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Hrbacek J, Kacperek A, Beenakker JWM, Mortimer L, Denker A, Mazal A, Shih HA, Dendale R, Slopsema R, Heufelder J, Mishra KK. PTCOG Ocular Statement: Expert Summary of Current Practices and Future Developments in Ocular Proton Therapy. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00748-X. [PMID: 38971383 DOI: 10.1016/j.ijrobp.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 05/08/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
Although rare cancers, ocular tumors are a threat to vision, quality of life, and potentially life expectancy of a patient. Ocular proton therapy (OPT) is a powerful tool for successfully treating this disease. The Particle Therapy Co-Operative Ocular Group) formulated an Evidence and Expert-Based Executive Summary of Current Practices and Future Developments in OPT: comparative dosimetric and clinical analysis with the different OPT systems is essential to set up planning guidelines, implement best practices, and establish benchmarks for eye preservation, vision, and quality of life measures. Contemporary prospective trials in select subsets of patients (eg, tumors near the optic disc and/or macula) may allow for dosimetric and clinical analysis between different radiation modalities and beamline systems to evaluate differences in radiation delivery and penumbra, and resultant tumor control, normal tissue complication rates, and overall clinical cost-effectiveness. To date, the combination of multimodal imaging (fundus photography, ultrasound, etc), ophthalmologist assessment, and clip surgery with radiation planning have been keys to successful treatment. Increased use of three-dimensional imaging (computed tomography/magnetic resonance imaging) is anticipated although its spatial resolution might be a limiting factor (eg, detection of flat diffuse tumor parts). Commercially produced ocular treatment-planning systems are under development and their future use is expected to expand across OPT centers. Future continuity of OPT will depend on the following: (1) maintaining and upgrading existing older dedicated low-energy facilities, (2) maintaining shared, degraded beamlines at large proton therapy centers, and (3) developing adapted gantry beams of sufficient quality to maintain the clinical benefits of sharp beam conformity. Option (1) potentially offers the sharpest beams, minimizing impact on healthy tissues, whereas (2) and (3) potentially offer the advantage of substantial long-term technical support and development as well as the introduction of new approaches. Significant patient throughputs and close cooperation between medical physics, ophthalmology, and radiation therapy, underpinned by mutual understanding, is crucial for a successful OPT service.
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Affiliation(s)
- Jan Hrbacek
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
| | | | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands; Department of Radiology, C.J. Gorter MRI Center, Leiden University Medical Center, Leiden, Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands; HollandPTC, Delft, Netherlands
| | - Linda Mortimer
- Medical Physics Department, The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom
| | - Andrea Denker
- Helmholtz-Zentrum Berlin für Materialien und Energie, Proton Therapy (BE-APT), Berlin, Germany
| | - Alejandro Mazal
- Medical Physics Service, Centro de Protonterapia Quironsalud, Madrid, Spain
| | - Helen A Shih
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Remi Dendale
- Institut Curie Protontherapy Center, Orsay, France
| | - Roelf Slopsema
- Department of Radiation Oncology, Emory Proton Therapy Center, Atlanta, Georgia
| | - Jens Heufelder
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, BerlinProtonen am HZB, Berlin, Germany
| | - Kavita K Mishra
- Proton Ocular Radiation Therapy Program, Department of Radiation Oncology, Osher Center for Integrative Health, Osher Foundation Endowed Chair in Clinical Programs in Integrative Health, University of California San Francisco, San Francisco, California
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Zheng Y, Tang Y, Yao Y, Ge T, Pan H, Cui J, Rao Y, Tao X, Jia R, Ai S, Song X, Zhuang A. Correlation Analysis of Apparent Diffusion Coefficient Histogram Parameters and Clinicopathologic Features for Prognosis Prediction in Uveal Melanoma. Invest Ophthalmol Vis Sci 2024; 65:3. [PMID: 38953846 PMCID: PMC11221615 DOI: 10.1167/iovs.65.8.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose To investigate the correlation between apparent diffusion coefficient (ADC) histograms and high-risk clinicopathologic features related to uveal melanoma (UM) prognosis. Methods This retrospective study included 53 patients with UM who underwent diffusion-weighted imaging (DWI) between August 2015 and March 2024. Axial DWI was performed with a single-shot spin-echo echo-planar imaging sequence. ADC histogram parameters of ADCmean, ADC50%, interquartile range (IQR), skewness, kurtosis, and entropy were obtained from DWI. The relationships between histogram parameters and high-risk clinicopathological characteristics including tumor size, preoperative retinal detachment, histological subtypes, Ki-67 index, and chromosome status, were analyzed by Spearman correlation analysis, Mann-Whitney U test, or Kruskal-Wallis test. Results A total of 53 patients (mean ± SD age, 55 ± 15 years; 22 men) were evaluated. The largest basal diameter (LBD) was correlated with kurtosis (r = 0.311, P = 0.024). Tumor prominence (TP) was correlated with entropy (r = 0.581, P < 0.001) and kurtosis (r = 0.273, P = 0.048). Additionally, significant correlations were identified between the Ki-67 index and ADCmean (r = -0.444, P = 0.005), ADC50% (r = -0.487, P = 0.002), and skewness (r = 0.394, P = 0.014). Finally, entropy was correlated with monosomy 3 (r = 0.541, P = 0.017). Conclusions The ADC histograms provided valuable insights into high-risk clinicopathologic features of UM and hold promise in the early prediction of UM prognosis.
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Affiliation(s)
- Yue Zheng
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yan Tang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiran Yao
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Tongxin Ge
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Hui Pan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Junqi Cui
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yamin Rao
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Songtao Ai
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Song
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ai Zhuang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Klaassen L, Haasjes C, Hol M, Cambraia Lopes P, Spruijt K, van de Steeg-Henzen C, Vu K, Bakker P, Rasch C, Verbist B, Beenakker JW. Geometrical accuracy of magnetic resonance imaging for ocular proton therapy planning. Phys Imaging Radiat Oncol 2024; 31:100598. [PMID: 38993288 PMCID: PMC11234150 DOI: 10.1016/j.phro.2024.100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 07/13/2024] Open
Abstract
Background & purpose Magnetic resonance imaging (MRI) is increasingly used in treatment preparation of ocular proton therapy, but its spatial accuracy might be limited by geometric distortions due to susceptibility artefacts. A correct geometry of the MR images is paramount since it defines where the dose will be delivered. In this study, we assessed the geometrical accuracy of ocular MRI. Materials & methods A dedicated ocular 3 T MRI protocol, with localized shimming and increased gradients, was compared to computed tomography (CT) and X-ray images in a phantom and in 15 uveal melanoma patients. The MRI protocol contained three-dimensional T2-weighted and T1-weighted sequences with an isotropic reconstruction resolution of 0.3-0.4 mm. Tantalum clips were identified by three observers and clip-clip distances were compared between T2-weighted and T1-weighted MRI, CT and X-ray images for the phantom and between MRI and X-ray images for the patients. Results Interobserver variability was below 0.35 mm for the phantom and 0.30(T1)/0.61(T2) mm in patients. Mean absolute differences between MRI and reference were below 0.27 ± 0.16 mm and 0.32 ± 0.23 mm for the phantom and in patients, respectively. In patients, clip-clip distances were slightly larger on MRI than on X-ray images (mean difference T1: 0.11 ± 0.38 mm, T2: 0.10 ± 0.44 mm). Differences did not increase at larger distances and did not correlate to interobserver variability. Conclusions A dedicated ocular MRI protocol can produce images of the eye with a geometrical accuracy below half the MRI acquisition voxel (<0.4 mm). Therefore, these images can be used for ocular proton therapy planning, both in the current model-based workflow and in proposed three-dimensional MR-based workflows.
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Affiliation(s)
- Lisa Klaassen
- Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
| | - Corné Haasjes
- Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
| | - Martijn Hol
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
- HollandPTC, Delft, the Netherlands
| | | | | | - Christal van de Steeg-Henzen
- Leiden University Medical Center, Department of Radiology, Leiden, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Khanh Vu
- Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands
| | - Pauline Bakker
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Coen Rasch
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Berit Verbist
- Leiden University Medical Center, Department of Radiology, Leiden, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Jan-Willem Beenakker
- Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
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Gelmi MC, Jager MJ. Uveal melanoma: Current evidence on prognosis, treatment and potential developments. Asia Pac J Ophthalmol (Phila) 2024; 13:100060. [PMID: 38641203 DOI: 10.1016/j.apjo.2024.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024] Open
Abstract
Uveal Melanoma (UM) is a rare disease, yet it is the most common primary intraocular malignancy in adult patients. Despite continuous advancements and research, the risk of metastasis remains high. It is possible to stratify patients according to their risk of metastases using a variety of known risk factors. Even though there is no gold standard for the prognostication of patients with uveal melanoma, it is becoming increasingly clear that combining histo-pathological, patient-related and molecular prognostic markers allows a more accurate prediction of the metastatic risk than by using one parameter. Primary UM in the eye are treated very effectively with eye-sparing radiation-based techniques or enucleation. However, it is not yet possible to prevent or treat metastases with the current therapeutic options. Nonetheless, the efforts to find new therapeutic targets continue and progress is being made, especially in the field of targeted therapy, as exemplified by the anti-gp100 bispecific molecule Tebentafusp. This review delves into the history of uveal melanoma, its incidence, presentation and diagnosis, the known prognostic factors and the treatment options, both for the primary tumour and for metastases. We show that different populations may have different risks for developing UM, and that each country should evaluate their own patients.
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Affiliation(s)
- Maria Chiara Gelmi
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
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Lim JZ, Gokul A, Misra SL, Pan X, Charlton A, McGhee CNJ. An optimized 3T MRI scan protocol to assess iris melanoma with subsequent histopathological verification - A prospective study. Asia Pac J Ophthalmol (Phila) 2024; 13:100047. [PMID: 38417788 DOI: 10.1016/j.apjo.2024.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) has demonstrated high levels of tissue contrast, accuracy and reproducibility in evaluating posterior uveal melanoma. Owing to smaller size, the role of MRI in detecting and characterising iris melanoma has not yet been explored. AIMS To develop a protocol to image iris melanoma and describe the MRI characteristics of histopathological-confirmed iris melanoma. MATERIALS AND METHODS An optimised MRI protocol, using a 3T MRI scanner and a 32-channel head coil, was developed to image iris tumours. A prospective, single-centre, 12-month study was conducted on all patients with lesions suspicious for iris melanoma. All patients were offered an MRI scan in addition to the standardised clinical procedures. Image quality comparison was made with existing clinical investigations. Iris melanoma characteristics on MRI are described. RESULTS A successful optimised MRI scan protocol was developed that was able to detect and characterise iris melanoma. One normal participant and five patients with subsequent histopathological-confirmed iris melanoma (n = 6) were recruited. Four patients completed the full MRI sequence. All iris melanoma were detected on at least one T1- or T2-weighted images. When compared to the vitreous, all iris melanomas demonstrated hyper-intensity on T1-weighted images and hypo-intensity on T2-weighted images. On T1-mapping, T1-values of iris melanoma demonstrated an inverse relationship with the degree of tumour pigmentation. CONCLUSIONS This study highlights an optimised, easily reproducible MRI scan protocol to image iris melanoma. Numerous MR imaging characteristics of iris melanoma are reported for the first time and a potential non-invasive tumour biomarker is described.
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Affiliation(s)
- Joevy Z Lim
- Department of Ophthalmology, New Zealand Eye Centre, University of Auckland, New Zealand; Department of Ophthalmology, Te Whatu Ora - Health New Zealand Auckland, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand Eye Centre, University of Auckland, New Zealand
| | - Stuti L Misra
- Department of Ophthalmology, New Zealand Eye Centre, University of Auckland, New Zealand
| | - Xingzheng Pan
- Department of Physiology, School of Medical Science, New Zealand Eye Centre, University of Auckland, New Zealand
| | - Amanda Charlton
- Department of Histopathology, Te Whatu Ora - Health New Zealand Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand Eye Centre, University of Auckland, New Zealand; Department of Ophthalmology, Te Whatu Ora - Health New Zealand Auckland, New Zealand.
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Jaarsma-Coes MG, Klaassen L, Marinkovic M, Luyten GPM, Vu THK, Ferreira TA, Beenakker JWM. Magnetic Resonance Imaging in the Clinical Care for Uveal Melanoma Patients-A Systematic Review from an Ophthalmic Perspective. Cancers (Basel) 2023; 15:cancers15112995. [PMID: 37296958 DOI: 10.3390/cancers15112995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Conversely to most tumour types, magnetic resonance imaging (MRI) was rarely used for eye tumours. As recent technical advances have increased ocular MRI's diagnostic value, various clinical applications have been proposed. This systematic review provides an overview of the current status of MRI in the clinical care of uveal melanoma (UM) patients, the most common eye tumour in adults. In total, 158 articles were included. Two- and three-dimensional anatomical scans and functional scans, which assess the tumour micro-biology, can be obtained in routine clinical setting. The radiological characteristics of the most common intra-ocular masses have been described extensively, enabling MRI to contribute to diagnoses. Additionally, MRI's ability to non-invasively probe the tissue's biological properties enables early detection of therapy response and potentially differentiates between high- and low-risk UM. MRI-based tumour dimensions are generally in agreement with conventional ultrasound (median absolute difference 0.5 mm), but MRI is considered more accurate in a subgroup of anteriorly located tumours. Although multiple studies propose that MRI's 3D tumour visualisation can improve therapy planning, an evaluation of its clinical benefit is lacking. In conclusion, MRI is a complementary imaging modality for UM of which the clinical benefit has been shown by multiple studies.
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Affiliation(s)
- Myriam G Jaarsma-Coes
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lisa Klaassen
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - T H Khanh Vu
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Teresa A Ferreira
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Tang MCY, Ferreira TA, Marinkovic M, Jaarsma-Coes MG, Klaassen L, Vu THK, Creutzberg CL, Rodrigues MF, Horeweg N, Klaver YLB, Rasch CRN, Luyten GPM, Beenakker JWM. MR-based follow-up after brachytherapy and proton beam therapy in uveal melanoma. Neuroradiology 2023:10.1007/s00234-023-03166-1. [PMID: 37249621 DOI: 10.1007/s00234-023-03166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE MRI is increasingly used in the diagnosis and therapy planning of uveal melanoma (UM). In this prospective cohort study, we assessed the radiological characteristics, in terms of anatomical and functional imaging, of UM after ruthenium-106 plaque brachytherapy or proton beam therapy (PBT) and compared them to conventional ultrasound. METHODS Twenty-six UM patients were evaluated before and 3, 6 and 12 months after brachytherapy (n = 13) or PBT (n = 13). Tumour prominences were compared between ultrasound and MRI. On diffusion-weighted imaging, the apparent diffusion value (ADC), and on perfusion-weighted imaging (PWI), the time-intensity curves (TIC), relative peak intensity and outflow percentages were determined. Values were compared between treatments and with baseline. RESULTS Pre-treatment prominences were comparable between MRI and ultrasound (mean absolute difference 0.51 mm, p = 0.46), but larger differences were observed post-treatment (e.g. 3 months: 0.9 mm (p = 0.02)). Pre-treatment PWI metrics were comparable between treatment groups. After treatment, brachytherapy patients showed favourable changes on PWI (e.g. 67% outflow reduction at 3 months, p < 0.01). After PBT, significant perfusion changes were observed at a later timepoint (e.g. 38% outflow reduction at 6 months, p = 0.01). No consistent ADC changes were observed after either treatment, e.g. a 0.11 × 10-3mm2/s increase 12 months after treatment (p = 0.15). CONCLUSION MR-based follow-up is valuable for PBT-treated patients as favourable perfusion changes, including a reduction in outflow, can be detected before a reduction in size is apparent on ultrasound. For brachytherapy, a follow-up MRI is of less value as already 3 months post-treatment a significant size reduction can be measured on ultrasound.
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Affiliation(s)
- Michael C Y Tang
- Department of Ophthalmology, Leiden University Medical Center, P.O. 9600, 2300, RC, Leiden, The Netherlands.
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
| | - Teresa A Ferreira
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, P.O. 9600, 2300, RC, Leiden, The Netherlands
| | - Myriam G Jaarsma-Coes
- Department of Ophthalmology, Leiden University Medical Center, P.O. 9600, 2300, RC, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Lisa Klaassen
- Department of Ophthalmology, Leiden University Medical Center, P.O. 9600, 2300, RC, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - T H Khanh Vu
- Department of Ophthalmology, Leiden University Medical Center, P.O. 9600, 2300, RC, Leiden, The Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Myra F Rodrigues
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
- Holland Proton Therapy Center, Delft, Netherlands
| | - Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Yvonne L B Klaver
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
- Holland Proton Therapy Center, Delft, Netherlands
| | - Coen R N Rasch
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
- Holland Proton Therapy Center, Delft, Netherlands
| | - Gre P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, P.O. 9600, 2300, RC, Leiden, The Netherlands
| | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, P.O. 9600, 2300, RC, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
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Huang T, Xu X, Cheng C, Wang J, Yang L. Cooperative phototherapy based on bimodal imaging guidance for the treatment of uveal melanoma. J Nanobiotechnology 2023; 21:146. [PMID: 37143039 PMCID: PMC10161622 DOI: 10.1186/s12951-023-01891-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Uveal melanoma (UM) is adults' most common primary intraocular malignant tumor, prone to metastasis and high mortality. Eyeball enucleation commonly used in the clinic will lead to permanent blindness and mental disorders. Thus, new methods are urgently needed to diagnose and treat UM early to preserve patients' vision. METHODS AND RESULTS Herein, multifunctional nanoparticles (NPs) were synthesized by loading chlorin e6 (Ce6) in poly-lactic-co-glycolic acid (PLGA) NPs and wrapping FeIII-tannic acid (FeIII-TA) on the outside (FeIII-TA/PLGA/Ce6, designated as FTCPNPs). Then, the synergistic photothermal therapy (PTT) and photodynamic therapy (PDT) antitumor effects of FTCPNPs excited by near-infrared (NIR) laser were evaluated. Moreover, we verified the mechanism of synergistic PTT/PDT leading to mitochondrial dysfunction and inducing tumor cell apoptosis. Additionally, FTCPNPs can be used as excellent magnetic resonance (MR)/photoacoustic (PA) imaging contrast agents, enabling imaging-guided cancer treatment. Finally, The NPs have good biological safety. CONCLUSION This noninvasive NIR light-triggered cooperative phototherapy can easily penetrate eye tissue and overcome the disadvantage of limited penetration of phototherapy. Therefore, cooperative phototherapy is expected to be used in fundus tumors. This treatment model is applied to UM for the first time, providing a promising strategy and new idea for integrating the diagnosis and treatment of UM.
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Affiliation(s)
- Tong Huang
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Xinzhi Xu
- Department of Ultrasound, Chongqing University Cancer Hospital, Chongqing, 400030, P. R. China
| | - Chen Cheng
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Jianxin Wang
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China.
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, P. R. China.
| | - Liping Yang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China.
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Hussain RN, Damato B, Heimann H. Choroidal biopsies; a review and optimised approach. Eye (Lond) 2023; 37:900-906. [PMID: 35941182 PMCID: PMC10050311 DOI: 10.1038/s41433-022-02194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022] Open
Abstract
The majority of choroidal tumours are diagnosed accurately with clinical examination and the additional data obtained from non-invasive imaging techniques. Choroidal biopsies may be undertaken for diagnostic clarity in cases such as small melanocytic or indeterminate lesions, identifying the primary tumour in the case of choroidal metastases or the subclassification of rarer conditions such as uveal lymphoma. There is however an increasing use of biopsy techniques for prognostication in uveal melanoma. This review explores the main indications and surgical techniques for tumour acquisition, and the optimised approach utilised by the current authors to improve successful yield for histological and genetic analysis.
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Affiliation(s)
- R N Hussain
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK.
| | - B Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - H Heimann
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
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Gelmi MC, Wierenga AP, Kroes WG, van Duinen SG, Karuntu JS, Marinkovic M, Bleeker JC, Luyten GP, Vu TK, Verdijk RM, Jager MJ. Increased histological tumour pigmentation in Uveal Melanoma is related to eye colour and loss of chromosome 3/BAP1. OPHTHALMOLOGY SCIENCE 2023; 3:100297. [PMID: 37193315 PMCID: PMC10182323 DOI: 10.1016/j.xops.2023.100297] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/04/2023] [Accepted: 02/17/2023] [Indexed: 03/16/2023]
Abstract
Purpose Heavy pigmentation is known to be a prognostic risk factor in uveal melanoma (UM). We analyzed whether genetic tumor parameters were associated with tumor pigmentation and whether pigmentation should be included in prognostic tests. Design Retrospective comparison of clinical, histopathological, and genetic features and survival in UM with different pigmentation. Participants A total of 1058 patients with UM from a White European population with diverse eye colors enucleated between 1972 and 2021. Methods Cox regression and log-rank tests were used for survival analysis; the chi-square test and Mann-Whitney U test were used for correlation analysis. Main Outcome Measures Uveal melanoma-related survival based on tumor pigmentation and chromosome status, correlation of tumor pigmentation with prognostic factors. Results The 5-year UM-related mortality was 8% in patients with nonpigmented tumors (n = 54), 25% with lightly pigmented tumors (n = 489), 41% with moderately pigmented tumors (n = 333), and 33% with dark tumors (n = 178) (P < 0.001). The percentage of tumors with monosomy 3 (M3) or 8q gain increased with increasing pigmentation (31%, 46%, 62%, and 70% having M3 [P < 0.001], and 19%, 43%, 61%, and 63% having 8q gain [P < 0.001] in the 4 increasing pigment groups, respectively). BRCA-associated protein 1 (BAP1) loss (known for 204 cases) was associated with increased tumor pigmentation (P = 0.001). Cox regression analysis on survival showed that when chromosome status and pigmentation were both included, pigmentation was not an independent prognostic indicator. Preferentially expressed antigen in melanoma (PRAME) expression was a significant prognostic marker in light tumors (P = 0.02) but not in dark tumors (P = 0.85). Conclusions Patients with moderately and heavily pigmented tumors showed a significantly higher UM-related mortality than patients with unpigmented and light tumors (P < 0.001), supporting prior reports on the relation between increased tumor pigmentation and a worse prognosis. Although we previously showed that a dark eye color was associated with tumor pigmentation, we now show that the tumor's genetic status (chromosome 3 and 8q/BAP1 status) is also related to tumor pigmentation. When pigmentation and chromosome 3 status are both included in a Cox regression analysis, pigmentation is not an independent prognostic factor. However, evidence from this and previous studies shows that chromosome changes and PRAME expression have a stronger association with survival when they occur in light tumors than in dark ones. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
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Jaarsma-Coes MG, Ferreira TA, Marinkovic M, Vu THK, van Vught L, van Haren GR, Rodrigues MF, Klaver YLB, Verbist BM, Luyten GPM, Rasch CRN, Beenakker JWM. Comparison of Magnetic Resonance Imaging-Based and Conventional Measurements for Proton Beam Therapy of Uveal Melanoma. Ophthalmol Retina 2023; 7:178-188. [PMID: 35840053 DOI: 10.1016/j.oret.2022.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Conventionally, ocular proton therapy (PT) is planned using measurements obtained by an ophthalmologist using ultrasound, fundoscopy, biometry, and intraoperative assessments. Owing to the recent advances in magnetic resonance imaging (MRI) of uveal melanoma (UM), it is possible to acquire high-resolution 3-dimensional images of the eye, providing the opportunity to incorporate MRI in ocular PT planning. In this study, we described how these measurements can be obtained using MRI, compared the MRI-based measurements with conventional ophthalmic measurements, and identified potential pitfalls for both modalities. DESIGN Cross-sectional study. SUBJECTS Data from 23 consecutive patients with UM treated with PT were retrospectively evaluated. METHODS Magnetic resonance imaging-based measurements of axial length, tumor height and basal diameter, and marker-tumor distances were compared with the conventional ophthalmic measurements, and discrepancies were evaluated in a multidisciplinary setting. MAIN OUTCOME MEASURES Tumor prominence and basal diameters on MRI and ultrasound, axial length on MRI and biometry, tumor-marker distances on MRI and measured intraoperatively. RESULTS The mean absolute differences of the tumor height and basal diameter measurements between ultrasound and MRI were 0.57 mm and 1.44 mm, respectively. Larger absolute differences in height and basal diameter were observed when the full tumor extent was not visible on ultrasound (0.92 mm and 1.67 mm, respectively) compared with when the full tumor extent was visible (0.44 mm and 1.15 mm, respectively). When the full tumor was not visible on ultrasound, MRI was considered more reliable. Tumor-marker distances measured using MRI and intraoperative techniques differed < 1 mm in 55% of the markers. For anteriorly located and mushroom-shaped tumors (25% of the markers), MRI provided more accurate measurements. In flat UM (15% of the markers), however, it was difficult to delineate the tumor on MRI. The mean absolute difference in axial length between optical biometry and MRI was 0.50 mm. The presence of the tumor was found to influence optical biometry in 15 of 22 patients; the remaining patients showed a better agreement (0.30 mm). Magnetic resonance imaging-based biometry was considered more reliable in patients with UM. CONCLUSIONS Magnetic resonance imaging allowed for the 3-dimensional assessment of the tumor and surrounding tissue. In specific patients, it provided a more reliable measurement of axial length, tumor dimensions, and marker-tumor distances and could contribute to a more accurate treatment planning. Nevertheless, a combined evaluation remains advised, especially for flat UM.
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Affiliation(s)
- Myriam G Jaarsma-Coes
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Teresa A Ferreira
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - T H Khanh Vu
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Luc van Vught
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Guido R van Haren
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Myra F Rodrigues
- HollandPTC, Delft, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne L B Klaver
- HollandPTC, Delft, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; HollandPTC, Delft, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Coen R N Rasch
- HollandPTC, Delft, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
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12
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Jaarsma-Coes MG, Klaassen L, Verbist BM, Vu TK, Klaver YL, Rodrigues MF, Nabarro C, Luyten GP, Rasch CR, van Herk M, Beenakker JWM. Inter-Observer Variability in MR-Based Target Volume Delineation of Uveal Melanoma. Adv Radiat Oncol 2022; 8:101149. [PMID: 36691449 PMCID: PMC9860418 DOI: 10.1016/j.adro.2022.101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/14/2022] [Indexed: 12/26/2022] Open
Abstract
Purpose Several efforts are being undertaken toward MRI-based treatment planning for ocular proton therapy for uveal melanoma (UM). The interobserver variability of the gross target volume (GTV) on magnetic resonance imaging (MRI) is one of the important parameters to design safety margins for a reliable treatment. Therefore, this study assessed the interobserver variation in GTV delineation of UM on MRI. Methods and Materials Six observers delineated the GTV in 10 different patients using the Big Brother contouring software. Patients were scanned at 3T MRI with a surface coil, and tumors were delineated separately on contrast enhanced 3DT1 (T1gd) and 3DT2-weighted scans with an isotropic acquisition resolution of 0.8 mm. Volume difference and overall local variation (median standard deviation of the distance between the delineated contours and the median contour) were analyzed for each GTV. Additionally, the local variation was analyzed for 4 interfaces: sclera, vitreous, retinal detachment, and tumor-choroid interface. Results The average GTV was significantly larger on T1gd (0.57cm3) compared with T2 (0.51cm3, P = .01). A not significant higher interobserver variation was found on T1gd (0.41 mm) compared with T2 (0.35 mm). The largest variations were found at the tumor-choroid interface due to peritumoral enhancement (T1gd, 0.62 mm; T2, 0.52 mm). As a result, a larger part of this tumor-choroid interface appeared to be included on T1gd-based GTVs compared with T2, explaining the smaller volumes on T2. Conclusions The interobserver variation of 0.4 mm on MRI are low with respect to the voxel size of 0.8 mm, enabling small treatment margins. We recommend delineation based on the T1gd-weighted scans, as choroidal tumor extensions might be missed.
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Affiliation(s)
- Myriam G. Jaarsma-Coes
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands,Leiden University Medical Center, Radiology, Leiden, Netherlands
| | - Lisa Klaassen
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands,Leiden University Medical Center, Radiology, Leiden, Netherlands
| | - Berit M. Verbist
- Leiden University Medical Center, Radiology, Leiden, Netherlands
| | - T.H. Khanh Vu
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands
| | - Yvonne L.B. Klaver
- HollandPTC, Radiation oncology, Delft, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands
| | - Myra F. Rodrigues
- HollandPTC, Radiation oncology, Delft, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands
| | - Claire Nabarro
- Leiden University Medical Center, Radiology, Leiden, Netherlands
| | | | - Coen R.N. Rasch
- HollandPTC, Radiation oncology, Delft, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands
| | - Marcel van Herk
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Jan-Willem M. Beenakker
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands,Leiden University Medical Center, Radiology, Leiden, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands,Corresponding author: Jan-Willem M. Beenakker
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Via R, Fattori G, Pica A, Paganelli C, Lomax A, Schalenbourg A, Weber DC, Baroni G, Hrbacek J. Response to "Letter to the Editor of Radiotherapy and Oncology regarding the paper titled "MRI and FUNDUS image fusion for improved ocular biometry in Ocular Proton Therapy" by Via et al.". Radiother Oncol 2022; 176:252. [PMID: 35988774 DOI: 10.1016/j.radonc.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Riccardo Via
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland.
| | - Giovanni Fattori
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Alessia Pica
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Chiara Paganelli
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Antony Lomax
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Ann Schalenbourg
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA, Lausanne, Switzerland
| | - Damien Charles Weber
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Guido Baroni
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Jan Hrbacek
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
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Klaassen L, Jaarsma-Coes MG, Verbist BM, Vu TK, Marinkovic M, Rasch CR, Luyten GP, Beenakker JWM. Automatic Three-Dimensional Magnetic Resonance-based measurements of tumour prominence and basal diameter for treatment planning of uveal melanoma. Phys Imaging Radiat Oncol 2022; 24:102-110. [PMID: 36386446 PMCID: PMC9649381 DOI: 10.1016/j.phro.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
Background and Purpose Three-dimensional (3D) Magnetic Resonance Imaging (MRI) is increasingly used to complement conventional two-dimensional ultrasound in the assessment of tumour dimension measurement of uveal melanoma. However, the lack of definitions of the 3D measurements of these tumour dimensions hinders further adaptation of MRI in ocular radiotherapy planning. In this study, we composed 3D MR-based definitions of tumour prominence and basal diameter and compared them to conventional ultrasound. Materials and methods Tumours were delineated on 3DT2 and contrast-enhanced 3DT1 (T1gd) MRI for 25 patients. 3D definitions of tumour prominence and diameter were composed and evaluated automatically on the T1gd and T2 contours. Automatic T1gd measurements were compared to manual MRI measurements, to automatic T2 measurements and to manual ultrasound measurements. Results Prominence measurements were similar for all modalities (median absolute difference 0.3 mm). Automatic T1gd diameter measurements were generally larger than manual MRI, automatic T2 and manual ultrasound measurements (median absolute differences of 0.5, 1.6 and 1.1 mm respectively), mainly due to difficulty defining the axis of the largest diameter. Largest differences between ultrasound and MRI for both prominence and diameter were found in anteriorly located tumours (up to 1.6 and 4.5 mm respectively), for which the tumour extent could not entirely be visualized with ultrasound. Conclusions The proposed 3D definitions for tumour prominence and diameter agreed well with ultrasound measurements for tumours for which the extent was visible on ultrasound. 3D MRI measurements generally provided larger diameter measurements than ultrasound. In anteriorly located tumours, the MRI measurements were considered more accurate than conventional ultrasound.
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Affiliation(s)
- Lisa Klaassen
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Myriam G. Jaarsma-Coes
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Berit M. Verbist
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Holland Particle Therapy Center, PO Box 110, 2600 AC Delft, the Netherlands
| | - T.H. Khanh Vu
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Marina Marinkovic
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Coen R.N. Rasch
- Leiden University Medical Center, Department of Radiation Oncology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Holland Particle Therapy Center, PO Box 110, 2600 AC Delft, the Netherlands
| | - Gregorius P.M. Luyten
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Jan-Willem M. Beenakker
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, PO Box 9600, 2300 RC Leiden, the Netherlands
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Orbital Tumors-Clinical, Radiologic and Histopathologic Correlation. Diagnostics (Basel) 2022; 12:diagnostics12102376. [PMID: 36292065 PMCID: PMC9600631 DOI: 10.3390/diagnostics12102376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Orbital masses include a broad spectrum of benign and malignant entities. Often these masses are asymptomatic or show a slow growth rate, so that emergence of clinical symptoms is prolonged. In this context, cross-sectional imaging plays an elementary role in the characterization of these lesions. Aside from the characterization of the underlying entity, an evaluation of the involved compartments is possible by sufficient imaging, which also facilitates optimal treatment and surgery planning. The purpose of this review is to explore different benign and malignant orbital tumors and their typical appearance in imaging together with histopathologic findings.
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de Bruyn DP, Beasley AB, Verdijk RM, van Poppelen NM, Paridaens D, de Keizer ROB, Naus NC, Gray ES, de Klein A, Brosens E, Kiliç E. Is Tissue Still the Issue? The Promise of Liquid Biopsy in Uveal Melanoma. Biomedicines 2022; 10:biomedicines10020506. [PMID: 35203714 PMCID: PMC8962331 DOI: 10.3390/biomedicines10020506] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/18/2022] Open
Abstract
Uveal melanoma (UM) is the second most frequent type of melanoma. Therapeutic options for UM favor minimally invasive techniques such as irradiation for vision preservation. As a consequence, no tumor material is obtained. Without available tissue, molecular analyses for gene expression, mutation or copy number analysis cannot be performed. Thus, proper patient stratification is impossible and patients’ uncertainty about their prognosis rises. Minimally invasive techniques have been studied for prognostication in UM. Blood-based biomarker analysis has become more common in recent years; however, no clinically standardized protocol exists. This review summarizes insights in biomarker analysis, addressing new insights in circulating tumor cells, circulating tumor DNA, extracellular vesicles, proteomics, and metabolomics. Additionally, medical imaging can play a significant role in staging, surveillance, and prognostication of UM and is addressed in this review. We propose that combining multiple minimally invasive modalities using tumor biomarkers should be the way forward and warrant more attention in the coming years.
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Affiliation(s)
- Daniël P. de Bruyn
- Department of Ophthalmology, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands; (D.P.d.B.); (N.M.v.P.); (D.P.); (N.C.N.)
- Department of Clinical Genetics, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands; (A.d.K.); (E.B.)
- Erasmus MC Cancer Institute, 3000 CA Rotterdam, The Netherlands
| | - Aaron B. Beasley
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; (A.B.B.); (E.S.G.)
| | - Robert M. Verdijk
- The Rotterdam Eye Hospital, 3011 BH Rotterdam, The Netherlands; (R.M.V.); (R.O.B.d.K.)
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Natasha M. van Poppelen
- Department of Ophthalmology, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands; (D.P.d.B.); (N.M.v.P.); (D.P.); (N.C.N.)
- Department of Clinical Genetics, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands; (A.d.K.); (E.B.)
- Erasmus MC Cancer Institute, 3000 CA Rotterdam, The Netherlands
| | - Dion Paridaens
- Department of Ophthalmology, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands; (D.P.d.B.); (N.M.v.P.); (D.P.); (N.C.N.)
- The Rotterdam Eye Hospital, 3011 BH Rotterdam, The Netherlands; (R.M.V.); (R.O.B.d.K.)
| | | | - Nicole C. Naus
- Department of Ophthalmology, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands; (D.P.d.B.); (N.M.v.P.); (D.P.); (N.C.N.)
- Erasmus MC Cancer Institute, 3000 CA Rotterdam, The Netherlands
| | - Elin S. Gray
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; (A.B.B.); (E.S.G.)
| | - Annelies de Klein
- Department of Clinical Genetics, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands; (A.d.K.); (E.B.)
- Erasmus MC Cancer Institute, 3000 CA Rotterdam, The Netherlands
| | - Erwin Brosens
- Department of Clinical Genetics, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands; (A.d.K.); (E.B.)
- Erasmus MC Cancer Institute, 3000 CA Rotterdam, The Netherlands
| | - Emine Kiliç
- Department of Ophthalmology, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands; (D.P.d.B.); (N.M.v.P.); (D.P.); (N.C.N.)
- Erasmus MC Cancer Institute, 3000 CA Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-107030683
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Histopathologic and MR Imaging Appearance of Spontaneous and Radiation-Induced Necrosis in Uveal Melanomas: Initial Results. Cancers (Basel) 2022; 14:cancers14010215. [PMID: 35008378 PMCID: PMC8750257 DOI: 10.3390/cancers14010215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Uveal melanomas may undergo necrosis, both spontaneously or following radiotherapy. Nowadays radiotherapy is the preferred treatment, whereas enucleation of the eye is used in selected cases. In order to differentiate the effects of radiotherapy from spontaneous degenerative changes in uveal melanomas, we compared the appearance of necrosis, both from a histopathological point of view and from the perspective of MR imaging, in two groups of patients with uveal melanoma: a group who had undergone previous proton beam radiotherapy (secondary enucleation); a control group who had undergone enucleation without any previous radiotherapy treatment (primary enucleation). Irradiated and nonirradiated uveal melanomas differ on the basis of the histological appearance, the MR imaging appearance and the distribution of necrosis. We hope that the findings we observed could be extended to all patients with uveal melanomas treated with radiotherapy, and may enhance the accuracy of radiologists in evaluating MR examinations after radiotherapy. Abstract Necrosis in uveal melanomas can be spontaneous or induced by radiotherapy. The purpose of our study was to compare the histopathologic and MRI findings of radiation-induced necrosis of a group of proton beam-irradiated uveal melanomas with those of spontaneous necrosis of a control group of patients undergoing primary enucleation. 11 uveal melanomas who had undergone proton beam radiotherapy, MRI and secondary enucleation, and a control group of 15 untreated uveal melanomas who had undergone MRI and primary enucleation were retrospectively identified. Within the irradiated and nonirradiated group, 7 and 6 eyes with histological evidence of necrosis respectively, were furtherly selected for the final analysis; the appearance of necrosis was assessed at histopathologic examination and MRI. Irradiated melanomas showed a higher degree of necrosis as compared with nonirradiated tumors. Irradiated and nonirradiated lesions differed based on the appearance and distribution of necrosis. Irradiated tumors showed large necrotic foci, sharply demarcated from the viable neoplastic tissue; nonirradiated tumors demonstrated small, distinct foci of necrosis. Radiation-induced necrosis, more pigmented than surrounding viable tumor, displayed high signal intensity on T1-weighted and low signal intensity on T2-weighted images. The hemorrhagic/coagulative necrosis, more prevalent in nonirradiated tumors (4 out of 6 vs. 1 out of 7 cases), appeared hyperintense on T2-weighted and hypointense on T1-weighted images. Our study boosts the capability to recognize radiation-induced alterations in uveal melanomas at MRI and may improve the accuracy of radiologists in the evaluation of follow-up MR examination after radiotherapy.
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