The role of radiotherapy in the treatment of pterygium: a review of the literature including more than 6000 treated lesions

Pterygium is a benign conjunctival neoformation usually treated by surgical excision, but recurrences may affect 30% to 89% of cases, so that adjunctive therapies like conjunctival autografting, antimitotic drugs and beta-irradiation (β-irradiation) are often used to improve the rate of local control. Our essay has reviewed relevant studies addressing the role of postoperative irradiation in the treatment of pterygium in the last 30 years through an Internet-based search and hand search in libraries. Sixteen studies on β-irradiation and one on soft X-ray irradiation were accessible. They covered more than 6000 lesions treated by surgical excision and postoperative β-irradiation using strontium-90 ((90)Sr) applicators at doses varying from 10 to 60 Gy/1-6 fractions/1-6 weeks starting within 3 days postoperatively. The rates of local recurrence were in general lower than 15% and major complications such as scleral thinning, ulceration, infections, or radiation-induced cataract were rarely encountered. Early postoperative β-irradiation at a dose of 30 Gy/three fractions/2-3 weeks starting within 24h from surgical excision is an effective and safe procedure with local control rates comparable to chemotherapeutic agents and conjunctival autografting and superior to simple excision alone.