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Shin D, Yoo SH, Moon SH, Yoon M, Lee SB, Park SY. Eye tracking and gating system for proton therapy of orbital tumors. Med Phys 2012; 39:4265-73. [PMID: 22830760 DOI: 10.1118/1.4729708] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A new motion-based gated proton therapy for the treatment of orbital tumors using real-time eye-tracking system was designed and evaluated. METHODS We developed our system by image-pattern matching, using a normalized cross-correlation technique with LabVIEW 8.6 and Vision Assistant 8.6 (National Instruments, Austin, TX). To measure the pixel spacing of an image consistently, four different calibration modes such as the point-detection, the edge-detection, the line-measurement, and the manual measurement mode were suggested and used. After these methods were applied to proton therapy, gating was performed, and radiation dose distributions were evaluated. RESULTS Moving phantom verification measurements resulted in errors of less than 0.1 mm for given ranges of translation. Dosimetric evaluation of the beam-gating system versus nongated treatment delivery with a moving phantom shows that while there was only 0.83 mm growth in lateral penumbra for gated radiotherapy, there was 4.95 mm growth in lateral penumbra in case of nongated exposure. The analysis from clinical results suggests that the average of eye movements depends distinctively on each patient by showing 0.44 mm, 0.45 mm, and 0.86 mm for three patients, respectively. CONCLUSIONS The developed automatic eye-tracking based beam-gating system enabled us to perform high-precision proton radiotherapy of orbital tumors.
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Affiliation(s)
- Dongho Shin
- National Cancer Center, Goyang, Gyeonggi, Republic of Korea
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Abstract
PURPOSE The purpose of this article is to determine the incidence, etiology, management, and outcome of vitreous hemorrhage (VH) after plaque radiotherapy for uveal melanoma. METHODS Retrospective review of medical records. RESULTS Of 3,707 eyes treated with plaque radiotherapy for uveal melanoma, VH developed in 4.1% at 1 year, 15.1% at 5 years, and 18.6% at 10 years by Kaplan-Meier analysis. Presumed causes of VH included tumor necrosis (29%), proliferative radiation retinopathy (24%), posterior vitreous detachment (16%), vascular occlusion (5%), and unknown (19%). Tumor necrosis was the most common cause of VH early in the follow-up period (3% at 1 year), while proliferative radiation retinopathy was the most common source of VH later (6.2% at 15 years). The most common initial management was conservative observation for resolution in 48%, laser photocoagulation in 24%, and vitrectomy in 18%. After a mean follow-up period of 5 years, the VH was completely resolved in 41%, partially resolved in 19%, unresolved in 20%, worsened in 5%, and enucleation was necessary in 15%. By multivariable analysis, risk factors for development of VH were the presence of diabetic retinopathy at first visit (relative risk, 6.64), shorter tumor distance to the optic disc (relative risk, 1.07), greater initial tumor thickness (relative risk, 1.1), and break in the Bruch membrane (relative risk, 2.93). The rates of local tumor recurrence, extraocular extension, and distant metastasis in 74 patients who underwent vitrectomy for VH removal after tumor regression were similar to those in patients who did not have vitrectomy for VH. CONCLUSION Vitreous hemorrhage occurs after plaque radiotherapy for uveal melanoma in 15.1% of the patients by 5 years. The main factors predictive of VH included underlying diabetic retinopathy, closer tumor proximity to the disc, greater tumor thickness, and break in the Bruch membrane. After tumor regression, vitrectomy for blood removal appears to be safe.
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Toivonen P, Kivelä T. Infiltrating macrophages in extratumoural tissues after brachytherapy of uveal melanoma. Acta Ophthalmol 2012; 90:341-9. [PMID: 20809904 DOI: 10.1111/j.1755-3768.2010.01985.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare distribution of macrophages in extratumoural ocular tissues in enucleated eyes with irradiated and nonirradiated uveal melanomas to find out how irradiation affects distribution of macrophages so as to gain insight into their potential routes of migration and changes in local inflammatory responses. METHODS Thirty-four matched pairs of primarily enucleated nonirradiated and secondarily enucleated irradiated eyes with choroidal and ciliary body melanoma were stained with mAb PG-M1, and the extratumoural immunopositive elements were counted under the microscope. Main outcome variables were the number of macrophages in the sclera underlying the tumour, in the choroid adjacent to the tumour, and in the ciliary body. The number of macrophage aggregates in the anterior ipsi- and contralateral episclera adjacent to the limbus was also counted. RESULTS Macrophages were more numerous within the sclera under the tumour in irradiated eyes when compared to primarily enucleated eyes (median 1514 versus 619/mm², p = 0.0001), and more aggregates of episcleral macrophages adjacent to the limbus were found after irradiation (ipsilateral side, median 132 versus 0, p = 0.0034; contralateral side, median 79 versus 0, p = 0.014). In primarily enucleated eyes, increasing numbers of tumour-infiltrating macrophages were associated with presence of higher numbers of macrophages in the ciliary body (p = 0.003) and the adjacent choroid (p = 0.044), whereas in the irradiated eyes, increasing numbers of tumour-infiltrating macrophages (p = 0.010) and increasing extent of necrosis (p < 0.001) were associated with higher numbers of intrascleral macrophages underlying the tumour. CONCLUSIONS Resident macrophages are present in extratumoural tissues in eyes with uveal melanoma. Brachytherapy may alter their route of migration and increase the number of macrophages in the sclera and episclera. Histopathologically detectable episcleral aggregates of macrophages adjacent to the limbus are detected predominantly after irradiation, a population of which is clinically visible as episcleral deposits after irradiation.
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Affiliation(s)
- Päivi Toivonen
- Ocular Oncology Service, Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
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Radiogenic Side Effects After Hypofractionated Stereotactic Photon Radiotherapy of Choroidal Melanoma in 212 Patients Treated Between 1997 and 2007. Int J Radiat Oncol Biol Phys 2012; 83:121-8. [DOI: 10.1016/j.ijrobp.2011.06.1957] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 06/01/2011] [Accepted: 06/03/2011] [Indexed: 11/19/2022]
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Russo A, Laguardia M, Damato B. Eccentric ruthenium plaque radiotherapy of posterior choroidal melanoma. Graefes Arch Clin Exp Ophthalmol 2012; 250:1533-40. [PMID: 22354369 DOI: 10.1007/s00417-012-1962-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 01/16/2012] [Accepted: 02/01/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this work is to report on conservation of visual acuity after eccentric ruthenium(106) (Ru-106) brachytherapy of posterior choroidal melanoma. METHODS Fifty-four patients with choroidal melanoma extending to within 5 mm of the optic disc or fovea were treated at a single institution during the 3 years up to July 31, 2007. The plaque was positioned eccentrically with its posterior edge aligned with the posterior tumor margin to reduce the radiation dose to the optic disc and fovea. The main outcome measures were local tumor control and conservation of vision of 6/12 or better, according to baseline variables. RESULTS The tumors had a mean longest basal diameter of 12.0 mm and a mean thickness of 3.1 mm. The posterior tumor margin extended to within 3 mm of the fovea in 30 patients (56%). In the 24 eyes with the posterior tumor margin located 3.1-5.0 mm from the fovea, 74.9% retained visual acuity of 6/12 or better 4 years after treatment (95% confidence interval [CI], 55.5-94.3%). In the 30 eyes with tumor extension to within 3.0 mm of the fovea, then 3 years after treatment only 25.3% retained such vision (95% CI, 5.3-45.3%). Recurrence at the posterior tumor margin occurred in two patients. CONCLUSIONS Eccentric ruthenium(106) plaque radiotherapy of posterior choroidal melanoma achieves good rates of local tumor control and conservation of vision if special measures are taken to ensure that the plaque is positioned correctly.
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Affiliation(s)
- Andrea Russo
- St. Paul's Eye Unit, Oncology Service, Royal Liverpool University Hospital, Prescot Street, L7 8XP, Liverpool, UK.
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Muller K, Naus N, Nowak PJ, Schmitz PI, de Pan C, van Santen CA, Marijnissen JP, Paridaens DA, Levendag PC, Luyten GP. Fractionated stereotactic radiotherapy for uveal melanoma, late clinical results. Radiother Oncol 2012; 102:219-24. [DOI: 10.1016/j.radonc.2011.06.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 04/16/2011] [Accepted: 06/24/2011] [Indexed: 12/17/2022]
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Russo A, Coupland SE, Raja V, Damato BE. Recurrent choroidal melanoma after brachytherapy in an eye with scleral calcification. Acta Ophthalmol 2011; 89:e657-8. [PMID: 20946331 DOI: 10.1111/j.1755-3768.2010.02019.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stereotactic Fractionated Radiotherapy in the Treatment of Juxtapapillary Choroidal Melanoma: The McGill University Experience. Int J Radiat Oncol Biol Phys 2011; 81:e455-62. [DOI: 10.1016/j.ijrobp.2011.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 04/30/2011] [Accepted: 05/05/2011] [Indexed: 11/22/2022]
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Schuster R, Bechrakis NE, Stroux A, Busse A, Schmittel A, Thiel E, Foerster MH, Keilholz U. Prognostic relevance of circulating tumor cells in metastatic uveal melanoma. Oncology 2011; 80:57-62. [PMID: 21625180 DOI: 10.1159/000328283] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 02/08/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Uveal melanoma primarily metastasizes hematogenously with metastases often confined to the liver. The aim of this study was to investigate the presence of circulating tumor cells (CTC) in patients with metastatic disease as a marker for systemic disease and to determine their prognostic relevance. METHODS Blood samples from 68 patients were collected at the time of initial treatment of metastases. mRNA expression of tyrosinase and MelanA/MART1 as a surrogate marker for the presence of CTC was analyzed by real-time RT-PCR and compared with patient characteristics. RESULTS CTC were detected in 63% of all patients and in 67% of the 48 patients with only liver metastases. Univariate and multivariate analyses revealed PCR results and serum lactate dehydrogenase as independent prognostic factors for progression-free (hazard ratios 2.2/3.5) and overall survival (hazard ratios 4.0/6.5). Combination of PCR and lactate dehydrogenase divided the patient cohort into 3 groups with distinct prognosis. CONCLUSION CTC as evidence for systemic disease can be found in the majority of patients with metastatic uveal melanoma, including patients with visible disease confined to the liver. Detection of CTC-specific mRNA transcripts for tyrosinase and MelanA/MART1 by PCR is a poor prognostic factor for progression-free and overall survival. Characterization of CTC could improve the understanding of their biology.
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Affiliation(s)
- R Schuster
- Department of Hematology and Oncology, Charité CBF, Berlin, Germany.
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Gündüz K, Kurt RA, Akmeşe HE, Köse K, Uçakhan-Gündüz Ö. Ruthenium-106 plaque radiotherapy alone or in combination with transpupillary thermotherapy in the management of choroidal melanoma. Jpn J Ophthalmol 2010; 54:338-43. [DOI: 10.1007/s10384-010-0821-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
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Dunavoelgyi R, Dieckmann K, Gleiss A, Sacu S, Kircher K, Georgopoulos M, Georg D, Zehetmayer M, Poetter R. Local tumor control, visual acuity, and survival after hypofractionated stereotactic photon radiotherapy of choroidal melanoma in 212 patients treated between 1997 and 2007. Int J Radiat Oncol Biol Phys 2010; 81:199-205. [PMID: 20675066 DOI: 10.1016/j.ijrobp.2010.04.035] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 04/21/2010] [Accepted: 04/27/2010] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate long-term local tumor control, visual acuity, and survival after hypofractionated linear accelerator-based stereotactic photon radiotherapy in patients with choroidal melanoma. METHODS AND MATERIALS Between 1997 and 2007, 212 patients with choroidal melanoma unsuitable for ruthenium-106 brachytherapy or local resection were treated stereotactically at a linear accelerator with 6-MV photon beams at the Medical University of Vienna in five fractions over 7 days. Twenty-four patients received a total dose of 70 Gy (five fractions of 14 Gy), 158 a total dose of 60 Gy (five fractions of 12 Gy) and 30 patients a total dose of 50 Gy (five fractions of 10 Gy) applied on the 80% isodose. Ophthalmologic examinations were performed at baseline and every 3 months in the first 2 years, every 6 months until 5 years, and once a year thereafter until 10 years after radiotherapy. Assessment of visual acuity, routine ophthalmologic examinations, and measurement of tumor base dimension and height using standardized A-scan and B-scan echography were done at each visit. Funduscopy and fluorescein angiography were done when necessary to document tumor response. RESULTS Median tumor height and volume decreased from 4.8 mm and 270.7 mm3 at baseline to 2.6 mm and 86.6 mm3 at the last individual follow-up, respectively (p<0.001, p<0.001). Median visual acuity decreased from 0.55 at baseline to hand motion at the last individual follow-up (p<0.001). Local tumor control was 95.9% after 5 years and 92.6% after 10 years. Thirty-two patients developed metastatic disease, and 22 of these patients died during the follow-up period. CONCLUSION Hypofractionated stereotactic photon radiotherapy with 70 to 50 Gy delivered in five fractions in 7 days is sufficient to achieve excellent local tumor control in patients with malignant melanoma of the choroid. Disease outcome and vision are comparable to those achieved with proton beam radiotherapy. Decreasing the total dose below 60 Gy seems to be possible.
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Affiliation(s)
- Roman Dunavoelgyi
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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Long-term outcomes of eye-conserving treatment with Ruthenium106 brachytherapy for choroidal melanoma. Radiother Oncol 2010; 95:332-8. [DOI: 10.1016/j.radonc.2010.03.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 01/15/2010] [Accepted: 03/14/2010] [Indexed: 11/21/2022]
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Langmann G. Eine kurze Geschichte der Gamma Knife Radiochirurgie (LGR) von Aderhautmelanomen. SPEKTRUM DER AUGENHEILKUNDE 2010. [DOI: 10.1007/s00717-010-0381-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bechrakis NE, Schmid E, Blatsios G, Widmann-Schuchter B, Höcht S, Moser L, Cordini D, Heufelder J, Willerding G, H. Foerster M. Protonenstrahlentherapie bei Aderhautmelanomen des hinteren Augenpols. SPEKTRUM DER AUGENHEILKUNDE 2010. [DOI: 10.1007/s00717-010-0379-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Querques G, Bux AV, Iaculli C, Delle Noci N. Local resection versus combined local resection and plaque radiotherapy in the treatment of choroidal melanoma. Eur J Ophthalmol 2009; 20:194-200. [PMID: 19882527 DOI: 10.1177/112067211002000127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the outcome of local resection versus combined local resection and plaque radiotherapy in the treatment of choroidal melanoma. METHODS We retrospectively analyzed the records of 60 patients (60 eyes) managed by local resection (group 1, 30 patients, external or internal local resection) or combined local resection and plaque radiotherapy (group 2, 30 patients, both Ruthenium-106 or Cobalt-60), among the 364 melanomas treated at our Department of Ophthalmology, between January 1980 and December 2006. Main outcomes measures were postsurgical complications, visual acuity, local recurrence, reasons for enucleation, and development of metastasis. RESULTS The 2 groups of patients were considered sufficiently homogeneous as regards location, cell type, and age. Mean follow-up was 7 years. The median largest basal tumor diameter was 9.8 mm and 10.1, and the median tumor thickness was 7.9 mm and 8, respectively, in groups 1 and 2. No statistically significant differences resulted between group 1 and group 2 as regards postsurgical complications (vitreous hemorrhage, retinal detachment, maculopathy, cataract, and optic neuropathy) (p>0.05), visual acuity (p>0.05), local recurrence (p>0.05), reasons for enucleation (p>0.05), or development of metastasis (p>0.05). CONCLUSIONS No adjunctive benefits from the combined local resection and plaque radiotherapy can be ruled out from our study.
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Affiliation(s)
- Giuseppe Querques
- Department of Ophthalmology, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy.
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Isager P, Ehlers N, Urbak SF, Overgaard J. Visual outcome, local tumour control, and eye preservation after 106Ru/Rh brachytherapy for choroidal melanoma. Acta Oncol 2009; 45:285-93. [PMID: 16644571 DOI: 10.1080/02841860500468950] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To study the visual outcome, local tumour control, and eye preservation 5 years after ruthenium/rhodium 106 brachytherapy for choroidal melanoma. The study included 55 consecutive patients treated by 106Ru/Rh brachytherapy for a choroidal melanoma during the period 1988-2000 and followed through 2004. The 5-year probability for not losing at least 5 Snellen lines was 59% (n = 45), for retaining a visual acuity of 0.33 or better was 28% (n = 34), and for retaining better than 0.1 was 40% (n = 45). The 5-year probability for no local recurrence was 73% and for eye preservation 72% (n = 55). 106Ru/Rh brachytherapy for choroidal melanoma resulted in a clinically significant vision loss, no local recurrence, and eye preservation in most patients after 5 years. 106Ru/Rh brachytherapy can be regarded as a good treatment option for small and medium-sized tumours but not for large tumours.
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Affiliation(s)
- Peter Isager
- Department of Ophthalmology, Arhus University Hospital, Denmark.
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A multimodal approach to eye melanoma: patterns of care and related complications. Oncol Rev 2009. [DOI: 10.1007/s12156-009-0002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Muñoz A, Oiler JC, Blanco F, Gorfinkiel JD, Limão-Vieira P, Maira-Vidal A, Borge MJG, Tengblad O, Huerga C, Téllez M, García G. Energy deposition model based on electron scattering cross section data from water molecules. ACTA ACUST UNITED AC 2008. [DOI: 10.1088/1742-6596/133/1/012002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wilkinson DA, Kolar M, Fleming PA, Singh AD. Dosimetric comparison of 106Ru and 125I plaques for treatment of shallow (<or=5 mm) choroidal melanoma lesions. Br J Radiol 2008; 81:784-9. [PMID: 18628320 DOI: 10.1259/bjr/76813976] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to compare dosimetric parameters between iodine-125 ((125)I) and ruthenium-106 ((106)Ru) plaques of similar sizes in the treatment of choroidal melanomas. The study design included retrospective double planning of each case. 26 consecutive patients with choroidal melanomas measuring 5 mm or less in thickness were included. Dose distributions were calculated using Plaque Simulator treatment-planning software for a prescription of 85 Gy to the tumour apex. Doses to the outer sclera, lens, fovea and optic disc were obtained for each case using appropriately sized plaques of each isotope. Statistical inferences were made using the non-parametric Wilcoxon signed rank test. The mean dose to the macula, disc and lens was 18%, 53% and 89% less, respectively, with (106)Ru than with (125)I. Scleral doses were greater for (106)Ru. The use of collaborative ocular melanoma study dosimetry results in even higher mean doses to the macula, disc, lens and sclera. Two-dimensional dose distributions and dose volume histograms demonstrated the increase in dose outside the tumour volume using (125)I. This comparison shows that, for tumours not exceeding 5 mm in thickness, the use of (106)Ru plaques has the potential to reduce the radiation dose to nearby normal structures and possibly lower the risk of radiation-induced visual loss.
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Affiliation(s)
- D A Wilkinson
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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70
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Schuster R, Bechrakis NE, Stroux A, Busse A, Schmittel A, Scheibenbogen C, Thiel E, Foerster MH, Keilholz U. Circulating tumor cells as prognostic factor for distant metastases and survival in patients with primary uveal melanoma. Clin Cancer Res 2007; 13:1171-8. [PMID: 17317826 DOI: 10.1158/1078-0432.ccr-06-2329] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to determine in patients with high-risk primary uveal melanoma whether the detection of circulating tumor cells by quantitative reverse transcription-PCR (RT-PCR) is of prognostic relevance. EXPERIMENTAL DESIGN Blood samples from 110 patients with high-risk nonmetastatic uveal melanoma were collected on the occasion of primary treatment or follow-up visit. mRNA expression of tyrosinase and MelanA/MART1 were analyzed by real-time RT-PCR and compared with clinical data at presentation and follow-up by univariate and multivariate analyses. RESULTS The RT-PCR assay yielded a positive result in 11 of 110 patients, with five positive findings for tyrosinase and five for MelanA/MART1, and one sample positive for both markers. At a median follow-up of 22 months, 25% of patients had developed metastases and 15% had died. Univariate statistical analysis revealed RT-PCR and the largest tumor diameter as important prognostic factors for the development of metastases and for survival. In a Cox proportional hazard model, RT-PCR result and largest tumor diameter predicted metastases (hazard ratios 7.3 and 2.6, respectively), whereas PCR result, largest tumor diameter, and Karnofsky performance status were significant variables for disease-specific survival (hazard ratios 22.6, 4.7, and 6.0, respectively). Analysis of individual RT-PCR results revealed both tyrosinase and MelanA/MART1 transcripts as independent prognostic factors. CONCLUSION The presence of tyrosinase or MelanA/MART1 transcripts is an independent prognostic factor in patients with high-risk primary uveal melanoma for subsequent development of metastases and for survival and can be used to select patients for adjuvant treatment studies.
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Affiliation(s)
- Ronny Schuster
- Department of Medicine III (Hematology, Oncology, and Transfusion Medicine), Charité, Campus Benjamin Franklin, Berlin, Germany
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Dias RS, Giordani AJ, Erwenne CM, Segreto HRC, Teixeira LF, Segreto RA. Braquiterapia com rutênio-106 em melanomas uveais - resultados preliminares: experiência uni-institucional. Radiol Bras 2007. [DOI: 10.1590/s0100-39842007000200008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar os resultados preliminares da braquiterapia com rutênio-106 em pacientes portadores de melanomas uveais. MATERIAIS E MÉTODOS: No período de abril de 2002 a julho de 2003, 20 pacientes com diagnóstico de melanoma uveal foram tratados com braquiterapia com rutênio-106. A dose calculada no ápice tumoral variou de 55 Gy a 100 Gy. Pacientes com lesões com altura maior que 5 mm foram submetidos a termoterapia transpupilar concomitante à colocação da placa oftálmica. RESULTADOS: Quanto à localização da lesão, esta se encontrava na coróide em 75% dos casos, na íris em 15% e no corpo ciliar em 10% dos pacientes. Com seguimento mediano de 19 meses, a sobrevida livre de progressão para a braquiterapia e para a associação com a termoterapia transpupilar foi de 69% e 87%, respectivamente. Observou-se redução significante da altura tumoral após o tratamento. Nenhum dos pacientes foi submetido a enucleação. CONCLUSÃO: Nossos resultados preliminares mostram que a braquiterapia com rutênio-106 é uma opção adequada para o tratamento conservador de melanomas uveais em termos de controle local, manutenção do globo ocular e visão útil, com índice aceitável de complicações.
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Zografos L. Radiotherapy in ophthalmology : 2004 Jules Gonin lecture of the Retina Research Foundation. Graefes Arch Clin Exp Ophthalmol 2007; 244:895-906. [PMID: 16847686 DOI: 10.1007/s00417-005-0120-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Heindl LM, Lotter M, Strnad V, Sauer R, Naumann GOH, Knorr HLJ. Hochdosisbrachytherapie des malignen Aderhaut- und Ziliarkörpermelanoms mit 106Ruthenium. Ophthalmologe 2007; 104:149-57. [PMID: 17123048 DOI: 10.1007/s00347-006-1451-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to report the multifactorial results of high-dose (106)Ruthenium plaque brachytherapy for (cilio-)choroidal melanoma and to confirm them by histological examinations. PATIENTS AND METHODS 100 patients with choroidal or ciliochoroidal melanoma treated by high-dose 106Ruthenium plaque brachytherapy were followed-up for 5 years. 12 secondary enucleated eyes were compared to a non-irradiated matched group by light microscopy. RESULTS The 5-year local tumour control rate was 93%, the 5-year survival rate 91%. Late radiogenic side effects occured as a retinopathy in 13%, as an optic neuropathy in 5% and as a secondary glaucoma in 3% of the patients. 14% had to be enucleated, 10% developed metastases. The histopathologic examination revealed significantly higher degrees of necrosis (p=0,041), balloon cell degeneration (p=0,025) and fibrosis (p<0,001) in the irradiated melanomas than in the control tumours. CONCLUSION High-dose 106Ruthenium plaque brachytherapy turned out to be an effective treatment procedure for posterior uveal melanoma (not exceeding a prominence of 5,5 mm) with a high rate of local tumour control and a low rate of side effects.
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Affiliation(s)
- L M Heindl
- Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
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Gündüz K, Esmaeli B. Ocular oncology: diagnosis and management of malignant intraocular tumors. EXPERT REVIEW OF OPHTHALMOLOGY 2006. [DOI: 10.1586/17469899.1.2.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gambrelle J, Grange JD, Devouassoux Shisheboran M, Rivoire M, Baggetto LG, Jean-Louis B, Fleury J, Kodjikian L. Survival after primary enucleation for choroidal melanoma: changes induced by the introduction of conservative therapies. Graefes Arch Clin Exp Ophthalmol 2006; 245:657-63. [PMID: 17119996 DOI: 10.1007/s00417-006-0477-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 10/05/2006] [Accepted: 10/06/2006] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Most uveal melanomas are currently treated by eye-preserving radiotherapies. However, for melanomas of the largest size or with initial complications, enucleation remains the reference treatment. Enucleation is called primary when it is proposed as the only local treatment option for a melanoma. There is very little literature on the use of primary enucleation after the introduction of conservative treatments. Our main goal was to evaluate the survival of melanoma patients treated by primary enucleation since the introduction of proton-beam therapy in France in 1991. METHODS All melanoma patients undergoing primary enucleation in our department between 1991 and 2002 were included in this retrospective study. The 5-year melanoma-specific survival rate was calculated using the Kaplan-Meier method. The multivariate prognostic analysis was performed using the Cox proportional hazards model. RESULTS Forty patients, representing 8% of all patients with choroidal uveal melanoma diagnosed and followed up in our department during an 11-year period, were included in the study. No patient was lost to follow-up. The 5-year melanoma-specific survival rate was 31.45% (SE: 7.8) after primary enucleation. Significant prognosis factors in the multivariate analysis were: tumor thickness > 12 mm (p = 0.03), anterior margin of the tumor involving the iris (p = 0.018), and presence of epithelioid cells (p = 0.02). CONCLUSIONS The very low survival rate reported reflects the evolution of primary enucleation, which is currently indicated only for melanomas with the worst prognosis. The knowledge of current post-enucleation survival rates represents an essential achievement for both correct assessment of conservative therapies and patient counseling.
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Affiliation(s)
- J Gambrelle
- Department of Ophthalmology, Croix-Rousse Hospital, 103, Grande rue de la Croix-Rousse, Lyon, 69004, France
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Shields CL, Demirci H, Marr BP, Mashayekhi A, Dai VV, Materin MA, Shields JA. Intravitreal triamcinolone acetonide for acute radiation papillopathy. Retina 2006; 26:537-44. [PMID: 16770260 DOI: 10.1097/00006982-200605000-00007] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate intravitreal triamcinolone acetonide for patients with visually symptomatic acute radiation-induced papillopathy. METHODS In a prospective, nonrandomized, single-center case series, intravitreal triamcinolone acetonide (4 mg/0.1 mL) was injected through the pars plana using sterile technique in 9 patients with radiation papillopathy after plaque radiotherapy for choroidal melanoma. Status of radiation papillopathy and final visual acuity were the main outcome measures. RESULTS At the time of diagnosis of the choroidal melanoma, visual acuity was 20/20 to 20/40 (n = 6), 20/60 (n = 2), and 20/100 (n = 1). The mean radiation dose to the optic disk was 6,175 cGy (median, 5,994 cGy; range, 3,571-12,760 cGy). Radiation papillopathy developed a mean of 18 months (median, 17 months; range, 6-33 months) after plaque radiotherapy. In all cases, the choroidal melanoma was regressed, and there was no retinal detachment or neovascularization of the retina, optic disk, or iris. Concomitant radiation maculopathy was found in 8 eyes manifesting as macular edema (n = 8), intraretinal dot hemorrhages (n = 6), intraretinal exudation (n = 6), or nerve fiber layer infarction (n = 3). The radiation papillopathy findings included optic disk hyperemia (n = 9), edema (n = 9), and circumpapillary hemorrhage (n = 8). At the time of diagnosis of radiation papillopathy, visual acuity was 20/70 (n = 1), 20/100 (n = 4), 20/200 (n = 1), and counting fingers (n = 3). At 1 week after injection of triamcinolone acetonide, visual acuity improvement was found in seven patients, and resolution of optic disk hyperemia and edema was noted for four and three patients, respectively. At a mean follow-up of 11 months (median, 9 months; range, 6-19 months), visual acuity was stable or improved in 7 patients, and resolution of optic disk hyperemia and edema was found in all 9 patients. The mean time to improvement in visual acuity by > or =2 lines was 3 weeks (median, 1 week; range, 1-12 weeks). The mean time to complete resolution of radiation papillopathy was 4 months. The two patients with worse final visual acuity also had macular hole and central retinal vein obstruction. The only complication of this therapy was possibly related cataract in three patients. CONCLUSION During short-term follow-up, acute radiation-induced papillopathy appears to respond rapidly to intravitreal triamcinolone acetonide injection with resolution of optic disk hyperemia and edema and modest return of visual acuity. The long-term effects remain unknown.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Kreusel KM, Bechrakis N, Riese J, Krause L, Wachtlin J, Foerster MH. Combined brachytherapy and transpupillary thermotherapy for large choroidal melanoma: tumor regression and early complications. Graefes Arch Clin Exp Ophthalmol 2006; 244:1575-80. [PMID: 16738857 DOI: 10.1007/s00417-006-0357-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 04/16/2006] [Accepted: 04/18/2006] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND To determine the effectiveness and risk profile of combined ruthenium- (Ru)-106-brachytherapy and transpupillary thermotherapy (TTT) of the tumour apex for the treatment of large choroidal melanoma. METHODS A consecutive series of 31 large choroidal melanoma treated by Ru-106-brachytherapy and adjuvant TTT was studied. TTT was performed 1 day prior to plaque removal and up to 3 times (mean: 1.8) during follow-up. Evaluation comprised tumour regression, treatment-related adverse events, necessity of additional treatment and visual results. RESULTS Mean follow-up was 21.6+/-7.8 (10.8-38.3) months. Mean tumour thickness was 6.8+/-1.0 (5.0-8.9) mm prior to treatment. Mean residual tumour thickness at the end of follow-up was 2.5+/-1.0 mm. Relevant adverse treatment effects were exudative maculopathy or macula oedema (22.6%), vitreous haemorrhage (16.1%), optic neuropathy (16.1%) and retinal detachment (9.7%). One tumour recurrence occurred during follow-up, and was treated by enucleation. CONCLUSIONS The combination of Ru-106-brachytherapy with TTT allows for the treatment of large posterior choroidal melanoma. The rate of treatment-related adverse events appears to be acceptable.
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Bechrakis NE, Foerster MH. Neoadjuvant proton beam radiotherapy combined with subsequent endoresection of choroidal melanomas. Int Ophthalmol Clin 2006; 46:95-107. [PMID: 16365558 DOI: 10.1097/01.iio.0000195856.31324.00] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nikolaos E Bechrakis
- Department of Ophthalmology, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Germany
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Marucci L, Lane AM, Li W, Egan KM, Gragoudas ES, Adams JA, Collier JM, Munzenrider JE. Conservation treatment of the eye: Conformal proton reirradiation for recurrent uveal melanoma. Int J Radiat Oncol Biol Phys 2006; 64:1018-22. [PMID: 16376492 DOI: 10.1016/j.ijrobp.2005.09.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Revised: 08/23/2005] [Accepted: 09/07/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the outcomes of a second course of proton beam radiation therapy (PBRT) in patients with recurrent uveal melanoma. METHODS AND MATERIALS Thirty-one patients received a second course of PBRT. The mean interval between the first and the second PBRT course was 50.2 months (range, 8-165 months). Most patients (87%) received 70 cobalt Gray equivalent (CGE) for both courses. Visual acuity was 20/200 or better in 30 patients initially and in 22 patients at the second treatment. The mean follow-up time after the second treatment was 50 months (range, 6-164 months). RESULTS At the time of the last follow-up, 20 patients were classified as having no evidence of disease, defined as tumor regression or an absence of tumor progression. Nine eyes (29%) were enucleated because of local recurrence (n = 5) or intractable pain (n = 4). The 5-year eye retention rate was 55% (95% confidence interval: 25.2-77.4). Six of the 22 patients who retained the eye (27%) had useful vision (20/200 or better). CONCLUSIONS A second course of PBRT for recurrent uveal melanoma to total doses between 118 and 140 CGE was associated with a relatively good probability of local control and a low enucleation rate. Although most patients lost vision, the majority were able to retain the reirradiated eye. Further evaluation is needed to assess metastasis-free survival of additional proton irradiation vs. enucleation after local recurrence.
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Affiliation(s)
- Laura Marucci
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
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Damato B, Patel I, Campbell IR, Mayles HM, Errington RD. Visual acuity after Ruthenium106 brachytherapy of choroidal melanomas. Int J Radiat Oncol Biol Phys 2005; 63:392-400. [PMID: 15990248 DOI: 10.1016/j.ijrobp.2005.02.059] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Accepted: 02/01/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE To report on conservation of visual acuity after Ruthenium(106) (Ru-106) brachytherapy of choroidal melanoma. METHODS AND MATERIALS This study was a noncomparative interventional case series of 458 patients with choroidal melanoma treated at a single center between January 1993 and December 2001. The intervention consisted of Ru-106 brachytherapy delivering minimum scleral and apex doses of 300 Gy and 80 Gy, respectively, using a 15-mm or 20-mm plaque. For discrete, posterior tumors, the plaque was positioned eccentrically with its posterior edge aligned with the posterior tumor margin. To ensure correct plaque positioning, any overlying extraocular muscles were dis-inserted, and the locations of both tumor and plaque edges were confirmed by transillumination and indentation. The main outcome measures were conservation of vision of 20/40 or better, 20/200 or better, and Counting Fingers or better, according to baseline variables. RESULTS The actuarial rate of conservation of 20/40 or better was 55% at 9 years, loss of such vision correlating with posterior tumor extension (p < 0.001), temporal tumor location (p = 0.001), increased tumor height (p = 0.01), and older age (p < 0.01) (Cox multivariate analysis). Similar analyses showed conservation of 20/200 or better in 57% of eyes at 9 years, loss correlating with reduced initial visual acuity (p < 0.001), posterior tumor extension (p < 0.001), and temporal tumor location (p = 0.006). Counting Fingers or better vision was conserved in 83% of patients at 9 years, loss correlating with increased tumor height (p < 0.0001). Local tumor recurrence occurred in 9 patients (actuarial rate, 3% at 9 years). CONCLUSION Ruthenium(106) brachytherapy of posterior choroidal melanoma achieves good conservation of vision if the tumor does not extend close to the optic nerve or fovea.
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Affiliation(s)
- Bertil Damato
- Ocular Oncology Service, St. Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom.
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Kaulich TW, Zurheide J, Haug T, Nüsslin F, Bamberg M. Clinical quality assurance for 106Ru ophthalmic applicators. Radiother Oncol 2005; 76:86-92. [PMID: 15972240 DOI: 10.1016/j.radonc.2005.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Revised: 04/17/2005] [Accepted: 05/09/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Episcleral brachytherapy using 106Ru/106Rh ophthalmic applicators is a proven method of therapy of uveal melanomas sparing the globe and in many cases sparing the vision. In the year 2001, an internal clinical quality assurance procedure revealed that part of the ophthalmic applicators leaked and that the calibration was erroneous. Consequently, the producer modernized its production procedures and, in May 2002, introduced a dose rate calibration that is traceable to the NIST standard. This NIST calibration confirmed that the previous calibration had been incorrect. In order to study the effects of the producer's new internal quality assurance procedures on the ophthalmic applicators, applicators of this new generation were submitted to a newly improved internal clinical acceptance test. PATIENTS AND METHODS The internal clinical acceptance test consists of a leakage test and a dosimetric test of the ophthalmic applicators. The leakage test simulates contact of the ophthalmic applicators with chloride containing body fluid. The dosimetric tests measure depth dose curves and dose rate with a plastic scintillator dosimetric system and compare them with the indications in the producer's certificate. Furthermore, the depth dose profile of the most frequently used applicator (type CCB) was compared with published data. RESULTS The internal clinical leakage test showed that all of the tested ophthalmic applicators belonging to the new generation (n=17) were tight and not contaminated. The dosimetric acceptance tests applied to seven different types of applicators revealed that the relative depth dose profiles in the therapeutically relevant range (up to a depth of <or=7 mm) deviate from the producer's indications only by -2.7 to +3.2%. The acceptance test of the dose rate values of the ophthalmic applicators at a distance of 2mm from the surface of the applicators resulted in a coefficient of variation of 1.7% (n=17). In the evaluation of the depth dose profile of the type CCB applicator the producer's indications and the results of the entrance test conformed very well to published data. CONCLUSIONS The internal clinical quality assurance procedure has proved successful in three ways. (1) It had a catalytic effect that led to the development of a new generation of ophthalmic applicators. (2) It could be demonstrated that this new generation of applicators is up to the state of the art in brachytherapy. (3) With this new generation of 106Ru/106Rh ophthalmic applicators it is possible for the first time in the history of their use to apply the dose that is prescribed by the radiooncologist.
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Mourtada F, Koch N, Newhauser W. 106Ru/106Rh plaque and proton radiotherapy for ocular melanoma: a comparative dosimetric study. RADIATION PROTECTION DOSIMETRY 2005; 116:454-60. [PMID: 16604677 DOI: 10.1093/rpd/nci266] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The objective of this study was to perform comparative dosimetric studies of both 106Ru/106Rh plaque brachytherapy and external beam proton therapy proposed for ocular treatments at the University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. These modalities were also compared with traditional 125I plaque brachytherapy. Using a standardised eye model with a representative ocular melanoma tumour, the relative dose distributions within the tumour and surrounding tissue were calculated using the Monte Carlo code MCNPX. Published absorbed dose distributions benchmarked the Monte Carlo models. Results indicate that the proton beam provided superior dose uniformity within the tumour volume, whereas the dose distribution from 106Ru/106Rh was more heterogeneous. Relative to 125I COMS plaque, both 106Ru/106Rh and protons have shown more confined dose distributions to the tumour volume in this situation, thus sparing other critical ocular structures. For protons, it has been shown that only doses lower than the maximum dose are delivered outside the tumour volume. Depending on the clinical situation, this may aid in the sparing of critical structures located in the sclera and optic disc boundary. The Monte Carlo model's statistical uncertainties of the mean dose estimates for the 106Ru/106Rh plaque and proton beam were 3 and 2.5%, respectively.
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Affiliation(s)
- F Mourtada
- Radiation Physics Department, Box 94, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Langmann G, Wackernagel W, Stücklschweiger G, Feichtinger K, Papaefthymiou G, Faulborn J. Dosis-Volumen-Histogramm-Regressionsanalyse von Aderhautmelanomen nach einzeitiger Leksell-Gamma-Knife-Radiochirurgie. Ophthalmologe 2004; 101:1111-9. [PMID: 15205904 DOI: 10.1007/s00347-003-0984-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND To evaluate tumor regression and sequelae in 30 uveal melanomas treated with Gamma Knife radiosurgery between 1992 and 1995 at the Gamma Knife center in Graz. PATIENTS A total of 30 uveal and ciliary body melanomas were treated with a single fraction of the Gamma Knife. The mean marginal dose was 52.1 Gy, (median 50 Gy). Of the tumors, 15 were large (higher than 8 mm), 14 were medium sized (3-8 mm) and one was a small melanoma (<3 mm). Among them were 6 juxtapapillary, 10 (juxta-) maculary melanomas, 5 tumors located in the midperiphery and 9 ciliary body melanomas. METHOD Dose-volume histogram analysis. RESULTS After a maximum follow up of 9 years and 7 months, 8 tumors regressed into a scar, 17 tumors into a residual prominence between 50% and 80% of the initial tumor height, 3 tumors showed no change and in 2 patients recurrence was obvious. Sequelae were classified as mild (in 3 patients), moderate (3), severe (5) and very severe (19). CONCLUSIONS Significant factors for the development of severe sequelae were the tumor volume and the marginal dose, the mean dose proved to be more important than the marginal dose and the irradiated volume more important than the selective critical dose.
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Schmittel A, Bechrakis NE, Martus P, Mutlu D, Scheibenbogen C, Bornfeld N, Foerster MH, Thiel E, Keilholz U. Independent prognostic factors for distant metastases and survival in patients with primary uveal melanoma. Eur J Cancer 2004; 40:2389-95. [PMID: 15519510 DOI: 10.1016/j.ejca.2004.06.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Revised: 05/27/2004] [Accepted: 06/26/2004] [Indexed: 11/16/2022]
Abstract
Adjuvant treatment strategies in uveal melanoma require determination of prognostic factors. Patients, who received primary therapy in 1994 and 1995 at our institution, were analysed. Of 271 patients 85% and 71% were available for follow up of 4 and 5 years. Forty three patients (15.9%) developed metastases. Kaplan-Meier analysis revealed a 5-year progression free survival (PFS) of 79% for the whole patient cohort. Extraocular tumor growth (EOG), ciliary body involvement or a largest tumor diameter (LTD) >14 mm were associated with a significantly lower 5-year PFS of 28%, 61.4% or 67.6%. In multivariate analysis time to progression was significantly associated with ciliary body involvement and LTD, and survival was associated with ciliary body involvement. Ciliary body involvement profoundly increased the risk for metastases (hazard ratio 6.9, P<0.001) within the first 3 years. This study determined patients with ciliary body involvement to be candidates for future adjuvant therapeutic interventions.
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Affiliation(s)
- Alexander Schmittel
- Department of Medicine III (Hematology, Oncology and Transfusionmedicine), Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
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Heufelder J, Cordini D, Fuchs H, Heese J, Homeyer H, Kluge H, Morgenstern H, Höcht S, Nausner M, Bechrakis NE, Hinkelbein W, Foerster MH. [Five years of proton therapy of eye neoplasms at the Hahn-Meitner Institute, Berlin]. Z Med Phys 2004; 14:64-71. [PMID: 15104012 DOI: 10.1078/0939-3889-00190] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Eye tumors (choroidal melanomas, iris melanomas, and choroidal hemangiomas) are being treated with 68 MeV protons since 1998 at the Ion Beam Laboratory of the Hahn-Meitner Institute of Berlin (Germany's first proton therapy center), in cooperation with the Charité University Hospital in Berlin, Campus Benjamin Franklin. The proton beam, generated via a combination of Van de Graaff accelerator and cyclotron, is prepared by passive shaping for conformal tumor irradiation. A digital X-ray verification of the tumor location with the patient in sitting position limits the position uncertainties to a maximum of 0.3 mm. The treatment planning is performed using the program EYEPLAN. OCTOPUS, a CT-based planning program developed in cooperation with the German Cancer Research Center of Heidelberg, is under pre-clinical testing. Thus far, more than 400 patients have been irradiated. The first results are comparable to those obtained in other proton therapy centers. At the end of 2002, the University Hospital of Essen has also become a cooperation partner of the Hahn-Meitner Institute.
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Augsburger JJ, Khouri L, Roumeliotis A, Kersten RC, Kulwin DR, Schneider S. Enucleation versus preservation of blind eyes following plaque radiotherapy for choroidal melanoma. Can J Ophthalmol 2004; 39:372-9. [PMID: 15327102 DOI: 10.1016/s0008-4182(04)80008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Currently available information about patients with posterior uveal melanoma treated by plaque radiotherapy is insufficient to determine what to do about eyes that become blind as a consequence of the tumour and its treatment. Should they be enucleated, or is ocular preservation just as good in terms of survival? METHODS We performed a retrospective survival analysis of secondary enucleation versus ocular preservation in patients with a posterior uveal melanoma treated by plaque radiotherapy whose irradiated eye became completely blind following that treatment. Of the 79 patients who fulfilled defined inclusion criteria, 25 underwent secondary enucleation of the blind eye, and 54 retained their irradiated blind eye. RESULTS Most of the baseline demographic and tumour-related variables evaluated were similarly distributed between the subgroups. The 5-year, 10-year and 15-year all-cause death rates in the secondary enucleation subgroup were 24.7%, 51.5% and 52.0% respectively, and those in the ocular preservation subgroup were 7.4%, 32.9% and 48.1% respectively. In spite of the apparent slight difference between the curves, the difference was not statistically significant (p = 0.41, Mantel-Haenszel test). INTERPRETATION Although a retrospective study of this type has several limitations, our results suggest that secondary enucleation is not likely to substantially improve survival of patients whose irradiated eye becomes totally blind following plaque radiotherapy for choroidal or ciliochoroidal melanoma.
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Affiliation(s)
- James J Augsburger
- Oncology Service, Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0527, USA.
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Kodjikian L, Roy P, Rouberol F, Garweg JG, Chauvel P, Manon L, Jean-Louis B, Little RE, Sasco AJ, Grange JD. Survival after proton-beam irradiation of uveal melanomas. Am J Ophthalmol 2004; 137:1002-10. [PMID: 15183783 DOI: 10.1016/j.ajo.2004.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the independent prognostic factors for survival, metastasis, local recurrence, and enucleation in patients who had undergone proton-beam therapy for posterior uveal melanomas. DESIGN Interventional case series. METHODS In this retrospective study, 224 consecutive incident cases were treated at the Biomedical Cyclotron Centre (Nice, France) from June 1991 to December 1997. Overall, metastasis-free, local recurrence-free, and enucleation-free survival rates were calculated according to the Kaplan-Meier method using the log-rank test. The multivariate prognostic analysis was performed using the Cox proportional hazards model. RESULTS The 5-year overall survival rate was 78.1% (SE: 3.7%). A largest basal tumor diameter (LTD) below 10 mm and female sex were independently associated with a better prognosis. The 5-year metastasis-free survival rate was 75.6% (SE: 3.6%). Only an LTD above 10 mm and ciliary body involvement were independently associated with metastasis. Ten patients (4.5%) had a local recurrence, which was correlated with the risk of metastasis (P =.045). The 5-year enucleation-free survival rate was 69.6% (SE: 4.0%). Once again, an LTD below 10 mm and female sex were predictive of a better prognosis. CONCLUSION Our results with proton-beam therapy correspond to those reported in the literature. This treatment strategy is safe and yields predictably good results. In addition to the two independent prognostic factors for survival and metastasis, namely LTD and ciliary body involvement, sex also had a significant impact in our case series, but the clinical relevance of this finding is unknown.
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Affiliation(s)
- L Kodjikian
- Department of Ophtalmology, Croix-Rousse Hospital, and Laboratory of Biomaterials and Matrix Remodelling, Claude Bernard University, Lyon, France.
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Damato B, Lecuona K. Conservation of eyes with choroidal melanoma by a multimodality approach to treatment. Ophthalmology 2004; 111:977-83. [PMID: 15121377 DOI: 10.1016/j.ophtha.2003.09.028] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Accepted: 09/05/2003] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To report on conservation of eyes with choroidal melanoma with a multimodality approach to treatment. DESIGN Prospective, noncomparative, interventional case series. PARTICIPANTS All 1632 patients with choroidal melanoma treated at a single center between 1993 and 2002. INTERVENTION Primary enucleation (35%), brachytherapy (31.3%), proton beam radiotherapy (16.7%), transscleral local resection (11.0%), endoresection (3.7%), transpupillary thermotherapy (2.5%), and photocoagulation (0.1%). MAIN OUTCOME MEASURES Primary and secondary enucleation. RESULTS Logistic regression showed the main predictive factors for primary enucleation to be: age more than 60 years (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.8%-3.2%); reduced visual acuity (OR, 2.5; 95% CI, 1.9%-3.2%); posterior extension close to or involving the optic disc and fovea (OR, 1.7; 95% CI, 1.2%-2.4%); circumferential spread around the ciliary body, iris, or angle (OR, 3.1; 95% CI, 1.8%-5.5%); basal tumor diameter (OR, 3.5; 95% CI, 2.4%-5.0%); and tumor height (OR, 6.3; 95% CI, 4.5%-8.9%). After conservative treatment, the actuarial rate of secondary enucleation was 11.1% at 5 years (95% CI, 8.6%-13.6%). Cox multivariate analysis indicated the factors independently predicting secondary enucleation as: nasal/midline tumor location (risk ratio [RR], 2.6; 95% CI, 1.6%-4.4%); disc involvement (RR, 2.2; 95% CI, 1.2%-4.1%); tumor diameter (RR, 1.2; 95% CI, 1.0%-1.5%); and tumor thickness (RR, 1.8; 95% CI, 1.5%-2.1%). CONCLUSIONS With a multimodality approach to treatment, 65% of patients underwent conservative treatment, and of them, 89% retained their eye at 5 years, with success depending on tumor diameter, tumor thickness, disc involvement, and coronal location.
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Affiliation(s)
- Bertil Damato
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
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Hermann RM, Christiansen H, Schmidberger H, Hess CF, Pradier O. Comment on 'Dieckmann K, Georg D, Zehetmayer M, Bogner J, Georgopoulos M, Pötter R. LINAC based stereotactic radiotherapy of uveal melanoma: 4 years clinical experience.' [Radiother Oncol. 2003;67(2):199-206]. Radiother Oncol 2004; 70:211. [PMID: 15028413 DOI: 10.1016/j.radonc.2003.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Accepted: 11/21/2003] [Indexed: 11/20/2022]
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91
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Lumbroso-Le Rouic L, Charif Chefchaouni M, Levy C, Plancher C, Dendale R, Asselain B, Solignac S, Mazal A, Desjardins L. 125I plaque brachytherapy for anterior uveal melanomas. Eye (Lond) 2004; 18:911-6. [PMID: 15002010 DOI: 10.1038/sj.eye.6701361] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To describe the results of 125I plaque brachytherapy of uveal melanomas anterior to the equator in terms of local control and the associated complications while trying to identify their risk factors (patients' demographic data, ocular, and tumour characteristics). METHODS Retrospective analysis of a series of patients treated by 125I between 1990 and 2000 in a single institution. The main outcome measures are evaluation of local tumour control and complications associated with 125I plaque brachytherapy of these melanomas. RESULTS During the study period, 136 patients were treated for an anterior tumour. The median follow-up was 62 months. The overall 5-year survival rate was 88.3%, the 5-year metastasis rate was 4% and the local recurrence rate was 1.5%. The mean final visual acuity was 20/40. The ocular complications most frequently observed at 5 years were cataract (50.3%), maculopathy (18.3%), intraocular inflammation (19.3%), and glaucoma (10.6%). Optic neuropathy, retinal detachment, keratitis, and intravitreous haemorrhage were also described. Risk factors for worse survival were age greater than 65 years and initial tumour thickness greater than 4 mm. Risk factors for the development of cataract were age more than 65 years old, male gender, and tumour diameter of more than 10 mm. Risk factors for intraocular inflammation were tumour thickness of more than 4 mm and invasion of the ciliary body. CONCLUSIONS The use of 125I plaque brachytherapy to treat melanomas situated anterior to the equator allows good local and systemic control with a low rate of macular and optic disc complications. The most frequent complication was cataract formation.
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92
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Bartlema YM, Oosterhuis JA, Journée-De Korver JG, Tjho-Heslinga RE, Keunen JEE. Combined plaque radiotherapy and transpupillary thermotherapy in choroidal melanoma: 5 years' experience. Br J Ophthalmol 2004; 87:1370-3. [PMID: 14609837 PMCID: PMC1771877 DOI: 10.1136/bjo.87.11.1370] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the results of combined plaque radiotherapy and transpupillary thermotherapy (TTT) in 50 consecutive patients 5 years after treatment. METHODS 50 adult patients with choroidal melanoma were treated with ruthenium-106 ((106)Ru) plaque radiotherapy combined with TTT. A flat scar was the preferred end point of treatment. The mean tumour thickness was 3.9 mm (range 1.5-8.0 mm), the mean tumour diameter was 11.3 mm (range 5.8-15.0 mm). TTT was performed with an infrared diode laser at 810 nm, a beam diameter of 2-3 mm, and 1 minute exposures. Tumours >5 mm thick received an episcleral contact dose of 800 Gy (106)Ru; tumours <or=5 mm thick received a contact dose of 600 Gy (106)Ru. TTT was repeated in case of incomplete tumour regression after combined therapy. RESULTS Complete tumour regression was obtained in 45 patients. It required one, two, or three TTT sessions in 32, 11, and two patients, respectively. In tumours <or=3 mm thick complete flattening was achieved significantly faster than in tumours >3 mm thick (log rank test p = 0.01). Eight melanomas were amelanotic, seven of which required multiple TTT sessions. In one patient the tumour recurred at the central margin of the treated area; this eye was enucleated. In one patient the tumour failed to regress 6 months after treatment and enucleation was performed at the patient's request. Three eyes developed severe proliferative retinopathy. Radiation maculopathy caused a loss of the best corrected visual acuity: before treatment 31 patients had a best corrected visual acuity of 20/60 or better but in only 12 patients did it remain in this range 5 years after treatment. Three patients developed distant metastasis to the liver. CONCLUSION The 5 year results for combined plaque radiotherapy and TTT as treatment for choroidal melanoma are favourable in terms of complete tumour regression and low rate of recurrences; however, there was considerable loss of visual acuity as a result of radiation maculopathy.
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Affiliation(s)
- Y M Bartlema
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, Netherlands
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93
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Gambrelle J, Kodjikian L, Rouberol F, Donate D, Duquesne N, Jean-Louis B, Chauvel P, Gérard JP, Romestaing P, Grange JD. Mélanomes uvéaux impliquant le corps ciliaire. Analyse de la survie après protonthérapie ou bêta-curiethérapie par ruthénium-106. J Fr Ophtalmol 2004; 27:40-7. [PMID: 14968076 DOI: 10.1016/s0181-5512(04)96090-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Our main goals were to study the survival of patients with uveal melanomas involving the ciliary body 5 and 10 years after treatment and to review prognosis. MATERIAL AND METHODS This study investigated 106 tumors (27 ciliary body melanomas and 79 choroidal-ciliary melanomas) of patients treated between June 1983 and April 1998. Seventy-two patients were treated with 106-ruthenium applicators and 34 were treated with proton therapy. Some large tumors or recurrences required a second treatment. The mean follow-up period was 91 months. RESULTS The mean tumor sizes before treatment were 6,6mm for melanoma thickness and 10.3mm for mean largest basal melanoma diameters (LTD). Of the patients studied, 71% were still alive at 5 years, 35% had metastasis and 27.7% developed recurrences. Multivariate analysis showed that the risk factors for melanoma-related death were LTD greater than 13mm, presence of exudative retinal detachment, macroscopic iris root involvement at the time of diagnosis, and choroidal-ciliary location. DISCUSSION AND CONCLUSION With 71% of patients still alive at 5 years, this review shows that melanomas involving the ciliary body do not seem less severe than more posterior uveal tumors. Because of size differences between ciliary body melanomas and choroidal-ciliary melanomas, we cannot come to the conclusion that choroidal-ciliary melanomas have a poorer prognosis than ciliary body melanomas. Largest tumor diameter over 13mm, presence of exudative retinal detachment, and macroscopic iris root involvement at the time of diagnosis are important risk factors for melanoma-related death, as shown by the multivariate analysis.
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Affiliation(s)
- J Gambrelle
- Service d'Ophtalmologie, Hôpital de la Croix-Rousse, Lyon
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94
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Abstract
The most common anterior segment tumors are primary neuroepithelial cysts, uveal melanomas, metastatic tumors, and benign tumors. In the majority of cases, the diagnosis can be made utilizing a careful clinical history and ocular examination. Ultrasound examination (low and high frequency) has become an indispensable tool used to determine tumor extension and involvement of the surrounding structures. In particular, high-frequency ultrasound has been used to uncover iris pigment epithelial cysts, to allow for the diagnosis of small ciliary body melanomas, and to measure tumors for plaque radiation planning. Whereas fluorescein angiography and computerized tomography have come to play a limited role, fine-needle aspiration biopsy has been found to be quite helpful in selected cases. Once the diagnosis is established, treatment decisions depend on the tumors' location, size, local extension, patterns of growth, and secondary complications. Most anterior segment tumors can be observed for growth prior to treatment. Other options include local resection (iridectomy, lamellar sclerouvectomy, or eye-wall resection) and radiation (ophthalmic plaque or external beam). Enucleation is typically employed if these eye- and vision-sparing treatments are not possible and for uncontrollable secondary glaucoma. This review examines the unique role of high-frequency ultrasonography for the diagnosis and treatment of anterior segment tumors as well as an overview of clinical practice.
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Affiliation(s)
- Flavio A Marigo
- The New York Eye Cancer Center; The Federal University of Minas Gerais and Instituto da Visão, Belo Horizonte, Brazil
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95
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Bogner J, Petersch B, Georg D, Dieckmann K, Zehetmayer M, Pötter R. A noninvasive eye fixation and computer-aided eye monitoring system for linear accelerator-based stereotactic radiotherapy of uveal melanoma. Int J Radiat Oncol Biol Phys 2003; 56:1128-36. [PMID: 12829151 DOI: 10.1016/s0360-3016(03)00280-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To introduce a noninvasive eye fixation and computer-aided eye monitoring system for linear accelerator-based stereotactic radiotherapy for uveal melanoma. METHODS AND MATERIALS At the Department of Radiotherapy and Radiobiology, University of Vienna, stereotactic radiotherapy is offered to patients with uveal melanoma considered unsuitable for (106)Ru brachytherapy or local resection. For the present feasibility study, 8 patients were carefully selected according to their ability to fixate a small light source with the diseased eye and whether they had a rather small head to meet the limited geometric space available. A polymethyl methacrylate tube was attached to a stereotactic mask system in craniocaudal orientation supporting a 45 degrees mirror, which was placed in front of the diseased eye. At the other end of the tube, the patient was given a small fixation light, and a small camera was positioned beneath, which was shielded for use during MRI. A computer interface calculated and visualized the spatial difference of the actual and a given reference pupil position, which was defined before CT scanning, during the MRI sequences, and during treatment delivery at the linear accelerator. RESULTS The described system can be attached to a conventional stereotactic mask system with minor modifications. Because of the large distance between the eye and the fixation light, the optical fixation system was well tolerated by all patients, and a stable position of the eye was obtained. The camera system can be used during CT and MRI without interference. Absorption of the 6-MV photon beam by the mirror and the polymethyl methacrylate tube was negligible. The computer interface designed to determine the pupil position uses an image-processing algorithm that correlates a template of the reference image with the actual image of the eye. Provided sufficient illumination of the pupil, the correlation function showed a pronounced minimum at the reference position. The precision of the algorithm was tested by phantom measurements. For a given 1 mm or 2 mm displacement, the interface reported a mean shift of 0.96 +/- 0.18 mm or 2.07 +/- 0.11 mm, respectively. CONCLUSION The results of this study demonstrated the feasibility of a new optical fixation system for linear accelerator-based stereotaxis. The artifact-free application of the camera system during image acquisition and irradiation and the use of the computer interface, which automatically monitored eye movements with submillimeter precision, provided large improvements compared with existing techniques. Given well-defined interruption criteria and accelerated image processing, the described system has a high potential to perform automatically gated treatment beam delivery in the near future.
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Affiliation(s)
- Joachim Bogner
- Department of Radiotherapy and Radiobiology, University of Vienna, Vienna, Austria.
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Nag S, Quivey JM, Earle JD, Followill D, Fontanesi J, Finger PT. The American Brachytherapy Society recommendations for brachytherapy of uveal melanomas. Int J Radiat Oncol Biol Phys 2003; 56:544-55. [PMID: 12738332 DOI: 10.1016/s0360-3016(03)00006-3] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This article presents the American Brachytherapy Society (ABS) guidelines for the use of brachytherapy for patients with choroidal melanomas. METHODS Members of the ABS with expertise in choroidal melanoma formulated brachytherapy guidelines based upon their clinical experience and a review of the literature. The Board of Directors of the ABS approved the final report. RESULTS Episcleral plaque brachytherapy is a complex procedure and should only be undertaken in specialized medical centers with expertise in this sophisticated treatment program. Recommendations were made for patient selection, techniques, dose rates, and dosages. Most patients with very small uveal melanomas (<2.5 mm height and <10 mm in largest basal dimension) should be observed for tumor growth before treatment. Patients with a clinical diagnosis of medium-sized choroidal melanoma (between 2.5 and 10 mm in height and <16 mm basal diameter) are candidates for episcleral plaques if the patient is otherwise healthy and without metastatic disease. A histopathologic verification is not required. Small melanomas may be candidates if there is documented growth; some patients with large melanomas (>10 mm height or >16 mm basal diameter) may also be candidates. Patients with large tumors or with tumors at peripapillary and macular locations have a poorer visual outcome and lower local control that must be taken into account in the patient decision-making process. Patients with gross extrascleral extension, ring melanoma, and tumor involvement of more than half of the ciliary body are not suitable for plaque therapy. For plaque fabrication, the ophthalmologist must provide the tumor size (including basal diameters and tumor height) and a detailed fundus diagram. The ABS recommends a minimum tumor (125)I dose of 85 Gy at a dose rate of 0.60-1.05 Gy/h using AAPM TG-43 formalism for the calculation of dose. NRC or state licensing guidelines regarding procedures for handling of radioisotopes must be followed. CONCLUSIONS Brachytherapy represents an effective means of treating patients with choroidal melanomas. Guidelines are established for the use of brachytherapy in the treatment of choroidal melanomas. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose reporting policies. These guidelines will be modified as further clinical results become available.
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Affiliation(s)
- Subir Nag
- Department of Radiation Oncology, Ohio State University, Columbus, OH 43210, USA.
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Dieckmann K, Georg D, Zehetmayer M, Bogner J, Georgopoulos M, Pötter R. LINAC based stereotactic radiotherapy of uveal melanoma: 4 years clinical experience. Radiother Oncol 2003; 67:199-206. [PMID: 12812851 DOI: 10.1016/s0167-8140(02)00345-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To study local tumor control and radiogenic side effects after fractionated LINAC based stereotactic radiotherapy for selected uveal melanoma. PATIENTS AND METHODS Between June 1997 and March 2001, 90 patients suffering from uveal melanoma were treated at a LINAC with 6 MV. The head was immobilized with a modified stereotactic frame system (BrainLAB). For stabilization of the eye position a light source was integrated into the mask system in front of the healthy or the diseased eye. A mini-video camera was used for on-line eye movement control. Tumors included in the study were either located unfavorably with respect to macula and optical disc (<3 mm distance) or presented with a thickness >7 mm. Median tumor volume was 305+/-234 mm3 (range 70-1430 mm3), and mean tumor height was 5.4+/-2.3 mm (range 2.7-15.9 mm). Total doses of 70 (single dose 14 Gy @ 80% isodose) or 60 Gy (single dose 12 Gy @ 80% isodose) were applied in five fractions within 10 days. The first fractionation results in total dose (TD) (2 Gy) of 175 Gy for tumor and 238 Gy for normal tissue, corresponding values for the second fractionation schedule are 135 and 180 Gy, respectively. RESULTS After a median follow-up of 20 months (range 1-48 months) local control was achieved in 98% (n=88). The mean relative tumor reductions were 24, 27, and 37% after 12, 24 and 36 months. Three patients (3.3%) developed metastases. Secondary enucleation was performed in seven patients (7.7%). Long term side effects were retinopathy (25.5%), cataract (18.9%), optic neuropathy (20%), and secondary neovascular glaucoma (8.8%). CONCLUSION Fractionated LINAC based stereotactic photon beam therapy in conjunction with a dedicated eye movement control system is a highly effective method to treat unfavorably located uveal melanoma. Total doses of 60 Gy (single dose 12 Gy) are considered to be sufficient to achieve good local tumor control.
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Affiliation(s)
- Karin Dieckmann
- Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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98
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Abstract
This article reviews the current pathogenesis, molecular changes, diagnosis, and treatment of ocular melanomas. Ocular melanomas can involve the eyelid, conjunctiva, intraocular structures, and the orbit. The most common eye melanoma involves the uveal tract and is responsible for approximately 13% of melanoma deaths. Uveal melanomas account for 10% of all melanomas.
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Affiliation(s)
- Devron H Char
- The Tumori Foundation, CPMC, Davies Campus, 45 Castro Street, Suite 309, San Francisco, CA 94114, USA.
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99
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Egger E, Zografos L, Schalenbourg A, Beati D, Böhringer T, Chamot L, Goitein G. Eye retention after proton beam radiotherapy for uveal melanoma. Int J Radiat Oncol Biol Phys 2003; 55:867-80. [PMID: 12605964 DOI: 10.1016/s0360-3016(02)04200-1] [Citation(s) in RCA: 182] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To analyze the long-term results of eye retention after conservative treatment of uveal melanoma with proton beam radiotherapy, and to analyze the causes leading to enucleation after this conservative treatment approach. MATERIALS AND METHODS This was a prospective, noncomparative, interventional, consecutive case series. A total of 2645 patients (2648 eyes) with uveal melanoma were treated between 1984 and 1999 with proton beam radiotherapy. Data were analyzed as of February 2001. Patients' age ranged from 9 to 90 years, 1284 were men, and 1361 were women. Largest tumor diameter ranged from 4 to 27.5 mm, and tumor height from 0.9 to 15.6 mm. Median follow-up time was 44 months. RESULTS The overall eye retention rate at 5, 10, and 15 years after treatment was 88.9%, 86.2%, and 83.7%, respectively. In total, 218 eyes had to be enucleated. Enucleation was related to larger tumor size, mainly tumor height, proximity of posterior tumor margin to optic disc, male gender, high intraocular pressure, and large degree of retinal detachment at treatment time. After optimization of the treatment technique, the eye retention rate at 5 years was increased from 97.1% to 100% for small tumors, from 86.7% to 99.7% for medium, and from 71.1% to 89.5% for large tumors. CONCLUSIONS The treatment technique as used today results in excellent eye retention rates, even in less favorable cases such as large tumors and tumors located close to the optic disc. The experience and a continuous quality control program allowed us to improve the 5-year eye retention rate for all tumor sizes. These findings demonstrate the positive impact of experience and quality control-based efforts for treatment technique optimization.
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Affiliation(s)
- Emmanuel Egger
- Division of Radiation Medicine, Paul Scherrer Institute, Villigen, Switzerland.
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100
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Kirwan JF, Constable PH, Murdoch IE, Khaw PT. Beta irradiation: new uses for an old treatment: a review. Eye (Lond) 2003; 17:207-15. [PMID: 12640408 DOI: 10.1038/sj.eye.6700306] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Beta radiation has a long history as a treatment modality in ophthalmology. It is a convenient and practical method of applying radiation and has the advantage of minimal tissue penetration. There has been a recent resurgence in the use of beta radiation in other areas in medicine, such as the prevention of restenosis after coronary artery stenting. Beta radiation has been shown in vitro and in vivo to inhibit proliferation of human Tenon's fibroblasts, which enter a period of growth arrest but do not die. Effects on the cell cycle controller p53 have been shown to be important in this process. In ophthalmology, beta radiation has been used widely for the treatment of pterygium and is under evaluation for treatment of age-related macular degeneration and for controlling wound healing after glaucoma drainage surgery. In this latter role, beta radiation may be particularly appropriate for use in developing countries to improve the results of trabeculectomy while potentially avoiding some of the side effects of other antimetabolites.
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Affiliation(s)
- J F Kirwan
- Department of Epidemiology and International Eye Health Institute of Ophthamology, London, UK.
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