent basalioma of the eyelids and periorbital region. Ophthalmologe.2001;98(6):555-9.