Conjunctival-corneal intraepithelial neoplasia (Bowen disease) treated with orthovoltage

To report an exceptionally large conjunctival-corneal intraepithelial neoplasia (CCIN) (Bowen disease), for which the size of the tumor made classical treatment difficult, and to highlight the role of orthovoltage as an alternative treatment mode with good results.

Observational case report of a healthy 61-year-old man with CCIN. Given its extension, alternative treatment was performed with orthovoltage, thus avoiding surgery, with adjuvant cryotherapy and mitomycin C, and potential complications. After administering topical anesthetic, a therapeutic contact lens was placed on the cornea; then, the eyelids were held open with a blepharostat. A 1-mm lead plate with a window was placed over the blepharostat. The shape of the window reproduced the shape of the tumor to protect the rest of the eye structures from radiation. Orthovoltage was administered with direct field radiation that was focused on the tumor through the window. The patient received 500 cGy in 2 sessions/week for 2 weeks (2000 cGy) and then 7 sessions 300 cGy daily (2100 cGy).

Evolution was good without side effects. After one-year follow-up, the patient was asymptomatic, without alterations of ocular surface or deep structures.

Safely administered orthovoltage may be a good therapeutic option for the treatment of CCIN when complete surgical resection is complicated by the extension of the tumor. Compared with topical treatment, radiation is easier to administer, shortens and simplifies the treatment, and is independent of patient compliance.