%0 Journal Article
%T The Use of Strontium-90 Beta Radiotherapy as Adjuvant Treatment for Conjunctival Melanoma
%A Victoria M. L. Cohen
%A Vasilios P. Papastefanou
%A S. Liu
%A Ian Stoker
%A John L. Hungerford
%J Journal of Oncology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/349162
%X Background/Aims. To report the safety and efficacy of strontium (Sr90) beta radiotherapy as adjuvant treatment for conjunctival melanoma. Methods. A retrospective cohort study was undertaken from 1999 to 2007 of all patients who underwent Sr90 beta radiotherapy for incompletely excised conjunctival melanoma. Failure of treatment was defined as recurrence of a conjunctival melanoma at the same location following beta radiotherapy. Results. Twenty patients underwent Sr90 beta radiotherapy for incompletely excised conjunctival melanoma. Median follow-up interval was 59 months (8¨C152). All patients had conjunctival melanoma involving the bulbar conjunctiva. Underlying diagnoses included PAM with atypia in 60% (12 of 20), PAM without atypia in 15% (3 of 20), and de novo conjunctival melanoma in 25% (5 of 20). Following Sr90 beta radiotherapy, in 90% (18 out of 20) local control was achieved and visual acuity was not affected in any patient. Three patients (15%) had dry eye symptoms, episcleritis, and descemetcoele, respectively. No cataract or secondary glaucoma was reported. Conclusions. Sr90 treatment is a very effective adjuvant treatment after excisional biopsy and cryotherapy for conjunctival melanoma with a local success rate of 90%. The treatment is not associated with significant side effects and visual acuity is not affected. 1. Introduction Conjunctival melanoma accounts for 1-2% of all ocular melanomas [1]. The management of conjunctival melanoma is fraught with difficulties. The majority of patients have the associated condition of primary acquired melanosis (PAM) with atypia and are therefore prone to multiple new tumours throughout their lifetime [2, 3]. Recurrent or incompletely excised conjunctival melanoma is associated with an increased risk of metastases [3]. Therefore, primary conjunctival melanoma is managed by complete excision and double freeze-thaw cryotherapy. Adjuvant therapy is necessary to improve local tumour control and survival of the patient especially when the histopathology reports indicate tumour is present at the surgical margins. Adjuvant therapy includes cryotherapy [4], topical mitomycin C [5], brachytherapy [6¨C8], proton beam radiotherapy [9], or rarely alpha 2b interferon [10]. Brachytherapy includes the use of ruthenium-106, [6, 7] iodine-191 [8], or strontium-90 beta radiotherapy. Strontium-90 (Sr90) beta radiotherapy is a noninvasive treatment using a hand held applicator (Figure 1). It has also been used for controlling wound healing after glaucoma drainage surgery [11]. It is only available for the treatment of
%U http://www.hindawi.com/journals/jo/2013/349162/