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.

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.

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Background: 

Squamous cell carcinoma of the conjunctiva is described in the ophthalmic literature as 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 of 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 strategy: 

Using a sensitive search strategy, we attempted to identify all relevant trials, regardless of language or publication status, from the following electronic databases; PubMedPubMed, EMBASE and The Cochrane Library. We also searched clinical trial registries; WHO International Clinical Trials Registry Platform (ICTRP) and the US National Institutes of Health Clinicaltrials.gov. We searched the international conference proceedings of HIV/AIDS and AIDS-related cancers from the AIDS Education Global Education System (AEGIS). Searches were conducted between January and February 2012.

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.There is one ongoing RCT in Kenya that was registered in July 2012.

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