Conjunctival autograft alone or combined with adjuvant beta-radiation? A randomized clinical trial.

Abstract

PURPOSE:

To evaluate the effectiveness and safety of postoperative low single-dose of beta-irradiation (β-RT) in pterygium comparing conjunctival autograft (CAG) surgery with CAG plus adjuvant β-RT in a randomized clinical trial.

METHODS:

This trial was designed as a prospective, randomized, single-center study. Surgery was performed in all cases according to the CAG technique. One hundred and eight pterygia were postoperatively randomized to CAG + β-RT or CAG alone. In the case of β-RT, a (90) Sr eye applicator was used to deliver 10 Gy to the sclera surface at a dose rate of between 200 and 250 cGy/min. After treatment, both an ophthalmologist and a radiation oncologist performed the follow-up examinations. The accumulated data were analyzed using a group sequential test.

RESULTS:

Between February 2008 and September 2008, 116 eyes with primary pterygium were operated on according to the trial protocol. Adjuvant treatment was performed within 24 h postoperatively. Eight patients were lost to follow-up, resulting in 108 patients who could be analyzed. At a mean follow-up of 18 months (range, 8-33), in the 54 eyes randomized to receive CAG + β-RT, 5 relapses occurred compared with 12 recurrences in the 54 eyes in CAG, for a crude control rate of 90.8 % vs. 78%; p = 0.032, respectively. The treatment complications as hyperemia, total dehiscence of the autograft and dellen were significantly more frequent in the CAG (p < 0.05). The arm of β-RT resulted in better cosmetic results and improves of symptoms than CAG.

CONCLUSIONS:

A low single-dose of β-RT of 10 Gy after CAG surgery was a simple, effective, and safe treatment that reduced the risk of primary pterygium recurrence, improved symptoms after surgery, resulting in a better cosmetic effect than only CAG.

• Authors: Gustavo Arruda Viani, Ellen Carrara Fonseca, Ligia Issa De Fendi, Eduardo Melani Rocha
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 82 Issue 3 Pg. e507-11 (Mar 01 2012) ISSN: 1879-355X [Electronic] United States
• PMID: 22284040 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Strontium Radioisotopes

Topics

• Adult
• Aged
• Aged, 80 and over
• Conjunctiva (transplantation)
• Female
• Follow-Up Studies
• Humans
• Hyperemia (etiology)
• Male
• Middle Aged
• Prospective Studies
• Pterygium (radiotherapy, surgery)
• Radiotherapy Dosage
• Radiotherapy, Adjuvant (adverse effects, methods)
• Recurrence
• Strontium Radioisotopes (therapeutic use)
• Surgical Wound Dehiscence (etiology)
• Treatment Outcome
• Young Adult