Plaque brachytherapy for the management of ocular surface malignancies with corneoscleral invasion

Purpose:  To describe the outcome of patients treated by surgical excision followed by plaque brachytherapy for primary or recurrent ocular surface malignancies with evidence of deep margin (corneoscleral) invasion.
Methods:  Retrospective, non-comparative, interventional case series. Eleven consecutive patients presenting with biopsy-proven scleral and/or corneal stromal involvement from either conjunctival melanoma (CM) or squamous cell carcinoma (SCC) of the conjunctiva were reviewed.
Results:  Five patients had CM (pT3 N0 M0 [ n  = 3], pT4 N0 M0 [ n  = 2]) and six patients had SCC (T3 N0 M0 [ n  = 6]). Mean age was 60.8 years and male : female (3 : 8). Mean follow up was 23.4 months (range 12–36 months). All patients were treated with Iodine-125 plaque following biopsy-proven corneoscleral invasion on histopathology. The treatment dose was 100 Gy to a depth of 1.5–2.5 mm. Outcomes: Median visual acuity and intraocular pressure were unchanged after surgery. Five patients experienced corneal ulceration in the immediate postoperative period. None experienced recurrence at the treatment site. One SCC patient and two CM patients experienced new lesions distant from the treatment site. No sight-threatening complications were observed. No patients developed distant metastases.
Conclusion:  Plaque brachytherapy is an effective and well-tolerated modality for the management of patients with ocular surface malignancy with evidence of localized corneoscleral invasion.