TY - JOUR
T1 - β Irradiation of recurrent ptergia
T2 - results and complications
AU - Dusenbery, Kathryn E.
AU - Alul, Ida H.
AU - Holland, Edward J.
AU - Khan, Faiz M.
AU - Levitt, Seymour H.
PY - 1992
Y1 - 1992
N2 - Although postoperative β irradiation for prevention of pterygium recurrence is widely used, its complication rate has not been widely appreciated. Thirty-six patients underwent pterygium excision followed by irradiation with 90Sr to between 1600 and 5300 cGy (median 2400) in two to four fractions over 7 to 27 days. A median of three fields were used in each treatment course (range two to 10). Most patients had undergone previous treatment for their pterygia, including surgery alone (25 patients), or both surgery and irradiation (5 patients). Overall, recurrences developed in 10 eyes (28%). Recurrence occurred in one eye after re-irradiation (20%), compared to 9 of 31 (29%) previously non-irradiated eyes (p > 0.1). There was no association with number of excisions and recurrences, although all but β patients had undergone more than one excision. Thirteen patients (36%) developed complications including: epithelial defect or corneal thinning (3), symblepharon (5), cataract (4) and corneal ulceration (1). Complications developed in 4 of the 5 (80%) re-irradiated eyes compared to 9 of 31 (29%) previously non-irradiated eyes (p < 0.05). The power of the statistical analysis was limited by sample size, but no significant association was observed between the development of complications or recurrences and total dose, number of abutting fields, number of previous surgical excisions or patient age, even when re-irradiated patients were excluded. Recently described calibration uncertainties with the 90Sr applicator may explain in part these complications. Alternatively, technical factors such as the number of fields or volume treated may play a role. Excessive complications and recurrences with the use of postoperative β irradiation in this series emphasize the danger of re-treatment and the need for alternative safe and effective therapies.
AB - Although postoperative β irradiation for prevention of pterygium recurrence is widely used, its complication rate has not been widely appreciated. Thirty-six patients underwent pterygium excision followed by irradiation with 90Sr to between 1600 and 5300 cGy (median 2400) in two to four fractions over 7 to 27 days. A median of three fields were used in each treatment course (range two to 10). Most patients had undergone previous treatment for their pterygia, including surgery alone (25 patients), or both surgery and irradiation (5 patients). Overall, recurrences developed in 10 eyes (28%). Recurrence occurred in one eye after re-irradiation (20%), compared to 9 of 31 (29%) previously non-irradiated eyes (p > 0.1). There was no association with number of excisions and recurrences, although all but β patients had undergone more than one excision. Thirteen patients (36%) developed complications including: epithelial defect or corneal thinning (3), symblepharon (5), cataract (4) and corneal ulceration (1). Complications developed in 4 of the 5 (80%) re-irradiated eyes compared to 9 of 31 (29%) previously non-irradiated eyes (p < 0.05). The power of the statistical analysis was limited by sample size, but no significant association was observed between the development of complications or recurrences and total dose, number of abutting fields, number of previous surgical excisions or patient age, even when re-irradiated patients were excluded. Recently described calibration uncertainties with the 90Sr applicator may explain in part these complications. Alternatively, technical factors such as the number of fields or volume treated may play a role. Excessive complications and recurrences with the use of postoperative β irradiation in this series emphasize the danger of re-treatment and the need for alternative safe and effective therapies.
KW - Complications
KW - Pterygium
KW - β-irradiation
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U2 - 10.1016/0360-3016(92)90687-D
DO - 10.1016/0360-3016(92)90687-D
M3 - Article
C2 - 1526870
AN - SCOPUS:0026786281
SN - 0360-3016
VL - 24
SP - 315
EP - 320
JO - International Journal of Radiation Oncology, Biology, Physics
JF - International Journal of Radiation Oncology, Biology, Physics
IS - 2
ER -