Interventions for squamous cell carcinoma of the conjunctiva in HIV-infected individuals

 

Abstract

Background

Squamous cell carcinoma of the conjunctiva is a rare, slow-growing tumour of the eye, normally affecting elderly men around 70 years of age. In Africa, however, the disease is different. The incidence is rising rapidly, affecting young persons (around 35 years off age), and usually affecting women. It is more aggressive, with a mean history of three months at presentation. This pattern is related to the co-existence of the HIV/AIDS pandemic, high HPV exposure, and solar radiation in the region. Various interventions exist, but despite therapy, there is a high recurrence rate (up to 43%) and poor cosmetic results in late disease. This review was conducted to evaluate the interventions for treatment of conjunctival squamous cell carcinoma in HIV-infected individuals.

Objectives

To evaluate the effect of interventions for treating squamous cell carcinoma of the conjunctiva in HIV-infected individuals on local control, recurrence, death, time to recurrence, and adverse events.

Search methods

Using a sensitive search strategy, we attempted to identify all relevant trials, regardless of language or publication status, from the following electronic databases; Medline/PubMed, CENTRAL, AIDSearch, EMBASE, LILACS, African Healthline, Cochrane HIV/AIDS Specialised Register, and the Cochrane Cancer Network Specialised Register. We searched the clinical trial register of the US National Institutes of Health, searched the international conference proceedings of AIDS and AIDS-related cancers, and contacted individual researchers, research organisations, and pharmaceutical companies that manufacture the drugs used as interventions. Searches were done between September 2005 and June 2006.

Selection criteria

Randomised controlled trials (RCTs) involving HIV-infected individuals with ocular surface squamous neoplasia.

Data collection and analysis

We independently screened the results of the search to select potentially relevant studies and to retrieve the full articles. We independently applied the inclusion criteria to the potentially relevant studies. No studies were identified that fulfilled the selection criteria.

Main results

No RCTs of interventions currently used against conjunctival squamous cell carcinoma in HIV-infected individuals were identified.

Authors' conclusions

Implications for practice:
Current clinical practice in treatment of squamous cell carcinoma of the conjunctiva rests on a weak evidence base of case series and case reports.

Implications for research:
Randomised controlled trials for treatment of this disease are needed in settings where it occurs most frequently. Preventive interventions also need to be identified. HIV/AIDS research has not focused on treatment of this tumour.

 

Plain language summary

Interventions for squamous cell carcinoma of the conjunctiva in HIV-infected individuals

Conjunctival squamous cell carcinoma, a tumour of the thin membrane that covers the white of the eye, is becoming more common, more aggressive, and affecting more young people, especially women. This pattern is associated with the HIV/AIDS pandemic, exposure to solar radiation, and infection with human papilloma virus (HPV). Various treatment modalities exist, but the recurrence rate is high and the cosmetic outcome of late disease unsightly (Figure 1). Death may occur when the disease spreads to the surrounding structures and the brain. This review was conducted to evaluate the effects of the current interventions. No randomised controlled trials of any interventions for this cancer were found. Current clinical practice appears to be based on case series and case reports. These are weak sources of evidence for the effectiveness of a treatment. Randomised controlled clinical trials are needed.

 

摘要

背景

人類免疫缺乏病毒感染者結膜鱗狀細胞癌的介入性治療

結膜鱗狀細胞癌是一個罕見的、緩慢生長的眼部腫瘤，主要發生於70歲左右的老年男性。在非洲，此病有不同的流病學特徵：它的發生率正快速上升，主要發生於約35歲的年輕人，且女性多於男性。其病程更具侵襲性(aggressive)，平均發病3個月。此種疾病型態與其HIV/AIDS全國流行性、人類乳突病毒(HPV)高曝露率以及該地區的日光照射等條件並存有關。已有多種的介入性治療被使用，但即使經過治療，仍有很高的復發率(高達43%)，且疾病晚期常造成難看的外觀。本篇評論性文章主要在評估HIV感染者結膜鱗狀細胞癌的介入性治療效果。

目標

評估人類免疫缺乏病毒感染者結膜鱗狀細胞癌的介入性治療效果，包括局部控制率、復發率、死亡率、復發時程(time to recurrence)以及不良事件(adverse event)。

搜尋策略

我們使用敏感性高的尋找策略，希望找出所有相關的臨床試驗，不管發表的語言或狀態。尋找的來源包括： Medline/PubMed醫學文獻資料庫、CENTRAL資料庫、AIDSearch資料庫、EMBASE資料庫、LILACS資料庫、非洲健康線上資料庫(African Healthline)、考科藍HIV/AIDS專門登錄資料庫(Cochrane HIV/AIDS Specialised Register)、考科藍腫瘤網路專門登錄資料庫(Cochrane Cancer Network Specialised Register)。我們也搜尋了美國國家衛生研究院臨床試驗註冊資料庫、後天免疫缺乏症候群與其相關腫瘤的國際會議記錄，同時也接觸及聯絡個別的研究者、研究組織、及製造介入性治療藥物的藥商。搜尋時期為2005年9月至2006年6月。

選擇標準

收案的條件為HIV感染者合併眼球表面鱗狀腫瘤(squamous neoplasia)的隨機對照臨床試驗。

資料收集與分析

我們獨立地篩選了所搜尋到的結果，選擇潛在相關的臨床試驗且取得全文。我們獨立地將收案條件用於潛在相關試驗的篩選。沒有試驗符合篩選條件。

主要結論

目前沒有隨機對照臨床試驗關於人類免疫缺乏病毒感染者結膜鱗狀細胞癌的介入性治療。

作者結論

實用涵義：目前對人類免疫缺乏病毒感染者結膜鱗狀細胞癌的臨床治療，僅依據病例系列(case series)或病例報告(case reports)的微弱證據。 研究涵義：依據此病最常發生情況而設計關於疾病治療的隨機對照臨床試驗是需要的。預防性的介入性處置也需要被找出。人類免疫缺乏病毒/後天免疫缺乏症候群的相關研究仍未有針對此病的治療。

翻譯人

本摘要由臺北榮民總醫院鄧仲仁翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

結膜鱗狀細胞癌是發生於遮蓋眼白部分薄膜上的腫瘤，目前被發現愈來愈常發生、具侵襲性，且且侵犯更多年輕人，尤其是女性族群。此種疾病型態與其人類免疫缺乏病毒/後天免疫缺乏症候群全國流行性、以及該地區的日光照射等條件並存相關。目前有多種的治療策略，但復發率仍高，且疾病晚期常造成難看的外觀；當疾病進展擴散至鄰近組織與腦部，更可能造成死亡。本篇評論性文章乃是評估目前介入性治療的效果。但是對於此病的任何介入性治療，都沒有隨機對照臨床試驗的報告。目前的臨床治療都僅是依據病例系列或病例報告，其證據性太微弱而不足以證實治療的效果。進一步的隨機對照臨床試驗是需要的。