|LETTER TO THE EDITOR - DOCUMENTING A CASE
|Year : 2011 | Volume
| Issue : 4 | Page : 498-499
High dose rate interstitial brachytherapy in carcinoma eyelid: Can it be a primary treatment modality?
Mohammad Javed Ali1, Santosh G Honavar1, Vijay Anand P Reddy2
1 Ocular Oncology Service, L V Prasad Eye Institute, Hyderabad, India
2 Apollo Cancer Hospitals, Hyderabad, Andhra Pradesh, India
|Date of Web Publication||19-Jan-2012|
Santosh G Honavar
Ocular Oncology Service, L V Prasad Eye Institute, Road No. 2, Banjara Hills, Hyderabad - 500 034, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ali MJ, Honavar SG, Reddy VP. High dose rate interstitial brachytherapy in carcinoma eyelid: Can it be a primary treatment modality?. J Can Res Ther 2011;7:498-9
|How to cite this URL:|
Ali MJ, Honavar SG, Reddy VP. High dose rate interstitial brachytherapy in carcinoma eyelid: Can it be a primary treatment modality?. J Can Res Ther [serial online] 2011 [cited 2020 Feb 26];7:498-9. Available from: http://www.cancerjournal.net/text.asp?2011/7/4/498/92018
We read with great interest the article by Azad et al.  We congratulate the authors for carrying out a commendable work. We would like to articulate a few of our observations.
Surgical excision is the gold standard of treatment for an eyelid malignancy. Mohs micrographic surgery is the most reliable method for tumor extirpation as agreed by the authors themselves. Surgical excision offers the best cure rate and lowest recurrence rates. 
The Australian Mohs database II  has clearly shown that surgical modality is the best possible option for periocular basal cell carcinomas. Avril  in a randomized controlled trial has proven superiority of controlled surgical excision over radiotherapy as a primary modality of management and at the same time higher recurrences following radiotherapy. The five-year disease-free survival rates in the authors' series for basal cell carcinoma is not an encouraging enough indication for the use of interstitial brachytherapy. 
Malhotra et al.  have shown that the best option for a periocular squamous cell carcinoma is Mohs micrographic surgery. These tumors are known to be relatively radioresistant. Postoperative radiotherapy is recommended in cases with microscopic perineural invasion.
Sebaceous gland carcinomas of the eyelid are notorious for recurrences if not completely excised. Frozen section control or Mohs microsurgery is the way to go as evaluation of margins till histopathologic clearance is of prime importance. Protocol-based conjunctival map biopsies greatly aid in the management of pagetoid variants.
We do not agree with the authors' views that surgical corrections are associated with severe dysfunction and poor cosmesis. This is an exception rather than a rule. Two examples are provided where extensive excision of almost the entire eyelids was done with good function as well as cosmesis [Figure 1].
|Figure 1: (A) A large malignant melanoma of the eyelid involving upto half of the eyelid, (B) The lesion is excised along with almost two thirds of the eyelid followed by a flap reconstruction, (C) An extensive left upper eyelid sebaceous gland carcinoma, (D) Postoperative picture showing a well reconstructed upper eyelid using a cutler-Beard method with good functional retention and cosmesis|
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We would again like to congratulate the authors for exploring the pros and cons of a new possibility as a primary modality in the management of eyelid carcinomas.
| > References|| |
|1.||Azad S, Choudhry V. Treatment results of high dose rate interstitial brachytherapy in carcinoma of eyelid. J Cancer Res Ther 2011;7:157-61. |
|2.||Cook BE Jr, Bartley GB. Treatment options and future prospects for the management of eyelid malignancies: An evidence-based update. Ophthalmology 2011;108:2088-98. |
|3.||Malhotra R, Huilgol SC, Huynh NT, Selva D. The Australian Mohs Database. Part II. Periocular basal cell carcinoma outcome at 5 year follow-up. Ophthalmology 2004;111:631-6. |
|4.||Avril MF, Auperin A, Margulis A, Gerbaulet A, Duvillard P, Benhamoue E, et al. Basal cell carcinoma of the face: Surgery or radiotherapy? Results of a randomized study. Br J Cancer 1997;76:100-6. |
|5.||Malhotra R, Huligol SC, Huynh NT, Selva D. The Australian Mohs Database. Periocular squamous cell carcinoma. Ophthalmology 2004;111:617-23. |