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Romano MR, Catania F, Confalonieri F, Zollet P, Allegrini D, Sergenti J, Lanza FB, Ferrara M, Angi M. Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review. Int J Mol Sci 2021; 22:ijms221810066. [PMID: 34576231 PMCID: PMC8467120 DOI: 10.3390/ijms221810066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 01/15/2023] Open
Abstract
Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.
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Affiliation(s)
- Mario R. Romano
- Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (M.R.R.); (F.C.); (F.C.); (P.Z.)
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Fiammetta Catania
- Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (M.R.R.); (F.C.); (F.C.); (P.Z.)
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Filippo Confalonieri
- Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (M.R.R.); (F.C.); (F.C.); (P.Z.)
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Piero Zollet
- Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (M.R.R.); (F.C.); (F.C.); (P.Z.)
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Davide Allegrini
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Jessica Sergenti
- Ocular Oncology Service, Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (J.S.); (F.B.L.)
| | - Francesco B. Lanza
- Ocular Oncology Service, Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (J.S.); (F.B.L.)
| | - Mariantonia Ferrara
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Martina Angi
- Ocular Oncology Service, Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (J.S.); (F.B.L.)
- Correspondence: ; Tel.: +39-(0)2-2390-3896
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Toutée A, Angi M, Dureau S, Lévy-Gabriel C, Rouic LLL, Dendale R, Desjardins L, Cassoux N. Long-Term Visual Outcomes for Small Uveal Melanoma Staged T1 Treated by Proton Beam Radiotherapy. Cancers (Basel) 2019; 11:cancers11081047. [PMID: 31344948 PMCID: PMC6721317 DOI: 10.3390/cancers11081047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/16/2022] Open
Abstract
There is increasing evidence of the survival benefit of treating uveal melanoma in an early stage, however it is important to discuss with the patient the associated risk of visual loss. We investigated visual outcomes for uveal melanomas staged T1 (T1UM) treated by proton beam radiotherapy (PBR) as a function of their distance to fovea-optic disc. This retrospective study included a cohort of 424 patients with T1UM treated with PBR between 1991 and 2010 with at least a 5-year follow-up. Visual acuity (VA) was analyzed for patients with posterior edge of tumor located at ≥3 mm (GSup3) or <3 mm (GInf3) from fovea-optic disc. The mean follow-up duration was 122 months, no tumor recurrence was observed. The mean baseline and final VA were 20/25 and 20/32 for GSup3 (n = 75), and 20/40 and 20/80 for GInf3 (n = 317) respectively. The frequency of a 20/200 or greater visual conservation was 93.2%(CI95%:87.7-99.1) and 60.1%(CI95%:54.9-65.9) for GSup3 and GInf3 respectively. This difference between groups was statistically significant (p < 0.001). The risk factors for significant VA loss (less than 20/200) were GInf3 location (p < 0.001), tumor touching optic disc (p = 0.04), initial VA inferior to 20/40 (p < 0.001), documented growth (p = 0.002), and age greater than 60 years (p < 0.001). In summary, PBR for T1UM yields excellent tumor control and good long-term visual outcomes for tumors located ≥3 mm from fovea-optic disc.
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Affiliation(s)
- Adélaïde Toutée
- Department of Ocular Oncology, Institut Curie, 26, rue Ulm, 75005 Paris, France.
| | - Martina Angi
- Department of Ocular Oncology, Institut Curie, 26, rue Ulm, 75005 Paris, France
- National Cancer Institute IRCCS Foundation, via Venezian, 1, 20133 Milan, Italy
| | - Sylvain Dureau
- Department of Biostatistics, Institut Curie, 26, rue Ulm, 75005 Paris, France
| | | | | | - Rémi Dendale
- Department of Radiation Oncology, Institut Curie, 26, rue Ulm, 75005 Paris, France
| | - Laurence Desjardins
- Department of Ocular Oncology, Institut Curie, 26, rue Ulm, 75005 Paris, France
| | - Nathalie Cassoux
- Department of Ocular Oncology, Institut Curie, 26, rue Ulm, 75005 Paris, France
- School of Medicine Paris V Descartes, PSL University, 12 rue de l'Ecole de Medecine, 75006 Paris, France
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Zehn Jahre multimodale Therapie uvealer Melanome an der Universitätsaugenklinik Innsbruck. SPEKTRUM DER AUGENHEILKUNDE 2019. [DOI: 10.1007/s00717-019-0422-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mor JM, Semrau R, Baus W, Koch KR, Schaub F, Cursiefen C, Marnitz S, Heindl LM. [CyberKnife®: new treatment option for uveal melanoma]. Ophthalmologe 2017; 115:302-308. [PMID: 28849326 DOI: 10.1007/s00347-017-0560-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND CyberKnife® stereotactic radiosurgery is a new treatment option for uveal melanoma. OBJECTIVE This review outlines the technique of robot-assisted CyberKnife® therapy, as well as the pros and cons in the treatment of uveal melanoma. METHODS The study provides a PubMed literature review and own preliminary clinical experiences. RESULTS CyberKnife® therapy for choroidal and ciliary body melanomas shows comparable results concerning local tumor control and overall survival matching those of conventional therapies. With only low complication rates, a high level of quality of life can be conserved by possible preservation of visual acuity as well as the ocular globe. CONCLUSION Stereotactic radiosurgery using CyberKnife® seems to be an efficient and safe therapeutic option for malignant melanomas affecting the choroid and ciliary body. Comparative studies with conventional radiation strategies are now a high priority.
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Affiliation(s)
- J M Mor
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - R Semrau
- Klinik und Poliklinik für Strahlentherapie, Universität zu Köln, Köln, Deutschland
| | - W Baus
- Klinik und Poliklinik für Strahlentherapie, Universität zu Köln, Köln, Deutschland
| | - K R Koch
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - F Schaub
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - C Cursiefen
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - S Marnitz
- Klinik und Poliklinik für Strahlentherapie, Universität zu Köln, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland
| | - L M Heindl
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Str. 62, 50924, Köln, Deutschland. .,Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland.
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Seibel I, Cordini D, Hager A, Tillner J, Riechardt AI, Heufelder J, Davids AM, Rehak M, Joussen AM. Predictive risk factors for radiation retinopathy and optic neuropathy after proton beam therapy for uveal melanoma. Graefes Arch Clin Exp Ophthalmol 2016; 254:1787-92. [PMID: 27376824 DOI: 10.1007/s00417-016-3429-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/04/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This study was performed in order to evaluate the incidence of radiation retinopathy and optic neuropathy occurring after proton beam therapy for uveal melanoma. METHODS Included in this study were all patients who had been treated with primary proton beam therapy for uveal melanoma at the oncology service between May 1998 and June 2014 with a minimum follow-up of 12 months. Excluded were all patients who underwent re-irradiation, or vitrectomy due to exudative retinal detachment or for tumor-resection. RESULTS During this period, 1127 patients matched the inclusion criteria, of whom 768 (68.1 %) and 463 (41.0 %) developed radiation retinopathy and optic neuropathy after a median time of 18.9 months (2.0-99.84 months) and 19.8 months (0.2-170.4 months), respectively. Mean follow-up was 53.4 months (12-170.4 months). Included were 558 men (49.5 %) and 569 women (50.5 %). Mean age was 61 years (16-89 years). Visual acuity slightly decreased from initial levels of 0.3 logMAR-0.4 logMAR in patients without developing any radiation-induced complication but severely decreased to 1.0 logMAR or 1.5 logMAR in the case of developing radiation retinopathy only or optic neuropathy, respectively. Independent risk factors for radiation retinopathy were a centrally (<2.5 mm from sensitive structures) located tumor or a thick tumor located more than 2.5 mm from sensitive structures, while those for radiation optic neuropathy comprised a short distance and applied dose to the optic disk. CONCLUSION The risk for radiation retinopathy is higher in central uveal melanoma. Mid-/peripheral tumors are at high risk for radiation retinopathy and maculopathy if presenting with increased thickness.
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Affiliation(s)
- Ira Seibel
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Dino Cordini
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.,Berlin Protonen am Helmholtz-Zentrum Berlin für Materialien und Energie, Charité Universitätsmedizin Berlin, Lise-Meitner-Campus, Berlin, Germany
| | - Annette Hager
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Johanna Tillner
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Aline I Riechardt
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Jens Heufelder
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.,Berlin Protonen am Helmholtz-Zentrum Berlin für Materialien und Energie, Charité Universitätsmedizin Berlin, Lise-Meitner-Campus, Berlin, Germany
| | - Anja M Davids
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Matus Rehak
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Antonia M Joussen
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
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