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Case Reports
. 2021 Nov-Dec;37(6):e215-e217.
doi: 10.1097/IOP.0000000000002031.

Interstitial Brachytherapy for Orbital Sebaceous Carcinoma

Feng Li  1 , Robert D Stewart  2 , Paul T Finger  1   2
Affiliations
Case Reports

Interstitial Brachytherapy for Orbital Sebaceous Carcinoma

Feng Li et al. Ophthalmic Plast Reconstr Surg. 2021 Nov-Dec.

Abstract

Sebaceous carcinoma is characterized by its aggressive local tumor behavior and ability to metastasize. Small periocular sebaceous carcinoma are typically treated by excision with cryotherapy. Larger tumors often require adjuvant external beam radiotherapy (EBRT) and/or exenteration surgery. When used alone, EBRT techniques typically exceed the tolerance of critical normal ocular structures. The interstitial orbital brachytherapy-boost technique permits dose escalation to the tumor bed, while minimizing radiation dose to critical normal ocular structures. Here, we present a case of orbital sebaceous carcinoma treated with excision, cryotherapy, and super-thick amniotic membrane fornix reconstruction. Then, after 3 weeks of healing, adjuvant-combined electron interstitial high-dose rate brachytherapy-boost was added to electron-beam radiotherapy to optimize the orbital radiation dose distribution, increase dose to inferonasal orbit, and allow relative sparing of orbital tissues. At 1-year follow-up, there was no evidence of orbital tumor, no significant eye lash loss, normal ocular motility, no radiation retinopathy, optic neuropathy and a visual acuity of 20/20.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIG. 1.
FIG. 1.
Top left, slit lamp examination showing the multinodular white mass visible in the inferonasal conjunctival fornix. Top right, 1 year following (super-thick amniotic membrane graft) implantation and brachytherapy boost treatment depicting successful epithelialization of the ocular surface and no indications of local recurrence at the conjunctiva. Bottom, external photograph reveals 3 orbital brachytherapy catheters when attached to 3 high-dose rate (HDR) after-loader portals for treatment.
FIG. 2.
FIG. 2.
Top, computed axial tomography shows placement of orbital brachytherapy catheters (blue arrows) and surrounding isodose curves depict the iridium-192 “brachy-boost” dose volume. Bottom, computed axial tomography with electron-based EBRT overlay (lower right), a focused transverse view of EBRT field and dose-key. EBRT, external beam radiotherapy.
See this image and copyright information in PMC

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