1
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Tseng YH, Hsu CA, Chou YB. Comparing efficacy of charged-particle therapy with brachytherapy in treatment of uveal melanoma. Eye (Lond) 2024; 38:1882-1890. [PMID: 38565600 PMCID: PMC11226678 DOI: 10.1038/s41433-024-03035-y] [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: 08/13/2023] [Revised: 02/08/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Uveal melanoma (UM) is the most common primary ocular tumour in adults. The most used eye-preserving treatments are charged-particle therapy (CPT) and brachytherapy. We performed a systematic review and meta-analysis to compare efficacies and complications of these two radiotherapies. METHODS We searched EMBASE, PubMed, MEDLINE, and the Cochrane Library from January 2012 to December 2022. Two independent reviewers identified controlled studies comparing outcomes of CPT versus brachytherapy. Case series that utilize either treatment modality were also reviewed. RESULTS One hundred fifty studies met the eligibility criteria, including 2 randomized control trials, 5 controlled cohort studies, and 143 case series studies. We found significant reduction in local recurrence rate among patients treated with CPT compared to brachytherapy (Odds ratio[OR] 0.38, 95% Confidence interval [CI] 0.24-0.60, p < 0.01). Analysis also showed a trend of increased risks of secondary glaucoma after CPT. No statistically significant differences were found in analyzing risks of mortality, enucleation, and cataract. CONCLUSIONS Our study suggested no difference in mortality, enucleation rate and cataract formation rate comparing the two treatments. Lower local recurrence rate and possibly higher secondary glaucoma incidence was noted among patients treated with CPT. Nevertheless, the overall level of evidence is limited, and further high-quality studies are necessary to provide a more definitive conclusion.
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Affiliation(s)
- Yu-Hsuan Tseng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Chia-An Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, 11217, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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2
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van Poppelen NM, Cassoux N, Turunen JA, Naus NC, Verdijk RM, Vaarwater J, Cohen V, Papastefanou VP, Kiratli H, Saakyan SV, Tsygankov AY, Rospond-Kubiak I, Mudhar HS, Salvi SM, Kiilgaard JF, Heegaard S, Moulin AP, Saornil MA, Garciá-Alvarez C, Fili M, Eide NA, Meyer P, Kivelä TT, de Klein A, Kilic E, Al-Jamal RT. The Pediatric and Young Adult Choroidal and Ciliary Body Melanoma Genetic Study, A Survey by the European Ophthalmic Oncology Group. Invest Ophthalmol Vis Sci 2024; 65:12. [PMID: 38573618 PMCID: PMC10996971 DOI: 10.1167/iovs.65.4.12] [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: 05/04/2023] [Accepted: 12/28/2023] [Indexed: 04/05/2024] Open
Abstract
Purpose To explore the genetic background of choroidal and ciliary body melanoma among children and young adults, with special focus on BAP1 germline variants in this age group. Methods Patients under the age of 25 and with confirmed choroidal or ciliary body melanoma were included in this retrospective, multicenter observational study. Nuclear BAP1 immunopositivity was used to evaluate the presence of functional BAP1 in the tumor. Next-generation sequencing using Ion Torrent platform was used to determine pathogenic variants of BAP1, EIF1AX, SF3B1, GNAQ and GNA11 and chromosome 3 status in the tumor or in DNA extracted from blood or saliva. Survival was analyzed using Kaplan-Meier estimates. Results The mean age at diagnosis was 17 years (range 5.0-24.8). A germline BAP1 pathogenic variant was identified in an 18-year-old patient, and a somatic variant, based mainly on immunohistochemistry, in 13 (42%) of 31 available specimens. One tumor had a somatic SF3B1 pathogenic variant. Disomy 3 and the absence of a BAP1 pathogenic variant in the tumor predicted the longest metastasis-free survival. Males showed longer metastasis-free survival than females (P = 0.018). Conclusions We did not find a stronger-than-average BAP1 germline predisposition for choroidal and ciliary body melanoma among children and young adults compared to adults. Males had a more favorable survival and disomy 3, and the absence of a BAP1 mutation in the tumor tissue predicted the most favorable metastasis-free survival. A BAP1 germline pathogenic variant was identified in one patient (1%), and a somatic variant based mainly on immunohistochemistry in 13 (42%).
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Affiliation(s)
- Natasha M. van Poppelen
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nathalie Cassoux
- Department of Ophthalmology, Curie Institute, Université Paris Cité UFR Médecine, Paris, France
| | - Joni A. Turunen
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Eye Genetics Group, Folkhälsan Research Center, Helsinki, Finland
| | - Nicole C. Naus
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert M. Verdijk
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pathology, Leiden Universital Medical Center, Leiden, The Netherlands
| | - Jolanda Vaarwater
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Victoria Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | | | - Hayyam Kiratli
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Svetlana V. Saakyan
- Department of Ophthalmology, Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | - Alexander Y. Tsygankov
- Department of Ophthalmology, Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | - Iwona Rospond-Kubiak
- Department of Ophthalmology, Poznan University of Medical Sciences, Poznán, Poland
| | - Hardeep S. Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Sachin M. Salvi
- Sheffield Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Jens F. Kiilgaard
- Department of Ophthalmology, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, University of Copenhagen, Copenhagen, Denmark
| | - Alexandre P. Moulin
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne University, Lausanne, Switzerland
| | - Maria A. Saornil
- Department of Ophthalmology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Ciro Garciá-Alvarez
- Department of Ophthalmology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Maria Fili
- Department of Ophthalmology, St. Erik Eye Hospital, Stockholm, Sweden
| | - Nils A. Eide
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Peter Meyer
- Department of Ophthalmology, Basel University Hospital, Basel, Switzerland
| | - Tero T. Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annelies de Klein
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Emine Kilic
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rana'a T. Al-Jamal
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
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3
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Pica A, Weber DC, Schweizer C, Chaouch A, Zografos L, Schalenbourg A. Clinical Outcomes in AYAs (Adolescents and Young Adults) Treated with Proton Therapy for Uveal Melanoma: A Comparative Matching Study with Elder Adults. Cancers (Basel) 2023; 15:4652. [PMID: 37760619 PMCID: PMC10526519 DOI: 10.3390/cancers15184652] [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: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE The aim of this study was to compare the clinical outcomes of adolescents and young adults (AYAs) with those of elder adult patients treated with proton therapy (PT) for uveal melanoma (UM). MATERIAL AND METHODS A retrospective, comparative study was conducted in UM patients who underwent PT at the Ocular Oncology Unit of the Jules-Gonin Eye Hospital (University of Lausanne, Lausanne, Switzerland) and the Paul Scherrer Institute (PSI); (Villigen, Switzerland) between January 1997 and December 2007. Propensity score matching (PSM) was used to select for each AYA (between 15-39 years old) an elder adult patient (≥40 years) with similar characteristics. We assessed ocular follow-up, local tumor control, metastasis incidence, and overall and relative survival (OS and RS). Non-terminal outcomes were then compared between the two groups using competing risk survival analysis. RESULTS Out of a total of 2261 consecutive UM patients, after excluding 4 children (<15 years) and 6 patients who were metastatic at presentation, we identified 272 AYA patients and matched 270 of them with 270 elder adult patients. Before PSM, the AYA patients had a higher incidence of primary iris melanoma (4.0% vs. 1.4%; p = 0.005), while the elder patients were more likely to have other neoplastic diseases at presentation (9% vs. 3.7%; p = 0.004). Ocular outcomes and local tumor control were similar in both groups. Cumulative metastasis incidence for the AYA and elder adult groups was 13% and 7.9% at 5 years and 19.7% and 12.7% at 10 years, respectively, which was not significantly different between the groups (p = 0.214). The OS was similar in the two groups (p = 0.602), with estimates in the AYA and elder adult groups of 95.5% and 96.6% at 5 years and 94.6% and 91.4% at 10 years, respectively. However, the relative survival (RS) estimation was worse in the AYA group than the elder group (p = 0.036). CONCLUSION While AYAs treated with PT for UM have similar ocular outcomes and present the same metastasis incidence and OS as elder adults, their RS is worse than that in elder adults, when compared with the population in general.
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Affiliation(s)
- Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen West, Switzerland;
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen West, Switzerland;
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
- Department of Radiation Oncology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Claude Schweizer
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA (Fondation Asile des Aveugles), 1004 Lausanne, Switzerland; (C.S.); (L.Z.); (A.S.)
| | - Aziz Chaouch
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1011 Lausanne, Switzerland;
| | - Leonidas Zografos
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA (Fondation Asile des Aveugles), 1004 Lausanne, Switzerland; (C.S.); (L.Z.); (A.S.)
| | - Ann Schalenbourg
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA (Fondation Asile des Aveugles), 1004 Lausanne, Switzerland; (C.S.); (L.Z.); (A.S.)
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4
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Banou L, Tsani Z, Arvanitogiannis K, Pavlaki M, Dastiridou A, Androudi S. Radiotherapy in Uveal Melanoma: A Review of Ocular Complications. Curr Oncol 2023; 30:6374-6396. [PMID: 37504330 PMCID: PMC10378371 DOI: 10.3390/curroncol30070470] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/20/2023] [Accepted: 07/01/2023] [Indexed: 07/29/2023] Open
Abstract
Uveal melanoma represents the most prevalent form of primary malignant intraocular tumor in adults. Historically, enucleation was considered the gold-standard approach in the treatment of uveal melanoma. Currently, radiotherapy is the most commonly used therapy, aiming at a better quality of life. However, radiotherapy can result in several ocular complications, some of which may be vision-threatening. Radiation-induced dry eye, scleral necrosis, cataract, rubeosis iridis, neovascular glaucoma, radiation retinopathy, maculopathy, and optic neuropathy are the most common complications. This article aims to summarize the current literature regarding the ocular complications after radiotherapy, as well as their clinical features, risk factors, and management strategies. A thorough understanding of these issues is crucial for ophthalmologists and oncologists to provide optimal patient care, improve visual outcomes, and minimize long-term complications.
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Affiliation(s)
- Lamprini Banou
- Department of Ophthalmology, University of Thessaly, 41110 Larissa, Greece
| | - Zoi Tsani
- Department of Ophthalmology, University of Thessaly, 41110 Larissa, Greece
| | | | - Maria Pavlaki
- Department of Ophthalmology, University of Thessaly, 41110 Larissa, Greece
| | - Anna Dastiridou
- Department of Ophthalmology, University of Thessaly, 41110 Larissa, Greece
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, 41110 Larissa, Greece
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5
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Hu Q, Xu L, Yi Q, Yuan J, Wu G, Wang Y. miR-204 suppresses uveal melanoma cell migration and invasion through negative regulation of RAB22A. Funct Integr Genomics 2023; 23:49. [PMID: 36705739 DOI: 10.1007/s10142-022-00953-6] [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: 10/22/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/28/2023]
Abstract
Uveal melanoma (UM), a frequently seen adulthood primary ocular malignancy, shows high aggressiveness. Accumulating studies have revealed the crucial effects of microRNAs (miRNAs) on tumorigenesis and development in various human tumors. miR-204, the cancer-associated miRNA, shows dysregulation and is related to several human malignancies, but its effect on UM remains unknown. The present work focused on exploring miR-204's effect on UM and elucidating its possible molecular mechanisms. According to our results, miR-204 expression markedly increased within both UM tissues and cell lines. As revealed by functional analysis, miR-204 suppressed UM cell invasion and migration. Besides, RAB22A expression decreased through directly binding miR-204 into the corresponding 3' untranslated region (3'UTR) in UM cells. Furthermore, the RAB22A mRNA level increased, which was negatively related to the miR-204 level within UM samples. As revealed by mechanical research, miR-204 exerted its inhibition on the invasion and migration of UM cells via RAB22A. Taken together, this study suggested the tumor-suppressing effect of miR-204 on UM through down-regulating RAB22A. Thus, miR-204 may serve as the new anti-UM therapeutic target.
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Affiliation(s)
- Qidi Hu
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China
| | - Lingli Xu
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China
| | - Quanyong Yi
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China
| | - Jianshu Yuan
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China
| | - Guohai Wu
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China
| | - Yuwen Wang
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China.
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6
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Nakagawa N, Morimoto T, Miyamura T, Suzuki S, Shimojo H, Nishida K. A case of retinoblastoma resulting in phthisis bulbi after proton beam radiation therapy. Am J Ophthalmol Case Rep 2022; 28:101715. [PMID: 36204723 PMCID: PMC9530840 DOI: 10.1016/j.ajoc.2022.101715] [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: 10/24/2021] [Revised: 08/30/2022] [Accepted: 09/23/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Proton beam radiation therapy (PBRT) is a treatment option for advanced retinoblastoma (RB) resistant to chemotherapy and focal ophthalmic treatment. Here we report a case of RB with phthisis bulbi following PBRT. Observations A 16-day-old boy with a family history of RB was referred to our institution. Initial examination revealed an extensive white mass in the right eye and a small tumor near the optic disk of the left eye. The patient was diagnosed with bilateral RB and treated with chemotherapy and focal ophthalmic therapy. The right eye showed shrinkage in the treatment course. The tumor control was not achieved bilaterally, and, therefore, PBRT was performed to preserve the eyes. However, the right eye became significantly phthisical following PBRT and ultimately required enucleation. Conclusions and importance PBRT for RB may result in phthisis bulbi. Further investigations of its role and possible complications are warranted.
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Affiliation(s)
- Norihiko Nakagawa
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Morimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Corresponding author. Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamada-Oka 2-2, Osaka, 565-0871, Japan.
| | - Takako Miyamura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigenobu Suzuki
- Department of Ophthalmologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Shimojo
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
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7
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Stålhammar G, Herrspiegel C. Long-term relative survival in uveal melanoma: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2022; 2:18. [PMID: 35603296 PMCID: PMC9053233 DOI: 10.1038/s43856-022-00082-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/18/2022] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
A large proportion of patients with uveal melanoma develop metastases and succumb to their disease. Reports on the size of this proportion vary considerably.
Methods
PubMed, Web of Science and Embase were searched for articles published after 1980. Studies with ≥100 patients reporting ≥five-year relative survival rates were included. Studies solely reporting Kaplan-Meier estimates and cumulative incidences were not considered, due to risk for competing risk bias and classification errors. A meta-analysis was performed using random-effects and weighted averages models, as well as a combined estimate based on curve fitting.
Results
Nine studies and a total of 18 495 patients are included. Overall, the risk of selective reporting bias is low. Relative survival rates vary across the population of studies (I2 48 to 97% and Qp < 0.00001 to 0.15), likely due to differences in baseline characteristics and the large number of patients included (τ2 < 0.02). The 30-year relative survival rates follow a cubic curve that is well fitted to data from the random-effects inverse-variance and weighted average models (R2 = 0.95, p = 7.19E−7). The estimated five, ten, 15, 20, 25 and 30-year relative survival rates are 79, 66, 60, 60, 62 and 67%, respectively.
Conclusions
The findings suggest that about two in five of all patients with uveal melanoma ultimately succumb to their disease. This indicates a slightly better prognosis than what is often assumed, and that patients surviving 20 years or longer may have a survival advantage to individuals of the same sex and age from the general population.
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Iatrogenic Ocular Surface Diseases Occurring during and/or after Different Treatments for Ocular Tumours. Cancers (Basel) 2021; 13:cancers13081933. [PMID: 33923737 PMCID: PMC8073875 DOI: 10.3390/cancers13081933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The ocular surface represents a finely regulated system that allows the protection of the eye. It can be affected by therapies used for the treatment of various intraocular tumours, particularly conjunctival cancers and uveal melanoma. In these conditions, treatments are chosen according to the characteristics of the lesion, and include a combination of selective surgery, anticancer eye drops, and/or radiotherapy delivered through different mechanisms. Possible side effects affecting the ocular surface range from transient dry eye or keratitis up to more severe complications such as corneal melting and perforation. These complications deserve careful evaluation for the risk of permanent sight-threatening sequelae. Physicians involved in the management of patients affected by ocular tumours should be aware of this risk in order to reach an early diagnosis and promptly set up an adequate treatment. The present review summarizes acute and chronic complications affecting the ocular surface following different therapies for the treatment of conjunctival cancers and uveal melanoma, and also reports clinical cases of representative patients who experienced these complications. Abstract The ocular surface represents a finely regulated system that allows the protection of the eye. It is particularly susceptible to different treatments for intraocular tumours, such as uveal melanoma and conjunctival cancers. Traditionally, the management of ocular tumours depends on the characteristics of the lesion, and is based on a combination of selective surgery, topical chemotherapy, and/or radiotherapy delivered through different mechanisms (e.g., charged-particle radiotherapy or brachytherapy). Possible complications involving the ocular surface range from transient dry eye disease or keratitis up to corneal melting and perforation, which in any case deserve careful evaluation for the risk of permanent sigh-threatening complications. Clinicians involved in the management of these patients must be aware of this risk, in order to reach an early diagnosis and promptly set up an adequate treatment. The present review of the literature will summarize acute and chronic complications affecting the ocular surface following different therapies for the treatment of ocular tumours.
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van Poppelen NM, de Bruyn DP, Bicer T, Verdijk R, Naus N, Mensink H, Paridaens D, de Klein A, Brosens E, Kiliҫ E. Genetics of Ocular Melanoma: Insights into Genetics, Inheritance and Testing. Int J Mol Sci 2020; 22:E336. [PMID: 33396957 PMCID: PMC7795687 DOI: 10.3390/ijms22010336] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 12/18/2022] Open
Abstract
Ocular melanoma consists of posterior uveal melanoma, iris melanoma and conjunctival melanoma. These malignancies derive from melanocytes in the uveal tract or conjunctiva. The genetic profiles of these different entities differ from each other. In uveal melanoma, GNAQ and GNA11 gene mutations are frequently found and prognosis is based on mutation status of BAP1, SF3B1 and EIF1AX genes. Iris melanoma, also originating from the uvea, has similarities to the genetic makeups of both posterior uveal melanoma (UM) and conjunctival melanoma since mutations in GNAQ and GNA11 are less common and genes involved in conjunctival melanoma such as BRAF have been described. The genetic spectrum of conjunctival melanoma, however, includes frequent mutations in the BRAF, NRAS and TERT promoter genes, which are found in cutaneous melanoma as well. The BRAF status of the tumor is not correlated to prognosis, whereas the TERT promoter gene mutations are. Clinical presentation, histopathological characteristics and copy number alterations are associated with survival in ocular melanoma. Tissue material is needed to classify ocular melanoma in the different subgroups, which creates a need for the use of noninvasive techniques to prognosticate patients who underwent eye preserving treatment.
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Affiliation(s)
- Natasha M. van Poppelen
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Daniël P. de Bruyn
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Tolga Bicer
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Ophthalmology, University of Health Sciences Diskapi Training and Research Hospital, Ankara 06330, Turkey
| | - Rob Verdijk
- Department of Pathology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands;
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Nicole Naus
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
| | - Hanneke Mensink
- Department of Ophthalmic Oncology, The Rotterdam Eye Hospital, 3011 BH Rotterdam, The Netherlands;
| | - Dion Paridaens
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Ophthalmic Oncology, The Rotterdam Eye Hospital, 3011 BH Rotterdam, The Netherlands;
| | - Annelies de Klein
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Erwin Brosens
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Emine Kiliҫ
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
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10
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Fry MV, Augsburger JJ, Corrêa ZM. Clinical Features, Metastasis, and Survival in Patients Younger Than 21 Years With Posterior Uveal Melanoma. JAMA Ophthalmol 2019; 137:75-81. [PMID: 30422230 DOI: 10.1001/jamaophthalmol.2018.5132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Given the rarity of posterior uveal melanoma in patients younger than 21 years, reporting clinical experience in this area has relevance. Objective To describe the baseline clinical features, treatment, and clinical course of a group of patients younger than 21 years who have primary posterior uveal melanoma. Design, Setting, and Participants This retrospective descriptive case series of patients younger than 21 years who have a primary choroidal or ciliochoroidal melanoma was conducted at a single-center subspecialty referral practice. Patients in the relevant age group who were treated in a single practice between July 1980 and December 2013 were included; clinical data collected through December 2017 were captured to permit adequate follow-up time in all cases. Main Outcomes and Measures Conventional descriptive statistics of relevant clinical variables (eg, demographic, tumor, treatment, and outcome variables) of each patient were recorded. Actuarial metastasis-free and overall survival curves were computed and plotted, as was a postdetection survival curve of patients who developed metastasis during available follow-up. Results Of 2265 patients with posterior uveal melanoma encountered by the authors during the study interval, 18 (0.8%) were younger than 21 years when diagnosed and treated. Ten were female and 8 male, and the mean (SD) age was 16.6 (4.2) years. Through available follow-up, 8 of these patients had developed metastatic uveal melanoma (44%). All 8 died of metastasis. Actuarial survival analysis showed that the cumulative probability of metastatic death in this group exceeded 50%. The median overall survival time after treatment of the primary intraocular tumor was 11.9 (95% CI, 7.3-16.5) years. The median survival time after detection of metastasis in the 8 patients who developed metastasis was 2.3 months (95% CI, 0.0-5.2) months. Conclusions and Relevance Posterior uveal melanoma in patients younger than 21 years appears to have a similar if not worse prognosis than patients with PUM in the population overall. Owing to the later onset of metastasis observed, patients younger than 21 years should continue to have surveillance tests for more than 10 years after treatment.
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Affiliation(s)
- Matthew V Fry
- Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - James J Augsburger
- Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Zélia M Corrêa
- Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Bagger MM. Intraocular biopsy of uveal melanoma Risk assessment and identification of genetic prognostic markers. Acta Ophthalmol 2018; 96 Suppl A112:1-28. [PMID: 30133961 DOI: 10.1111/aos.13858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Mette Marie Bagger
- Departments of Clinical Genetics and Ophthalmology; Rigshospitalet Blegdamsvej; Copenhagen University Hospital; Copenhagen Denmark
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12
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Choi YJ, Kim TW, Kim S, Choung H, Lee MJ, Kim N, Khwarg SI, Yu YS. Effects on Periocular Tissues after Proton Beam Radiation Therapy for Intraocular Tumors. J Korean Med Sci 2018; 33:e120. [PMID: 29651818 PMCID: PMC5897156 DOI: 10.3346/jkms.2018.33.e120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/20/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To present our experience on orbital and periorbital tissue changes after proton beam radiation therapy (PBRT) in patients with intraocular tumors, apart from treatment outcomes and disease control. METHODS Medical records of 6 patients with intraocular tumors who had been treated with PBRT and referred to oculoplasty clinics of two medical centers (Seoul National University Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center) from October 2007 to September 2014 were retrospectively reviewed. The types of adverse effects associated with PBRT, their management, and progression were analyzed. In anophthalmic patients who eventually underwent enucleation after PBRT due to disease progression, orbital volume (OV) was assessed from magnetic resonance (MR) images using the Pinnacle3 program. RESULTS Among the six patients with PBRT history, three had uveal melanoma, and three children had retinoblastoma. Two eyes were treated with PBRT only, while the other four eyes ultimately underwent enucleation. Two eyes with PBRT only suffered from radiation dermatitis and intractable epiphora due to canaliculitis or punctal obstruction. All four anophthalmic patients showed severe enophthalmic features with periorbital hollowness. OV analysis showed that the difference between both orbits was less than 0.1 cm before enucleation, but increased to more than 2 cm³ after enucleation. CONCLUSION PBRT for intraocular tumors can induce various orbital and periorbital tissue changes. More specifically, when enucleation is performed after PBRT due to disease progression, significant enophthalmos and OV decrease can develop and can cause poor facial cosmesis as treatment sequelae.
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Affiliation(s)
- Youn Joo Choi
- Department of Ophthalmology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Tae Wan Kim
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
| | - Suzy Kim
- Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.
| | - Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Namju Kim
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Young Suk Yu
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
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13
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Heyer LJ, Metz C, Flühs D, Heyer CM, Bornfeld N. [Uveal and iridociliary melanomas in young patients : A retrospective analysis of 57 cases]. Ophthalmologe 2016; 113:1046-1050. [PMID: 27286673 DOI: 10.1007/s00347-016-0285-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Uveal melanomas (UM) are rare malignancies in young patients. It is unknown if UM in young patients significantly differs from those in older patients concerning tumor size and localization, metastasis and genetics. The aim of this study was to evaluate the clinical course and tumor characteristics in young patients with UM. MATERIAL AND METHODS All patients with UM below the age of 32 years who had been treated at our hospital were included in the study. Patient age and sex, duration of symptoms, visual impairment, tumor size and location, genetics, therapy, follow-up interventions and tumor-associated deaths were documented. RESULTS A total of 57 patients (67 % male, mean age 24.7 years) were included in the study with an average symptomatic course of 5 months. Of the patients 8 (14 %) had an initial visual acuity of ≥ 0.9, 16 (28 %) 0.5-0.8, 22 (39 %) 0.05-0.4 and 9 (16 %) < 0.05 (no data for 2 patients, 4 %). After therapy visual acuity was < 0.05 in 54 % and 53 % of the tumors were choroidal UM (70 % juxtapapillary/circumpapillary), whereas 47 % were ciliochoroidal (54 % with iridociliary involvement). The average tumor size was 12.7 ± 3.6 mm with an average prominence of 6.2 ± 3.2 mm. Genetic evaluation (n = 16) revealed disomy 3 in 64 % and 54 % of the patients received radiotherapy with local application of ruthenium 106. In 46 % of cases follow-up interventions were neccessary including 70 % due to radiogenic retinopathy. CONCLUSION In young patients UM did not show any preferred localization. The majority of genetically evaluated tumors revealed disomy 3 with no significant correlation to tumor location. Independent of tumor size, location and therapy, approximately half of the patients needed follow-up interventions, predominantly due to radiogenic retinopathy.
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Affiliation(s)
- L J Heyer
- Klinik für Erkrankungen des hinteren Augenabschnittes, Universitätsklinikum Essen, Essen, Deutschland
| | - C Metz
- Klinik für Erkrankungen des hinteren Augenabschnittes, Universitätsklinikum Essen, Essen, Deutschland
| | - D Flühs
- Medizinische Physik der Strahlenklinik, Universitätsklinikum Essen, Essen, Deutschland
| | - C M Heyer
- Institut für Kinderradiologie am St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
| | - N Bornfeld
- Klinik für Erkrankungen des hinteren Augenabschnittes, Universitätsklinikum Essen, Essen, Deutschland
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Hrbacek J, Mishra KK, Kacperek A, Dendale R, Nauraye C, Auger M, Herault J, Daftari IK, Trofimov AV, Shih HA, Chen YLE, Denker A, Heufelder J, Horwacik T, Swakoń J, Hoehr C, Duzenli C, Pica A, Goudjil F, Mazal A, Thariat J, Weber DC. Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey. Int J Radiat Oncol Biol Phys 2016; 95:336-343. [DOI: 10.1016/j.ijrobp.2016.01.040] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/11/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
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Al-Jamal RT, Cassoux N, Desjardins L, Damato B, Konstantinidis L, Coupland SE, Heimann H, Petrovic A, Zografos L, Schalenbourg A, Velazquez-Martin JP, Krema H, Bogdali A, Markiewicz A, Romanowska-Dixon B, Metz CHD, Biewald E, Bornfeld N, Kiratli H, Bronkhorst IHG, Jager MJ, Marinkovic M, Fili M, Seregard S, Frenkel S, Pe'er J, Salvi SM, Rennie IG, Rospond-Kubiak I, Kociecki J, Kiilgaard JF, Heegaard S, Cohen VML, Sagoo MS, Amiryan A, Saakyan S, Eide N, Krohn J, Midena E, Parrozzani R, Grange JD, Kilic E, Blasi MA, Saornil MA, Kivelä TT. The Pediatric Choroidal and Ciliary Body Melanoma Study: A Survey by the European Ophthalmic Oncology Group. Ophthalmology 2016; 123:898-907. [PMID: 26854035 DOI: 10.1016/j.ophtha.2015.12.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/13/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To collect comprehensive data on choroidal and ciliary body melanoma (CCBM) in children and to validate hypotheses regarding pediatric CCBM: children younger than 18 years, males, and those without ciliary body involvement (CBI) have more favorable survival prognosis than young adults 18 to 24 years of age, females, and those with CBI. DESIGN Retrospective, multicenter observational study. PARTICIPANTS Two hundred ninety-nine patients from 24 ocular oncology centers, of whom 114 were children (median age, 15.1 years; range, 2.7-17.9 years) and 185 were young adults. METHODS Data were entered through a secure website and were reviewed centrally. Survival was analyzed using Kaplan-Meier analysis and Cox proportional hazards regression. MAIN OUTCOME MEASURES Proportion of females, tumor-node-metastasis (TNM) stage, cell type, and melanoma-related mortality. RESULTS Cumulative frequency of having CCBM diagnosed increased steadily by 0.8% per year of age between 5 and 10 years of age and, after a 6-year transition period, by 8.8% per year from age 17 years onward. Of children and young adults, 57% and 63% were female, respectively, which exceeded the expected 51% among young adults. Cell type, known for 35% of tumors, and TNM stage (I in 22% and 21%, II in 49% and 52%, III in 30% and 28%, respectively) were comparable for children and young adults. Melanoma-related survival was 97% and 90% at 5 years and 92% and 80% at 10 years for children compared with young adults, respectively (P = 0.013). Males tended to have a more favorable survival than females among children (100% vs. 85% at 10 years; P = 0.058). Increasing TNM stage was associated with poorer survival (stages I, II, and III: 100% vs. 86% vs. 76%, respectively; P = 0.0011). By multivariate analysis, being a young adult (adjusted hazard rate [HR], 2.57), a higher TNM stage (HR, 2.88 and 8.38 for stages II and III, respectively), and female gender (HR, 2.38) independently predicted less favorable survival. Ciliary body involvement and cell type were not associated with survival. CONCLUSIONS This study confirms that children with CCBM have a more favorable survival than young adults 18 to 25 years of age, adjusting for TNM stage and gender. The association between gender and survival varies between age groups.
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Affiliation(s)
- Rana'a T Al-Jamal
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | | | | | - Bertil Damato
- Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | | | - Sarah E Coupland
- Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, United Kingdom; Department of Cellular Pathology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Heinrich Heimann
- Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Aleksandra Petrovic
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles (FAA), Lausanne, Switzerland
| | - Leonidas Zografos
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles (FAA), Lausanne, Switzerland
| | - Ann Schalenbourg
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles (FAA), Lausanne, Switzerland
| | - Juan P Velazquez-Martin
- Department of Ocular Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - Hatem Krema
- Department of Ocular Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - Anna Bogdali
- Department of Ophthalmology and Ocular Oncology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Anna Markiewicz
- Department of Ophthalmology and Ocular Oncology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Bozena Romanowska-Dixon
- Department of Ophthalmology and Ocular Oncology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Claudia H D Metz
- Department of Ophthalmology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Eva Biewald
- Department of Ophthalmology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Norbert Bornfeld
- Department of Ophthalmology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Hayyam Kiratli
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Inge H G Bronkhorst
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Fili
- Department of Ophthalmic Oncology, St. Erik's Eye Hospital, Stockholm, Sweden
| | - Stefan Seregard
- Department of Ophthalmic Oncology, St. Erik's Eye Hospital, Stockholm, Sweden
| | - Shahar Frenkel
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Pe'er
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sachin M Salvi
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Ian G Rennie
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Iwona Rospond-Kubiak
- Department of Ophthalmology, Poznán University of Medical Sciences, Poznán, Poland
| | - Jaroslaw Kociecki
- Department of Ophthalmology, Poznán University of Medical Sciences, Poznán, Poland
| | - Jens Folke Kiilgaard
- Department of Ophthalmology, Copenhagen University Hospital Glostrup, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital Glostrup, Copenhagen, Denmark
| | - Victoria M L Cohen
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, United Kingdom
| | - Mandeep S Sagoo
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, United Kingdom
| | - Anush Amiryan
- Department of Ophthalmic Oncology and Radiology, Helmholtz Institute, Moscow, Russia
| | - Svetlana Saakyan
- Department of Ophthalmic Oncology and Radiology, Helmholtz Institute, Moscow, Russia
| | - Nils Eide
- Department of Ophthalmology, Oslo University Hospital-HF and University of Oslo, Oslo, Norway
| | - Jørgen Krohn
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Raffaele Parrozzani
- G. B. Bietti Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ocular Oncology and Toxicology Research Unit, Rome, Italy
| | | | - Emine Kilic
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Maria Antonia Saornil
- Department of Ophthalmology, Ocular Oncology Unit, Valladolid University Hospital, Valladolid, Spain
| | - Tero T Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Patel S, Kostaras X, Parliament M, Olivotto IA, Nordal R, Aronyk K, Hagen N. Recommendations for the referral of patients for proton-beam therapy, an Alberta Health Services report: a model for Canada? ACTA ACUST UNITED AC 2014; 21:251-62. [PMID: 25302033 DOI: 10.3747/co.21.2207] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Compared with photon therapy, proton-beam therapy (pbt) offers compelling advantages in physical dose distribution. Worldwide, gantry-based proton facilities are increasing in number, but no such facilities exist in Canada. To access pbt, Canadian patients must travel abroad for treatment at high cost. In the face of limited access, this report seeks to provide recommendations for the selection of patients most likely to benefit from pbt and suggests an out-of-country referral process. METHODS The medline, embase, PubMed, and Cochrane databases were systematically searched for studies published between January 1990 and May 2014 that evaluated clinical outcomes after pbt. A draft report developed through a review of evidence was externally reviewed and then approved by the Alberta Health Services Cancer Care Proton Therapy Guidelines steering committee. RESULTS Proton therapy is often used to treat tumours close to radiosensitive tissues and to treat children at risk of developing significant late effects of radiation therapy (rt). In uncontrolled and retrospective studies, local control rates with pbt appear similar to, or in some cases higher than, photon rt. Randomized trials comparing equivalent doses of pbt and photon rt are not available. SUMMARY Referral for pbt is recommended for patients who are being treated with curative intent and with an expectation for long-term survival, and who are able and willing to travel abroad to a proton facility. Commonly accepted indications for referral include chordoma and chondrosarcoma, intraocular melanoma, and solid tumours in children and adolescents who have the greatest risk for long-term sequelae. Current data do not provide sufficient evidence to recommend routine referral of patients with most head-and-neck, breast, lung, gastrointestinal tract, and pelvic cancers, including prostate cancer. It is recommended that all referrals be considered by a multidisciplinary team to select appropriate cases.
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Affiliation(s)
- S Patel
- Department of Radiation Oncology, Cross Cancer Institute, and Department of Oncology, University of Alberta, Edmonton, AB
| | - X Kostaras
- Guideline Utilization Resource Unit, Alberta Health Services, Calgary, AB
| | - M Parliament
- Department of Radiation Oncology, Cross Cancer Institute, and Department of Oncology, University of Alberta, Edmonton, AB
| | - I A Olivotto
- Division of Radiation Oncology, Tom Baker Cancer Centre, and University of Calgary, Calgary, AB
| | - R Nordal
- Division of Radiation Oncology, Tom Baker Cancer Centre, and University of Calgary, Calgary, AB
| | - K Aronyk
- Division of Neurosurgery, University of Alberta, Edmonton, AB
| | - N Hagen
- Guideline Utilization Resource Unit, Alberta Health Services, Calgary, AB
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