Description

Definitive radiation therapy can be an effective treatment option for conjunctival squamous cell carcinoma (SCC), particularly for lesions that are not amenable to surgical excision or for patients who are not suitable surgical candidates. We describe the case of a young man in his 40s who was referred to our clinic for management of a large orbital mass probably arising out of the ocular surface covering the whole globe (figure 1A). The fungating mass measured 5×5 cm, multilobular with overlying necrotic areas and haemorrhagic points. Reviewing his medical records, it was evident that 3 years ago, he underwent an enucleation procedure, which had to be halted due to intraoperative heart block. His condition at the time was critical, necessitating intensive care and significant resuscitation efforts. Due to the complexity of his case and the challenges associated with administering general anaesthesia, orbital exenteration was deemed unfeasible. Instead, an incision biopsy was performed to confirm the histopathology as invasive SCC (figure 1B). Subsequently, he was referred to a radiation oncologist to initiate definitive radiation therapy. The patient underwent conformal beam radiotherapy, specifically external beam radiotherapy (EBRT), targeting the left orbit. The treatment involved the use of 6 mV photon beams, with a total dose of 30 Gy administered over a span of 2 weeks, consisting of 10 fractions (figure 1C). EBRT was divided into 3 Gy/fraction as phase 1 and boost dose of 10 Gy in five fractions. The patient responded well to radiotherapy with adequate reduction in tumour mass, globe salvage as well as vision salvage (figure 1D). During the course of radiotherapy, the patient developed few side effects in the skin and conjunctiva (grade 1 reaction); however, there were no episodes of bleeding from the tumour mass. There were no clinical manifestations of tumour lysis syndrome.1 Currently, the patient’s left eye has a visual acuity of 20/200 and is accompanied by an immature cataract for which surgery has been scheduled. The patient has been consistently attending follow-up appointments and there has been no recurrence of the condition for the past year.

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Figure 1

(A) Clinical photo showing right-sided fungating mass (size 5×5 cm) over ocular surface consisting of multiple lobules, overlying necrotic areas and haemorrhagic points with indistinguishable ocular features. (B) Histopathology photomicrograph with 400× magnification showing dysplastic malignant squamous carcinoma cells, with squamous pearl formation. (C) External beam radiotherapy with conformal radiotherapy to left orbit. (D) Clinical photo showing complete reduction in tumour mass and globe salvage at the end of radiation therapy.

Brachytherapy techniques in conjunctival SCC include beta radiation using strontium-90,2 ruthenium-106,3 gamma radiotherapy using I125,4 5 superficial radiotherapy6 and electron beam radiotherapy,7 which have been used with good results. The advantages highlighted in these reports and small case series justify additional research into the feasibility of radiotherapy for a larger group of patients, which could potentially offer them a less-intrusive treatment option for selective cases of conjunctival SCC.