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Cherkas E, Kalafatis NE, Marous MR, Shields CL. Iris melanoma: Review of clinical features, risks, management, and outcomes. Clin Dermatol 2024; 42:62-70. [PMID: 37865279 DOI: 10.1016/j.clindermatol.2023.10.009] [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: 10/23/2023]
Abstract
Primary uveal melanoma is rare and affects approximately 8,000 persons per year worldwide. This malignancy can involve the iris, ciliary body, and choroid. Of these three structures, the iris is the least commonly affected site, representing only 4% of all uveal melanomas. Iris melanoma can arise from iris melanocytic nevus, iris melanocytosis, or de novo. In a longitudinal study of 1,611 patients with iris nevus, transformation into melanoma, using Kaplan-Meier estimates, was found in 2.6% by five years and in 4.1% by 10 years. The factors that predicted growth of iris melanocytic nevus into melanoma are denoted by a letter (ABCDEF) guide: A for age ≤40 years old at presentation (hazard ratio [HR] = 3, P = .01), B for blood (hyphema) (HR = 9, P < .0004), C for clock hour of tumor inferiorly (tumor location) (HR = 9, P = .03), D for diffuse flat tumor configuration (HR = 14, P = .02), E for ectropion uveae (HR = 4, P = .002), and F for feathery ill-defined margins (HR = 3, P = .02). At diagnosis, iris melanoma has a mean cross-sectional diameter of 5.5 mm and thickness of 2.1 mm, often with tumor seeding (28%) and secondary glaucoma (35%). We provide a comprehensive review of iris nevus and melanoma to explore relevant demographic and clinical data, risk factors for tumor growth, management, and prognosis, with the hope that clinicians will be more comfortable in understanding this rare malignant condition.
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Affiliation(s)
- Elliot Cherkas
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas E Kalafatis
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Molly R Marous
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Dockery PW, DeSimone JD, Liu CK, Achuck K, Hamburger J, Bas Z, Shields CL. Effectiveness of treatment for iris melanoma: surgical versus radiotherapeutic approaches. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00341-1. [PMID: 38040029 DOI: 10.1016/j.jcjo.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/08/2023] [Accepted: 10/28/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of preventing metastasis for each major treatment modality for iris melanoma. DESIGN Retrospective case series. PARTICIPANTS Three hundred consecutive eyes with iris melanoma at a single tertiary referral centre for ocular oncology. METHODS Retrospective analysis of eyes with iris melanoma, both with (n = 69 eyes) and without (n = 231 eyes) ciliary body extension, was undertaken for metastasis-free survival at 5, 10, and 20 years based on type of treatment, including globe-sparing surgical resection (n = 169 eyes), plaque radiotherapy (n = 74 eyes), or enucleation (n = 57 eyes). RESULTS For the total population, 5-, 10-, and 20-year metastasis-free survival rates were 95%, 93%, and 87%, respectively, and there was no difference in metastatic rates for tumours with versus without ciliary body extension (p = 0.95). Noninferiority was demonstrated for surgical resection and plaque radiotherapy, with metastasis-free survival rates of 98%, 97%, and 94% for surgical resection and 94%, 94%, and 89% for plaque radiotherapy (p = 0.002). The rates for globe salvage were 94%, 92%, and 90% for surgical resection and 94%, 86%, and 86% for plaque radiotherapy (p = 0.003). However, metastasis-free survival was worse in patients who underwent enucleation (86%, 67%, and NA; p < 0.001). CONCLUSIONS Metastasis-free survival and globe salvage following plaque radiotherapy and surgical resection are not inferior to either, but eyes undergoing enucleation demonstrated a lower metastasis-free survival, likely because enucleation is performed for larger, more extensive melanomas, often with secondary glaucoma. In this analysis, iris melanoma with ciliary body involvement did not increase the risk of metastasis.
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Affiliation(s)
- Philip W Dockery
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa
| | - Joseph D DeSimone
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa
| | - Catherine K Liu
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa
| | - Kathryn Achuck
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa
| | - Jordan Hamburger
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa
| | - Zeynep Bas
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa.
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Murdoch I, Puertas R, Hamedani M, Khaw PT. Long-Term Safety and Outcomes of β-radiation for Trabeculectomy. J Glaucoma 2023; 32:171-177. [PMID: 36375094 DOI: 10.1097/ijg.0000000000002144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022]
Abstract
PRCIS β-radiation is a neglected antiscarring therapy with past concerns for safety. This report found it safe and efficacious when used as an adjuvant to trabeculectomy surgery in 101 people (135 eyes) over 20 years. PURPOSE β-radiation has been used as an adjunct to prevent scarring in trabeculectomy surgery for many decades. Safety concerns were raised with the use of high doses on the bare sclera. Moorfields Eye Hospital has a large cohort of patients who have received β-radiation therapy. We report a review of the long-term safety and efficacy. METHODS Cases undertaken between August 1992 and August 1996 were reviewed. Those with records available for postoperative review of more than 5 years were included. Failure (reintervention/>21 mm Hg on 2 successive occasions) and any complication previously reported in association with β-radiation were the primary outcomes. RESULTS In total, 292 operations using β-radiation were recorded and 101 people (135 eyes) with trabeculectomy surgery and postoperative follow-up for over 4.5 years were included. The median follow-up period was 22.5 years. At the final follow-up, 48 (48%) single eyes per person had failed and 20/51 (51%) eyes with primary open angle glaucoma had cataract surgery. Other complications were rare and associated with copathology. CONCLUSION In glaucoma patients at risk of scarring and failure after trabeculectomy, as an antiscarring adjuvant, a 750 cGY dose of β-radiation was found to be safe and efficacious in the long term.
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Affiliation(s)
- Ian Murdoch
- UCL Institute of Ophthalmology
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust
| | - Renata Puertas
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust
| | | | - Peng Tee Khaw
- UCL Institute of Ophthalmology
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Cherkas E, Negretti GS, Zeiger JS, Shields CL. Iris melanoma outcomes based on the Cancer Genome Atlas (TCGA) classification in 78 consecutive patients. Ophthalmic Genet 2022; 43:736-741. [PMID: 36326016 DOI: 10.1080/13816810.2022.2141798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Cancer Genome Atlas (TCGA) classification of genetic alterations in uveal melanoma is widely used for prognostication. We present novel observations on the impact of TCGA Group specifically for iris melanoma. METHODS This was a retrospective cohort study at a tertiary referral ocular oncology center. All patients with a diagnosis of iris melanoma who underwent genetic evaluation and assessment for TCGA classification between 20 November 1995 and 5 April 2021 were included. The main outcome measures were visual acuity, secondary glaucoma, tumor recurrence, melanoma-related metastasis and death per TCGA group. RESULTS There were a total of 78 patients included. The mean patient age was 49.6 years (median 53.0, range 3.0-85.0), mean tumor basal diameter was 6.7 mm (median 6.0, range 1.5-22.0), and mean tumor thickness was 2.6 mm (median 2.5, range 0.5-8.5). Cytology results confirmed iris melanoma (93%) or were inconclusive (7%). The TCGA groups included Group A (n = 36, 46%), Group B (n = 7, 9%), Group C (n = 34, 44%), and Group D (n = 1, 1%). There was no statistically significant difference in outcomes of visual acuity, tumor thickness reduction, secondary glaucoma, tumor recurrence, melanoma-related metastasis or death per individual TCGA group (A vs. B vs. C vs. D) and per bimodal comparison (A/B vs. C/D). CONCLUSIONS In this analysis, iris melanoma was classified as TCGA group A or B in 55% and as C or D in 45%. The TCGA classification was not predictive of melanoma-related metastasis or death.
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Affiliation(s)
- Elliot Cherkas
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Guy S Negretti
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer S Zeiger
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Hopkins NS, Kornblau IS, Montes-Sabino CE, Boom A, Wilson MW. Delayed recurrence of an iridociliary malignant melanoma 180° from the primary tumor. Am J Ophthalmol Case Rep 2022; 28:101710. [PMID: 36262689 PMCID: PMC9574778 DOI: 10.1016/j.ajoc.2022.101710] [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: 04/28/2021] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose We report the case of a 66-year-old female who returned with a rare recurrence of iridociliary melanoma 180° from the original lesion. Observations Upon initial presentation eleven years prior, a pigmented iris lesion suspicious for primary uveal melanoma was noted in the right eye at 9 o'clock. After one year of observation, inferior growth of the iris lesion prompted treatment via primary iridectomy with excisional biopsy and pupilloplasty. Postoperative biopsy confirmed spindle B type melanoma with epithelial foci, and adjuvant brachytherapy was performed to treat the reported positive anterior ciliary body involvement. Ten years after initial plaque brachytherapy treatment, the patient returned with a pigmented iris lesion in the right eye at 3:30–5 o'clock, which was treated with enucleation. On pathology, the new melanoma was predominantly epithelioid, consistent with a transformed recurrent iridociliary melanoma. The patient remains metastasis free 13 years after initial diagnosis. Conclusions and importance This case describes a rare, late recurrence of an iridociliary melanoma 180° away eleven years after initial presentation, emphasizing the importance of lifelong follow-up for patients with iridociliary melanoma. This rare form of recurrence has not been previously reported in the literature. We hypothesize the original lesion contained radiotherapy resistant epithelioid cells which grew superficially on the posterior iris and anterior ciliary body, ultimately breaking back through the anterior iris 180° away.
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Affiliation(s)
- Nikolas S. Hopkins
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ilyse S. Kornblau
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Surgical Services, Ophthalmology Section, Veterans Health Administration, Memphis, TN, USA,Corresponding author. Department of Ophthalmology Hamilton Eye Institute, University of Tennessee Health Science, Center 930 Madison Ave Memphis, TN, 38103, United States.
| | - Christopher E. Montes-Sabino
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alan Boom
- Department of Pathology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Matthew W. Wilson
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
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Wei S, Li C, Li M, Xiong Y, Jiang Y, Sun H, Qiu B, Lin CJ, Wang J. Radioactive Iodine-125 in Tumor Therapy: Advances and Future Directions. Front Oncol 2021; 11:717180. [PMID: 34660280 PMCID: PMC8514864 DOI: 10.3389/fonc.2021.717180] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022] Open
Abstract
Radioactive iodine-125 (I-125) is the most widely used radioactive sealed source for interstitial permanent brachytherapy (BT). BT has the exceptional ability to deliver extremely high doses that external beam radiotherapy (EBRT) could never achieve within treated lesions, with the added benefit that doses drop off rapidly outside the target lesion by minimizing the exposure of uninvolved surrounding normal tissue. Spurred by multiple biological and technological advances, BT application has experienced substantial alteration over the past few decades. The procedure of I-125 radioactive seed implantation evolved from ultrasound guidance to computed tomography guidance. Compellingly, the creative introduction of 3D-printed individual templates, BT treatment planning systems, and artificial intelligence navigator systems remarkably increased the accuracy of I-125 BT and individualized I-125 ablative radiotherapy. Of note, utilizing I-125 to treat carcinoma in hollow cavity organs was enabled by the utility of self-expandable metal stents (SEMSs). Initially, I-125 BT was only used in the treatment of rare tumors. However, an increasing number of clinical trials upheld the efficacy and safety of I-125 BT in almost all tumors. Therefore, this study aims to summarize the recent advances of I-125 BT in cancer therapy, which cover experimental research to clinical investigations, including the development of novel techniques. This review also raises unanswered questions that may prompt future clinical trials and experimental work.
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Affiliation(s)
- Shuhua Wei
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Chunxiao Li
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Mengyuan Li
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Yan Xiong
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Bin Qiu
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | | | - Junjie Wang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
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Schmelter V, Heidorn S, Muacevic A, Priglinger SG, Foerster P, Liegl R. Robotic assisted CyberKnife radiosurgery for the treatment of iris melanoma. Sci Rep 2021; 11:5685. [PMID: 33707492 PMCID: PMC7952409 DOI: 10.1038/s41598-021-84290-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/16/2020] [Indexed: 11/09/2022] Open
Abstract
Iris melanoma is a rare form of uveal melanoma with potential metastic spread. Treatment options include surgical resection, enucleation or irradiation. We analysed visual outcome, complication appearance and management in eight patients with iris melanoma following robotic-assisted CyberKnife treatment. Consecutive patients from the Department of Ophthalmology at University of Munich were included in the study if they had an iris melanoma that was treated with CyberKnife and had a minimum follow-up of 12 months. We evaluated tumor thickness, largest diameter, visual acuity and complications. 8 patients were included in this report. The median age was 74 years (range: 53-86 years). The median follow-up was 23 months (range 12-48 months). Tumor thickness decreased from 2.1 to 1.4 mm on average. Four out of eight patients showed stable or increased visual acuity compared to visual acuity at first visit. We did not find a correlation of applied radiation volume or radiation dose on visual outcome. Radiation keratopathy was the most common complication in five patients. No recurrences were noted. Robotic-assisted radiosurgery following CyberKnife is a promising non-invasive, single session treatment option for iris melanoma with comparable results regarding recurrence rate or complications to brachytherapy and proton beam therapy. All included patients showed good visual outcome.
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Affiliation(s)
- Valerie Schmelter
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | | | | | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Paul Foerster
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Raffael Liegl
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany.
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9
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Abstract
BACKGROUND Benign iridal tumors rarely necessitate a therapeutic intervention. In contrast, malignant tumors of the iris can threaten the patient's life and eyesight and require early treatment to prevent the development of metastases. OBJECTIVE Presentation of current treatment options for iridal tumors with special emphasis on iridal melanoma. METHODS This article gives an overview of the current literature based on a PubMed search as well as own clinical experience. RESULTS Treatment options for iridal and ciliary body melanomas comprise radiotherapeutic and surgical (eyeball-sparing and non-sparing) approaches. The eyeball-sparing surgical procedure of choice is block excision. While local tumor control rates and metastasis rates of block excision and radiotherapy are comparable, there are distinct differences especially between the spectra of complications. New treatment procedures include immunomodulatory approaches and targeted therapies. Using checkpoint inhibitors, no convincing enhancement of overall survival could be demonstrated for metastatic iridal melanoma, as is the case for cutaneous melanoma. In contrast, tumor vaccination with the help of tumor RNA-laden patient-derived dendritic cells seems to be a promising option for a subgroup of high-risk patients. Targeted therapies aiming to suppress the MAPK and PI3K/Akt pathways could not achieve any improvement in patient survival. CONCLUSION For the primary treatment of iridal melanoma a surgical, eyeball-sparing approach and also when appropriate, radiotherapy can be recommended. In the future, eligible high-risk patients could profit from a tumor vaccination. To date, there is no effective systemic treatment for metastatic iridal melanoma.
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Zimmermann-Paiz MA, Quezada-Del Cid NC, García-de la Riva JC, Ordóñez-Rivas AM. Amelanotic iris melanoma in a 7 year-old hispanic boy with subclinical globe perforation. ACTA ACUST UNITED AC 2018; 94:81-84. [PMID: 30342820 DOI: 10.1016/j.oftal.2018.09.007] [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: 05/10/2018] [Revised: 08/03/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
We report an unusual case of an amelanotic melanoma in a 7 year old hispanic child with subclinical globe perforation. Uveal melanoma rarely occurs in children. Young affected patients are mostly light-colored eye Caucasian adolescents. Since they are not common, these tumors are usually not recognized and misdiagnosed. Differential diagnoses and therapeutic options are outlined.
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Affiliation(s)
- M A Zimmermann-Paiz
- Unidad de Oftalmología Pediátrica, Estrabismo y Neuro-Oftalmología «Dra. Ana María Illescas Putzeys», Benemérito Comité Pro Ciegos y Sordos de Guatemala, Hospital de Ojos y Oídos «Dr. Rodolfo Robles Valverde», Instituto de Ciencias de la Visión, Ciudad Guatemala, Guatemala
| | - N C Quezada-Del Cid
- Unidad de Oftalmología Pediátrica, Estrabismo y Neuro-Oftalmología «Dra. Ana María Illescas Putzeys», Benemérito Comité Pro Ciegos y Sordos de Guatemala, Hospital de Ojos y Oídos «Dr. Rodolfo Robles Valverde», Instituto de Ciencias de la Visión, Ciudad Guatemala, Guatemala.
| | - J C García-de la Riva
- Unidad de Patología Ocular, Benemérito Comité Pro Ciegos y Sordos de Guatemala, Hospital de Ojos y Oídos «Dr. Rodolfo Robles Valverde», Instituto de Ciencias de la Visión, Ciudad Guatemala, Guatemala
| | - A M Ordóñez-Rivas
- Unidad de Oftalmología Pediátrica, Estrabismo y Neuro-Oftalmología «Dra. Ana María Illescas Putzeys», Benemérito Comité Pro Ciegos y Sordos de Guatemala, Hospital de Ojos y Oídos «Dr. Rodolfo Robles Valverde», Instituto de Ciencias de la Visión, Ciudad Guatemala, Guatemala
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Salvage proton beam therapy for recurrent iris melanoma: outcome and side effects. Graefes Arch Clin Exp Ophthalmol 2018; 256:1325-1332. [DOI: 10.1007/s00417-018-3929-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 01/28/2018] [Accepted: 02/02/2018] [Indexed: 11/25/2022] Open
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Saakyan SV, Amiryan AG, Valskiy VV, Mironova IS. [Plaque radiotherapy for anterior uveal melanomas]. Vestn Oftalmol 2015; 131:5-12. [PMID: 26080576 DOI: 10.17116/oftalma201513125-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine the effectiveness of plaque radiation therapy for anterior uveal melanomas and to evaluate the risk and frequency of complications at different time intervals after the treatment. MATERIAL AND METHODS During 2010-2013 a total of 30 patients (10 male, 20 female) aged 11-73 (50 years on the average) with iris or iridociliary melanomas were treated with Ru-106 and Sr-90 ophthalmic plaques. In 8 patients the brachytherapy was preceded by local tumor excision. Morphological diagnosis was verified in 10 patients (8 iridectomies, 2 enucleations), of them 8 cases turned out to be spindle cell melanomas and the other 2--mixed cell melanomas. Follow-up period ranged from 1 to 54 months with the median of 13,5 months. RESULTS Tumor regression was achieved in all cases. Enucleation had to be performed in 2 patients due to cornea and sclera necrosis. In the early post-brachytherapy period (up to 1 month) the most frequent radiation-related complications were keratopathy and uveitis (8 and 6 patients correspondingly). In patients observed for up to 3 months (28 patients) these were keratopathy and cataract (8 and 5 patients correspondingly). In the long-term (over 6 months) cataract predominated (17 patients). At the end of the study all patients were alive. Metastatic disease was diagnosed in one patient 30 months after the treatment. CONCLUSIONS The results of the present clinical study confirm the effectiveness of brachytherapy for iris and iridociliary melanomas, which implies that tumor is well locally controlled and radiation-related complications are moderate and curable. This method of local tumor destruction can be another alternative to enucleation in cases when local tumor excision cannot be performed.
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Affiliation(s)
- S V Saakyan
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - A G Amiryan
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - V V Valskiy
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - I S Mironova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
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Abstract
Melanomas are highly lethal skin tumours that are frequently treated by surgical resection. However, the efficacy of such procedures is often limited by tumour recurrence and metastasis. Caveolin-1 (CAV1) has been attributed roles as a tumour suppressor, although in late-stage tumours, its presence is associated with enhanced metastasis. The expression of this protein in human melanoma development and particularly how the presence of CAV1 affects metastasis after surgery has not been defined. CAV1 expression in human melanocytes and melanomas increases with disease progression and is highest in metastatic melanomas. The effect of increased CAV1 expression can then be evaluated using B16F10 murine melanoma cells injected into syngenic immunocompetent C57BL/6 mice or human A375 melanoma cells injected into immunodeficient B6Rag1−/− mice. Augmented CAV1 expression suppresses tumour formation upon a subcutaneous injection, but enhances lung metastasis of cells injected into the tail vein in both models. A procedure was initially developed using B16F10 melanoma cells in C57BL/6 mice to mimic better the situation in patients undergoing surgery. Subcutaneous tumours of a defined size were removed surgically and local tumour recurrence and lung metastasis were evaluated after another 14 days. In this postsurgery setting, CAV1 presence in B16F10 melanomas favoured metastasis to the lung, although tumour suppression at the initial site was still evident. Similar results were obtained when evaluating A375 cells in B6Rag1−/− mice. These results implicate CAV1 expression in melanomas as a marker of poor prognosis for patients undergoing surgery as CAV1 expression promotes experimental lung metastasis in two different preclinical models.
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Willerding GD, Cordini D, Hackl C, Karle B, Lakotka N, Foerster MH, Bechrakis NN, Heufelder J, Moser L, Joussen AM. Proton beam radiotherapy of diffuse iris melanoma in 54 patients. Br J Ophthalmol 2014; 99:812-6. [PMID: 25505288 DOI: 10.1136/bjophthalmol-2014-305174] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 11/16/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Treatment modalities in iris melanoma include excision, plaque radiotherapy, photon or proton beam therapy and enucleation. In extensive tumours and diffuse seeding, radiotherapy remains as an alternative to enucleation. METHODS This study is a retrospective, consecutive, interventional, single-institutional case series. 54 patients with a diffuse and non-resectable iris melanoma diagnosed from September 1998 to June 2012 were included. A 68-megaelectron volt proton beam was used to treat the anterior segment with a total dose of 4×12.5 cobalt grey equivalent. The cases were evaluated for local tumour control, eye retention, functional outcome and local complications after treatment. RESULTS During a mean follow-up of 62.7 months (median 54.8 months, range 5.5-159.6 months), local tumour control was achieved in 96.3% of the patients. Cataract and glaucoma were the main complications developing after irradiation in 42.6% and 55.6%, respectively. In 34 of 44 patients (77.3%) who underwent cataract removal, a visual acuity of 20/40 or better following surgery was preserved. Enucleation was performed in three patients. The reason was suspected tumour recurrence in one and glaucoma in two. Hepatic metastasis occurred in one patient. CONCLUSIONS As an alternative to enucleation, whole anterior segment fractionated proton beam radiotherapy offered excellent local tumour control in diffuse iris melanoma. Given the limited alternatives, the rate of complications appears acceptable and visual function could be preserved in the majority of the patients during follow-up.
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Affiliation(s)
- Gregor D Willerding
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dino Cordini
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany Berlin Protonen at the Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany
| | - Christoph Hackl
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bettina Karle
- Berlin Protonen at the Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany
| | - Nona Lakotka
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Jens Heufelder
- Berlin Protonen at the Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany
| | - Lutz Moser
- Berlin Protonen at the Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany
| | - Antonia M Joussen
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Semenova E, Finger PT. Amniotic Membrane Corneal Buffering During Plaque Radiation Therapy for Anterior Uveal Melanoma. Ophthalmic Surg Lasers Imaging Retina 2013; 44:477-82. [DOI: 10.3928/23258160-20130909-10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/16/2013] [Indexed: 11/20/2022]
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McLaughlin JP, Fung AT, Shields JA, Shields CL. Iris melanoma in children: Current approach to management. Oman J Ophthalmol 2013; 6:53-5. [PMID: 23772128 PMCID: PMC3678200 DOI: 10.4103/0974-620x.111920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Iris melanoma usually affects middle aged, Caucasian patients with light colored eyes. Pediatric iris melanoma is rare. A 15-year-old Caucasian male presented with 1-month history of a brown nodule in the inferotemporal aspect of his left eye. Iris nevus was diagnosed, and the patient was observed. Nearly 2 years later the lesion had grown in basal diameter and thickness, and the tumor was excised by partial lamellar scleral flap and sector iridectomy. Histopathology confirmed spindle cell iris melanoma. Two years post-operatively, tumor recurrence with anterior chamber angle involvement and secondary glaucoma developed. He was then treated with custom designed Iodine125 plaque radiotherapy. This case demonstrates the recurrence of iris melanoma despite proper initial surgical management, and outlines current management options for pediatric iris melanoma.
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Affiliation(s)
- John P McLaughlin
- The Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA, USA
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