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Journal of Cancer Research and Therapeutics, Vol. 7, No. 4, October-December, 2011, pp. 498-499 Letter to the Editor - Documenting a Case 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 Code Number: cr11132 DOI: 10.4103/0973-1482.92018 Sir, We read with great interest the article by Azad et al. [1] 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. [2] The Australian Mohs database II [3] has clearly shown that surgical modality is the best possible option for periocular basal cell carcinomas. Avril [4] 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. [1] Malhotra et al. [5] 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]. 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
Copyright 2011 - Journal of Cancer Research and Therapeutics The following images related to this document are available:Photo images[cr11132f1.jpg] |
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