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Fleury E, Pignol JP, Kiliç E, Milder M, van Rij C, Naus N, Yavuzyigitoglu S, den Toom W, Zolnay A, Spruijt K, van Vulpen M, Trnková P, Hoogeman M. Comparison of stereotactic radiotherapy and protons for uveal melanoma patients. Phys Imaging Radiat Oncol 2024; 31:100605. [PMID: 39050744 PMCID: PMC11268348 DOI: 10.1016/j.phro.2024.100605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background and purpose Uveal melanoma (UM) is the most common primary ocular malignancy. We compared fractionated stereotactic radiotherapy (SRT) with proton therapy, including toxicity risks for UM patients. Materials and methods For a total of 66 UM patients from a single center, SRT dose distributions were compared to protons using the same planning CT. Fourteen dose-volume parameters were compared in 2-Gy equivalent dose per fraction (EQD2). Four toxicity profiles were evaluated: maculopathy, optic-neuropathy, visual acuity impairment (Profile I); neovascular glaucoma (Profile II); radiation-induced retinopathy (Profile III); and dry-eye syndrome (Profile IV). For Profile III, retina Mercator maps were generated to visualize the geographical location of dose differences. Results In 9/66 cases, (14 %) proton plans were superior for all dose-volume parameters. Higher T stages benefited more from protons in Profile I, especially tumors located within 3 mm or less from the optic nerve. In Profile II, only 9/66 cases resulted in a better proton plan. In Profile III, better retina volume sparing was always achievable with protons, with a larger gain for T3 tumors. In Profile IV, protons always reduced the risk of toxicity with a median RBE-weighted EQD2 reduction of 15.3 Gy. Conclusions This study reports the first side-by-side imaging-based planning comparison between protons and SRT for UM patients. Globally, while protons appear almost always better regarding the risk of optic-neuropathy, retinopathy and dry-eye syndrome, for other toxicity like neovascular glaucoma, a plan comparison is warranted. Choice would depend on the prioritization of risks.
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Affiliation(s)
- Emmanuelle Fleury
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- HollandPTC, Delft, The Netherlands
| | | | - Emine Kiliç
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
- Erasmus Medical Center, Department of Clinical Genetics, Rotterdam, The Netherlands
| | - Maaike Milder
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Caroline van Rij
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Nicole Naus
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
| | | | - Wilhelm den Toom
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Andras Zolnay
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | | | | | - Petra Trnková
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Mischa Hoogeman
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- HollandPTC, Delft, The Netherlands
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Early anti-VEGF treatment for radiation maculopathy and optic neuropathy: lessons learned. Eye (Lond) 2022; 37:866-874. [PMID: 35974178 PMCID: PMC10050069 DOI: 10.1038/s41433-022-02200-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/17/2022] [Accepted: 08/02/2022] [Indexed: 11/08/2022] Open
Abstract
Radiation therapy has saved both sight and life for eye cancer patients. The most common methods include ophthalmic plaque brachytherapy and external beam techniques. However, subsequent dose-dependent radiation vasculopathy invariably occurs within and around the targeted zone. In 2006, Finger discovered that periodic intravitreal anti-vascular endothelial growth factor (anti-VEGF) bevacizumab could reverse and suppress intraocular radiation vasculopathy. At first, it was administered at the onset of radiation-related vision loss. Though bevacizumab induced regression of macular oedema, retinal haemorrhages and cotton-wool infarcts, most patients were left with residual retinal damage, manifest as metamorphopsia and loss of vision. These results led to earlier and earlier anti-VEGF interventions: first after signs of progressive radiation retinopathy, and then for signs of radiation maculopathy, and finally for high-risk eyes with no clinical signs of retinopathy. Earlier initiation of intravitreal anti-VEGF therapy typically resulted in greater restoration and preservation of macular anatomy, reductions of retinal haemorrhages, resolution of cotton-wool spots and vision preservation. Recent research on optical coherence tomography angiography (OCT-A) has revealed that radiation vasculopathy occurs prior to clinical ophthalmic signs or symptoms. Therefore, it seemed reasonable to consider treating high-risk patients (considered certain to eventually develop radiation maculopathy) to prevent or delay vision loss. Herein, we describe the evolution of treatment for radiation maculopathy as well as recent research supporting anti-VEGF treatment of high-risk patients immediately following radiation to maximize vision outcomes.
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Bakshi AK, Shrivastava V, Chattaraj A, Samuel K, Palani Selvam T, Sapra BK, Sinharoy P, Banerjee D, Sugilala G, Manohar S, Kaushik CP. Surface dose rate variations in planar and curved geometries of 106Ru/ 106Rh plaque sources for ocular tumors. Phys Med 2021; 89:200-209. [PMID: 34399207 DOI: 10.1016/j.ejmp.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Investigation of surface dose rate variation with respect to the source configuration of 106Ru/106Rh eye plaque. To explore an alternate way to determine activity of brachytherapy plaques. METHODS The surface dose rates of 106Ru/106Rh plaque developed indigenously were measured by extrapolation chamber. To rule out possibility of any error in the activity distribution and quantity, same source was used in two different configurations namely planar and curved. EBT3 Gafchromic film was used for determination of uniformity in activity. Monte Carlo-based Codes EGSnrc and FLUKA were used to calculate dose rate in tissue, percentage depth dose and for determination of activity. Parameters and correction factors were estimated using simulations. RESULTS The measured reference absorbed dose rates for planar and curved 106Ru/106Rh eye plaques are found to be 589 ± 29 mGy/h and 560 ± 28 mGy/h, respectively. The difference in the reference absorbed dose rate of curved eye plaque is about ~5% as compared to planar configuration. The FLUKA-calculated dose values are almost independent of cavity length of the extrapolation chamber for both eye plaques. The FLUKA-based dose rates per μCi 106Ru/106Rh are about 17.28 ± 0.08 mGy/h and 16.48 ± 0.06 mGy/h, respectively for planar and curved eye plaques which match well with the measurements. The calculated activities for planar and curved eye plaques are 34.08 μCi and 33.98 μCi, respectively. CONCLUSIONS Surface dose rates for a prototype 106Ru/106Rh eye plaque with different configurations were estimated using simulations and measured experimentally. An alternate way to determine activity of beta-gamma brachytherapy plaque has been proposed.
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Affiliation(s)
- A K Bakshi
- Radiological Physics & Advisory Division, India; Homi Bhabha National Institute, Mumbai 400 094, India.
| | | | | | | | - T Palani Selvam
- Radiological Physics & Advisory Division, India; Homi Bhabha National Institute, Mumbai 400 094, India
| | - B K Sapra
- Radiological Physics & Advisory Division, India; Homi Bhabha National Institute, Mumbai 400 094, India
| | - Prithwish Sinharoy
- Nuclear Recycle Group, Bhabha Atomic Research Centre, Mumbai 400 085, India; Homi Bhabha National Institute, Mumbai 400 094, India
| | - Dayamoy Banerjee
- Nuclear Recycle Group, Bhabha Atomic Research Centre, Mumbai 400 085, India; Homi Bhabha National Institute, Mumbai 400 094, India
| | - G Sugilala
- Nuclear Recycle Group, Bhabha Atomic Research Centre, Mumbai 400 085, India; Homi Bhabha National Institute, Mumbai 400 094, India
| | - Smitha Manohar
- Radiological Physics & Advisory Division, India; Nuclear Recycle Group, Bhabha Atomic Research Centre, Mumbai 400 085, India; Homi Bhabha National Institute, Mumbai 400 094, India
| | - C P Kaushik
- Nuclear Recycle Group, Bhabha Atomic Research Centre, Mumbai 400 085, India; Homi Bhabha National Institute, Mumbai 400 094, India
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Itta F, Liuzzi R, Farella A, Porri G, Pacelli R, Conson M, Oliviero C, Buonanno F, Breve M, Cennamo G, Clemente S, Cella L. Personalized treatment planning in eye brachytherapy for ocular melanoma: Dosimetric analysis on ophthalmic structure at risk. Phys Med 2020; 76:285-293. [DOI: 10.1016/j.ejmp.2020.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/21/2022] Open
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Espensen CA, Appelt AL, Fog LS, Gothelf AB, Thariat J, Kiilgaard JF. Predicting Visual Acuity Deterioration and Radiation-Induced Toxicities after Brachytherapy for Choroidal Melanomas. Cancers (Basel) 2019; 11:E1124. [PMID: 31390850 PMCID: PMC6721463 DOI: 10.3390/cancers11081124] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 02/03/2023] Open
Abstract
Ruthenium-106 (Ru-106) brachytherapy is an established modality for eye-preserving treatment of choroidal melanoma. To achieve optimal treatment outcomes, there should be a balance between tumour control and the risk of healthy tissue toxicity. In this retrospective study, we examined normal tissue complication probability (NTCP) for visual acuity deterioration and late complications to aid the understanding of dose-dependence after Ru-106 treatments. We considered consecutive patients diagnosed with choroidal melanoma and primarily treated at a single institution from 2005-2014. Treatment plans were retrospectively recreated using dedicated software and image guidance to contour the tumour and determine the actual plaque position. Dose distributions were extracted from each plan for all relevant anatomical structures. We considered visual acuity deterioration and late complications (maculopathy, optic neuropathy, ocular hypertension, vascular obliteration, cataract and retinal detachment). Lasso statistics were used to select the most important variables for each analysis. Outcomes were related to dose and clinical characteristics using multivariate Cox regressions analysis. In total, 227 patients were considered and 226 of those were eligible for analysis. Median potential follow-up time was 5.0 years (95% CI: 4.5-6.0). Visual acuity deterioration was related to optic disc-tumour distance and dose metrics from the retina and the macula, with retina V10Gy showing the strongest correlation. Macula V10Gy was the only dose metric impacting risk of maculopathy, while optic disc-tumour distance also proved important. Optic disc V50Gy had the largest impact on optic neuropathy along with optic disc-tumour distance. Optic disc V20Gy was the only variable associated with vascular obliteration. Lens D2% had the largest impact on the risk of cataract along with older age and the largest base dimension. We found no variables associated with the risk of ocular hypertension and retinal detachment. Visual acuity deterioration and most late complications demonstrated dependence on dose delivered to healthy structures in the eye after Ru-106 brachytherapy for choroidal melanomas.
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Affiliation(s)
- Charlotte A Espensen
- Department of Oncology, Section of Radiotherapy, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ane L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds LS9 7TF, UK
| | - Lotte S Fog
- Department of Physical Sciences, The Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Anita B Gothelf
- Department of Oncology, Section of Radiotherapy, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Juliette Thariat
- Department of Radiation Oncology, Centre Francois Baclesse, 14000 Caen, France
- Laboratoire de Physique Corpusculaire IN2P3/ENSICAEN, 14000 Caen, France
- Laboratoire de Physique Corpusculaire IN2P3/ENSICAEN-UMR6534, Unicaen-Normandy University, 14000 Caen, France
| | - Jens F Kiilgaard
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
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Yang YM, Chow PE, McCannel TA, Lamb JM. A comparison of the shielding effectiveness of silicone oil vitreous substitutes when used with Palladium-103 and Iodine-125 eye plaques. Med Phys 2018; 46:1006-1011. [PMID: 30554429 DOI: 10.1002/mp.13341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/11/2018] [Accepted: 12/06/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Episcleral eye plaques provide excellent local control of ocular melanoma, but vision sparing remains a significant problem with 30% or more of patients experiencing significant visual acuity degradation. The use of silicone oil shielding with Iodine-125 plaques has previously been reported to improve critical structure sparing. We hypothesized that the use of Palladium-103 would improve the shielding effectiveness of silicone oil due to the strong energy dependence of the photoelectric effect. This Monte Carlo simulation study reports a comparison of the shielding effects of silicone oil when used in conjunction with Pd-103 and with I-125 plaques. MATERIALS AND METHODS GEANT4 was used to simulate eye plaque treatments to an eye with either water-equivalent vitreous humor, or silicone oil in place of the vitreous humor. Two solid gold plaques, 15 and 23 mm, were simulated loaded with I-125 and with Pd-103 source seeds. Seed activity was normalized such that 85 Gy was delivered to the tumor apex in the water-equivalent cases. Tumor apex dose, central axis dose, and inner sclera dose reductions with silicone oil were evaluated. RESULTS Silicone oil resulted in an underdosing to the tumor apex of 6.1% and 7.5% in the 15 mm plaque for I-125 and Pd-103, respectively, and 3.4% and 4.3% in the 23 mm plaque for I-125 and Pd-103, respectively. When renormalized to 85 Gy to the tumor apex in all scenarios, silicone oil reduced the dose to the inner sclera 90° from the plaque by 19-32% for the 15 and 23 mm plaques using I-125, and by 33-65% for the 15 and 23 mm plaques using Pd-103. CONCLUSIONS The combination of silicone oil and Pd-103 eye plaques offers the potential for greatly improved sparing to normal structures compared to Pd-103 plaques alone or I-125 plaques with or without silicone oil.
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Affiliation(s)
- You M Yang
- University of California, Los Angeles, 200 Medical Plaza Ste B265, Los Angeles, CA, 90095, USA
| | - Phillip E Chow
- University of California, Los Angeles, 200 Medical Plaza Ste B265, Los Angeles, CA, 90095, USA
| | - Tara A McCannel
- Department of Ophthalmology, Stein Eye and Doheny Eye Institutes, University of California, 100 Stein PLZ, Los Angeles, CA, 90095, USA
| | - James M Lamb
- University of California, Los Angeles, 200 Medical Plaza Ste B265, Los Angeles, CA, 90095, USA
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