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A technique for external beam radiotherapy to the eyelid without the need for an internal eye shield

International Journal of Radiology & Radiation Therapy
Tina Gorjiara,1 Aoife Conway,1 Joanne Sullivan,1 Pascale Guitera,2,3 Con Petsoglou,4,5 R. Max Conway,4,5 Vlad Illie,6 Gerald B. Fogarty1

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Cancer of the eyelids is difficult to treat. Surgery can lead to tissue loss. Superficial radiotherapy (SXRT) can be used in this scenario, but each fraction requires topical ophthalmic local anaesthetic and the insertion of an internal eye shield (IES) to protect the radiation sensitive anterior structures from the incident beam during beam-on time. The use of an IES comes with challenges. A technique was developed to avoid the IES based on the ability of selected cooperative patients to move the anterior structures out of the incident beam during beam-on time. We present two cases in which this technique was used. Case 1 involves the lower eyelid and case 2 the upper eyelid. Case 1 was a 69-year old, immunosuppressed woman needing definitive SXRT for lentigo maligna (LM) of the lower eye lid. She was treated using the new non-IES technique to a total dose of 50 Gy in 25 fractions using a 100 kV beam from a superficial Xstrahl 300 radiotherapy unit (Xstrahl, Surrey, UK). In vivo dosimetry (IVD) measured during a fraction on the posterior of the external eye shield located above the anterior structures showed that the transmitted dose through the external eye shield was less than ten percent of the dose applied. The patient developed conjunctivitis during SXRT that responded to topical antibiotics. Ophthalmology review five months post SXRT showed no change in eye function from baseline. Reflectance confocal microscopy (RCM) eight months after SXRT showed no LM. Case 2 was a 72-year old woman needing post-operative radiotherapy (PORT) for sebaceous cell carcinoma (SebC) of the upper eyelid. She was treated with 60 Gy in 30 fractions at 5 fractions per week with 100kV SXRT using the new non-IES technique. All the treatment was delivered on time. As per Case 1, IVD under the external eye shield showed the transmitted dose was less than 10 percent of the dose applied. Ophthalmology review preand post-RT showed no change in eye function. She remains in complete remission six months after the end of PORT. The new non-IES technique is safer and quicker and simplifies the workflow. This has become the standard technique in our department for treating eyelids with SXRT. Multidisciplinary care involving an ophthalmologist pre- and post-SXRT is advised


superficial radiotherapy, skin cancer, eyelid, internal eye shield, 3D printed external shield