Purpose

A 67-year-old male presented with a rapidly growing conjunctival mass, previously treated with interferon alfa at another institution. Biopsy confirmed conjunctival sarcoma. Contrast-enhanced CT of the head, orbits, chest, and abdomen showed locally confined disease with no evidence of metastases. An interdisciplinary tumor board recommended neoadjuvant radiotherapy followed by enucleation of the left eye; however, the patient refused enucleation. Presenting visual acuity was hand motion.

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Methods

The patient was qualified for globe-sparing multimodal treatment: surgical tumor resection with 7mm healthy tissue margins, intraoperative mitomycin C application (0.02%, 2 minutes), cryotherapy of surgical margins, and adjuvant brachytherapy of the tumor bed using a Ru-106 applicator (CCB; exposure time 20 hours 31 minutes; dose 103.7 Gy). Surgery was performed under general endotracheal anesthesia to minimize risk of tumor cell dissemination. Following applicator removal, the surgical defect was reconstructed with amniotic membrane transplantation onto the cornea.

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Results

At 9 months follow-up, visual acuity improved to 0.4–0.5, with no signs of local recurrence or distant metastases on imaging.

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Conclusion

Multimodal treatment combining resection, mitomycin C, cryotherapy, and Ru-106 brachytherapy may be a viable globe-preserving therapeutic option in patients with isolated ocular surface malignancy when enucleation is refused.

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Additional Authors

First name	Last name	Base Hospital / Institution
Michal	Kinasz	Military Institute of Medicine- National Research Institute
Magdalena	Plantowska	Military Institute of Medicine- National Research Institute
Anna	Rygielska	Military Institute of Medicine- National Research Institute
Justyna	Chalubinska-Fendler	Military Institute of Medicine- National Research Institute
Marek	Rekas	Military Institute of Medicine- National Research Institute

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