HDR 192Ir Brachytherapy in Treatment of Basal Cell Carcinoma of the Lower Eyelid and Inner Angle – Our Experience

Purpose: First experience and evaluation of relapses in group of patients after surgery with applied adjuvant HDR brachytherapy for recurrent tumor after incomplete excision of basal cell carcinoma of the lower eyelid and inner angle.
Methods: Patients with recurrent basal cell carcinoma of the lower eyelid in year 2010. In 3 male patients with recurrent finding of basal cell after surgery we applied adjuvant HDR 192Ir brachytherapy. The isodose curve chosen to prescribe the dose was 5 mm away from the skin surface.
Results: In the year 2010 we applied adjuvant HDR 192Ir brachytherapy in 3 male patients with recurrent basal cell carcinoma. The average age was 58 years (52 to 75 years). From group of 41 patients with non melanotic malignant tumors of the eyelids in 3 patients (7.3 %) with relapse after incomplete excision of the basal cell carcinoma of the lower eyelid we applied after removal of stitches after surgery adjuvant HDR 192Ir brachytherapy. For each patient was made individual orfit mask that bore plastic applicators. Tungsten eye shield applicator was applied to protect the eye globe. Treatment of 10 fractions of 4.5 Gy single dose (5 times weekly) were scheduled within 2 weeks. Patients received outpatient treatment.
Conclusion: Acute toxicity postradiation erythema of eyelid and skin around relieved by standard symptomatic treatment within a few days after completion of radiation therapy. In 2 year interval after HDR 192Ir brachytherapy we did not record the occurrence of late complications such as corneal ulcers. Our preliminary experience shows excellent early skin tolerance. After 2 years of follow-up at 6 month interval we did not recognize relapse in our group of patients. The proposed technique of HDR 192Ir brachytherapy after surgery should be considered a new clinical treatment in patients with recurrent non melanotic eyelid cancer. Its main advantage lies in the usefulness in all types of basal cell and squamous cell carcinoma and sebaceous carcinoma of the eyelids, without restriction by site, dimension, clinical or histological type, or the patient’s general status.