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Yilmaz MT, Sari SY, Zorlu F, Yazici G. External Beam Radiotherapy in the Management of Uveal Melanoma. Curr Treat Options Oncol 2024:10.1007/s11864-024-01212-5. [PMID: 38869695 DOI: 10.1007/s11864-024-01212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 06/14/2024]
Abstract
OPINION STATEMENT Uveal melanoma is the most common primary ocular tumor in adults. With the evidence demonstrating that episcleral plaque brachytherapy (EPB) has similar survival rates as enucleation in the Collaborative Ocular Melanoma Study (COMS), eye-sparing treatments have come to the fore today. External radiotherapy techniques (proton beam radiotherapy and stereotactic radiosurgery/fractionated stereotactic radiosurgery) are an important treatment option for globe-sparing treatments. There are no prospective randomized trials comparing these techniques; however, retrospective series, meta-analyses, and reviews indicate that these EPB and external radiotherapy techniques are equal. With this review, we aimed to examine the external radiotherapy techniques used in the treatment of uveal melanoma in detail with reference to the current literature.
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Affiliation(s)
- Melek Tugce Yilmaz
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Sezin Yuce Sari
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Faruk Zorlu
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Gozde Yazici
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
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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) 2024:10.1038/s41433-024-03035-y. [PMID: 38565600 DOI: 10.1038/s41433-024-03035-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Aye J, Gold A, Rodriguez B, Murray T. Gene Expression Profile Class Change in a Case of Aggressive, Recurrent Melanoma. JOURNAL OF VITREORETINAL DISEASES 2024; 8:93-96. [PMID: 38223774 PMCID: PMC10786084 DOI: 10.1177/24741264231215536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Purpose: To report a novel case of a recurrent melanoma that had a change in its genetic expression profile (GEP) class over a 2-year period. Methods: This retrospective case study evaluated a patient with a recurrent uveal melanoma that changed classes from 1A to 1B. Results: A large melanoma was first treated with brachytherapy, and during that time genetic testing revealed a class 1A tumor. Two years later the tumor was noted to be enlarging, and the patient elected for enucleation. Subsequent GEP showed a class 1B tumor. Conclusions: An aggressive and large recurrent uveal melanoma that had changed from a class 1A to a class 1B tumor on subsequent GEP testing has never been reported before to our knowledge. It may imply that a recurrent or aggressive tumor has more mutations over time that could lead to a higher risk for metastasis. The natural course of a tumor's GEP class should be explored further.
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Affiliation(s)
- Jennifer Aye
- Murray Ocular Oncology and Retina, Miami, FL, USA
| | - Aaron Gold
- Murray Ocular Oncology and Retina, Miami, FL, USA
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Sharifzadeh M, Chiniforoush TA, Sadeghi M. Design and optimizing a novel ocular plaque brachytherapy with dual-core of 103Pd and 106Ru. Phys Med 2021; 91:99-104. [PMID: 34742099 DOI: 10.1016/j.ejmp.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 10/19/2022] Open
Abstract
In recent decades, eye plaques of brachytherapy have been extensively used as primary treatment as well as a complementary treatment for ocular cancer. The purpose of this study is the development of the eye plaque brachytherapy throughout a new design of eye plaque by combining the COMS plaque and the CCB BEBIG plaque loaded by IRA1-103Pd and 106Ru, respectively. A new dual-core plaque with a diameter of 20 mm was designed in the way that the BEBIG plaque with a diameter of 20 mm loaded by 106Ru plate is attached to the COMS plaque with a diameter of 20 mm loaded by 24 of IRA1-103Pd seeds. Dose calculations for the new plaque were performed by using the MCNP5 code. Dose calculations of dual-core plaque including 103Pd seeds (gamma) and 106Ru plate (beta) were separately done for the sake of MCNP constraints in gamma and beta particle transfer simultaneously. The new dual-core plaque delivers a much higher dose rate to the tumor compared with every single plaque, while the dose rate reached to healthy tissues is slightly higher than each plaque separately. Of course, this is acceptable because the treatment time reduces and subsequently the error in radiation therapy reduces.
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Affiliation(s)
- Mohsen Sharifzadeh
- Radiation Application Research School, Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran
| | - Tayebeh A Chiniforoush
- Department of Medical Radiation Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mahdi Sadeghi
- Medical Physics Department, School of Medicine, Iran University of Medical Sciences, P.O. Box: 14155-6183 Tehran, Iran.
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Very late local recurrence of uveal melanoma following successful trans-scleral local resection. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2020. [DOI: 10.1016/j.cpccr.2020.100028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Zheng X, Han C, Yi J, Zhou Y, Ai Y, Xie C, Jin X. Comparative study of automatic and manual planning methods for volumetric modulated arc therapy in patients with intraocular cancer. PRECISION RADIATION ONCOLOGY 2020. [DOI: 10.1002/pro6.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Xiaomin Zheng
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Ce Han
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Jinling Yi
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Yongqiang Zhou
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Yao Ai
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Congying Xie
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Xiance Jin
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
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Chen MX, Liu YM, Li Y, Yang X, Wei WB. Elevated VEGF-A & PLGF concentration in aqueous humor of patients with uveal melanoma following Iodine-125 plaque radiotherapy. Int J Ophthalmol 2020; 13:599-605. [PMID: 32399411 DOI: 10.18240/ijo.2020.04.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/12/2020] [Indexed: 12/12/2022] Open
Abstract
AIM To measure the concentration of vascular endothelial growth factor-A (VEGF-A), and placental growth factor (PLGF) in aqueous humor of uveal melanoma patients before and after Iodine-125 plaque therapy (IPT), determine the postoperative fluctuation and evaluate associated factors in vivo. METHODS Participants were 18 Chinese patients with uveal melanoma who were elected to IPT. Undiluted aqueous humor samples were collected at Iodine plaque implant and removal time, then stored immediately at -80°C until assayed. The concentration of VEGF-A, PLGF and other 7 cytokines comprising interleukin-2 (IL-2), IL-8, IL-10, interferon (IFN)-γ, programmed death (PD)-1, transforming growth factor (TGF)-β1 and insulin-like growth factor (IGF)-1 in aqueous humor was measured using Raybiotech immunoassay kit, a high throughput strategy. The VEGF-A and PLGF levels were compared across preoperation and postoperation subgroups, as well as those of other 7 interleukins. Correlation and grouped analyses were conducted to determine the independent effects of clinical parameters and other cytokines on VEGF-A and PLGF concentration or fluctuation. This study set a self-control design. RESULTS VEGF-A (P=0.038) and PLGF (P=0.026) were the only two increased cytokines after IPT. Preoperative and postoperative level of VEGF-A and PLGF (r=0.575, P=0.013; r=0.987, P<0.001) correlated with each other significantly. Level of VEGF-A (r=0.626, P=0.005; r=0.588, P=0.01) and PLGF (r=0.616, P=0.007; r=0.588, P=0.01) had positive correlation with tumor thickness consistently. Elevated VEGF-A or PLGF level were strong predictive factors of each other (P=0.007, OR=60.0). The elevated VEGF-A group showed a higher postoperative level of IFN-γ (P=0.005), IL-2 (P<0.001) and IL-10 (P=0.004) in aqueous humor. When the elevated PLGF group got similar results that a higher postoperative level of IFN-γ (P=0.007), IL-2 (P<0.001) and IL-10 (P=0.013) in aqueous humor. CONCLUSION This study reveals that VEGF-A and PLGF in aqueous humor significantly increased with tumor thickness and radiation process in uveal melanoma patients. VEGF-A and PLGF may be crucial in uveal melanoma genesis and radiotherapy reactions. Immune mediators comprised IFN-γ, IL-2 and IL-10 could play roles in the link between inflammation and angiogenesis in uveal melanoma when exposed to radiotherapy.
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Affiliation(s)
- Meng-Xi Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Intraocular tumor Diagnosis and Treatment, Beijing 100730, China
| | - Yue-Ming Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Intraocular tumor Diagnosis and Treatment, Beijing 100730, China
| | - Yang Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Intraocular tumor Diagnosis and Treatment, Beijing 100730, China
| | - Xuan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Intraocular tumor Diagnosis and Treatment, Beijing 100730, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Intraocular tumor Diagnosis and Treatment, Beijing 100730, China
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Gong C, Shen M, Zheng X, Han C, Zhou Y, Xie C, Jin X. Precise delineation and tumor localization based on novel image registration strategy between optical coherence tomography and computed tomography in the radiotherapy of intraocular cancer. Phys Med Biol 2019; 64:125009. [PMID: 30844768 DOI: 10.1088/1361-6560/ab0ddf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Radiation-associated toxicities due to sophisticated ocular anatomy and shape variability of organs at risk (OARs) are major concerns during external beam radiation therapy (EBRT) of patients with intraocular cancer. A novel two-step image registration strategy between optical coherence tomography (OCT) and computed tomography (CT) images was proposed and validated to precisely localize the target in the EBRT of patients with intraocular cancer. Specifically, multiple features from OCT and CT images were extracted automatically, then spatial transformation based on thin-plate spline function was performed iteratively to achieve feature alignment between the CT and OCT images. Finally, an exclusive OR (XOR) algorithm was applied for precise 3D registration using a 3D-mesh model generated from OCT and CT volumes. The accuracy of the proposed novel registration strategy was validated and tested in a schematic-eye phantom with an artificially introduced tumor and in ten patients with confirmed primary and/or secondary intraocular cancer. There was an average registration error and computational time of 0.21 ± 0.05° and 259 ± 5 s, together with an average Dice similarity coefficient and Hausdorff distance of 88.4 ± 0.65 and 0.89 ± 0.09, respectively. The preliminary experimental results demonstrated that the proposed novel strategy to overcome current limitations on eye modeling and to localize precisely the tumor target during EBRT of intraocular cancer is promising.
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Affiliation(s)
- Changfei Gong
- Department of Radiation and Medical Oncology, Wenzhou Medical University 1st Affiliated Hospital, Wenzhou 325000, People's Republic of China. The authors contributed equally to this study
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Shih GC, Le BHA, Correa ZM, Sibug-Saber ME, Kim JW, Berry JL. Late Apical Recurrence of Choroidal Melanoma 10 Years after Successful Treatment with Brachytherapy. Ocul Oncol Pathol 2018; 4:225-229. [PMID: 30643766 PMCID: PMC6322081 DOI: 10.1159/000485131] [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: 09/08/2017] [Revised: 11/08/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To describe late apical relapse of a choroidal melanoma at the site of fine needle aspiration biopsy 10 years following successful treatment with 125I brachytherapy. METHODS Retrospective case report of a 78-year-old male presenting 10 years following successful 125I brachytherapy for a choroidal melanoma with a medium-sized nodular amelanotic tumor recurrence at the site of the prior tumor biopsy. RESULTS Fundus photography and B-scan ultrasound documented the findings at presentation at our institution. The patient was followed closely for 8 weeks while information was retrieved from the treating institution. During this short period, there was significant apical tumor growth. Additionally, there was a clear clinical change compared to the last documented photos from 5 years prior at the treating institution. Enucleation was recommended. Pathological analysis confirmed the diagnosis of recurrent choroidal melanoma at the apex of the treated lesion, at the site of prior biopsy. Systemic surveillance was negative for metastatic disease. CONCLUSION Current literature suggests the majority of choroidal melanoma recurrences occur within 5 years following treatment. However, this case of recurrence 10 years after brachytherapy emphasizes the importance of life-long ophthalmic care for these patients. Additionally, this case demonstrates the possibility of a rare recurrence at a prior biopsy site.
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Affiliation(s)
- Grace C. Shih
- University of Southern California Roski Eye Institute, Los Angeles, CA, USA
| | - Bao han A. Le
- University of Southern California Roski Eye Institute, Los Angeles, CA, USA
- John A. Burns School of Medicine at the University of Hawaii, Honolulu, HI, USA
| | - Zelia M. Correa
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Jonathan W. Kim
- University of Southern California Roski Eye Institute, Los Angeles, CA, USA
- The Vision Center at Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Jesse L. Berry
- University of Southern California Roski Eye Institute, Los Angeles, CA, USA
- The Vision Center at Children's Hospital of Los Angeles, Los Angeles, CA, USA
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Sánchez-Tabernero S, García-Alvarez C, Muñoz-Moreno MF, Diezhandino P, Alonso-Martínez P, de Frutos-Baraja JM, López-Lara F, Saornil MA. Pattern of Local Recurrence After I-125 Episcleral Brachytherapy for Uveal Melanoma in a Spanish Referral Ocular Oncology Unit. Am J Ophthalmol 2017; 180:39-45. [PMID: 28572063 DOI: 10.1016/j.ajo.2017.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the time, frequency, and clinical characteristics of treatment failure after I-125 brachytherapy in patients with uveal melanoma treated and followed in a Spanish referral ocular oncology unit. DESIGN Prospective, consecutive, interventional case series. METHODS Patients diagnosed with uveal melanoma from 1995 to 2016 and treated with episcleral brachytherapy were included. Demographic data collection, ophthalmic evaluation, ultrasound scan, and systemic studies were performed at baseline, every 6 months thereafter for 5 years, and subsequently at annual intervals. Recurrence was defined as presence of tumor growth after treatment. Baseline analysis was performed by descriptive methods and survival by Kaplan-Meier curves. RESULTS From 732 patients diagnosed with uveal melanoma, 311 were treated with brachytherapy. In the follow-up (mean 79 months, standard deviation = 55), 16 local tumor recurrences (5.1%) were detected. All relapsing patients had choroidal tumors and 15 presented with visual symptoms. All patients were treated with I-125 brachytherapy, and 2 received associated transpupillary thermotherapy. All the eyes were enucleated after recurrence. Kaplan-Meier analysis showed a mean time of recurrence of 3.7 years (standard deviation = 2.94 years, ranging from 1 to 12 years). Three patients had metastasis in the follow-up. Kaplan-Meier analysis showed worse survival for patients with recurrence. CONCLUSION Local treatment failure was a relatively infrequent event after I-125 brachytherapy in our series. Recurrences appear not only early but also late in the follow-up. They do not have a distinctive clinical pattern and are associated with poorer survival.
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Deng Z, Shen L, Zheng X, Zhou Y, Yi J, Han C, Xie C, Jin X. Dosimetric advantage of volumetric modulated arc therapy in the treatment of intraocular cancer. Radiat Oncol 2017; 12:83. [PMID: 28490344 PMCID: PMC5424493 DOI: 10.1186/s13014-017-0819-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 05/08/2017] [Indexed: 11/13/2022] Open
Abstract
Objective The purpose of this study is to investigate the dosimetric advantages of volumetric modulated arc therapy (VMAT) in the treatment of intraocular cancer by comparing it directly with three-dimensional conformal radiotherapy (CRT) and intensity-modulated radiotherapy (IMRT). Methods CRT plan, 7f-IMRT plan, and one-arc VMAT plan were generated for 14 intraocular cancer patients. Dosimetric and biological quality indices for target volume and organs at risks (OARs) were evaluated and compared. Results The target coverage presented by V95 for CRT, IMRT and VMAT were 95.02% ± 0.67%, 95.51% ± 2.25%, and 95.92% ± 3.05%, respectively. The homogeneity index (HI) for CRT, IMRT and VMAT were 0.15 ± 0.05, 0.23 ± 0.05, and 0.23 ± 0.06, respectively. IMRT and VMAT greatly decreased the dose to ipsilateral lens compared with CRT with a D1 of 2972.66 ± 1407.12 cGy, 3317.82 ± 915.28 cGy and 4809.54 ± 524.60 cGy for IMRT, VMAT and CRT, respectively. Similar results were observed for ipsilateral eyeballs. IMRT and VMAT also spared better on brainstem, optical nerves and optical chiasm compared CRT. However, CRT achieved lower dose to the eyeballs compared with IMRT and VMAT. VMAT and IMRT showed mixed results on target coverage and OAR sparing. The average MUs and delivery time of IMRT and VMAT were 531.25 ± 81.21 vs. 400.99 ± 61.49 and 5.05 ± 0.53 vs.1.71 ± 0.69 min, respectively. Conclusions Although no clear distinction on PTV coverage among CRT, IMRT and VMAT plans was observed in the treatment of intraocular cancer, VMAT and IMRT achieved better homogeneity and conformity for target volume, and delivered fewer doses to ipsilateral lens and eyeballs compared with CRT. However, VMAT and IMRT increased the low dose volume to the contralateral OARs. Although VMAT and IMRT showed mixed results on target coverage and OAR sparing, VMAT decreased MU and delivery time significantly compared with IMRT. VMAT is a promising and feasible external beam radiotherapy technique in the treatment of intraocular cancer patients.
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Affiliation(s)
- Zhenxiang Deng
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Lanxiao Shen
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Xiaomin Zheng
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Yongqiang Zhou
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Jinling Yi
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Ce Han
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Congying Xie
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Xiance Jin
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China.
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Bellerive C, Aziz HA, Bena J, Wilkinson A, Suh JH, Plesec T, Singh AD. Local Failure After Episcleral Brachytherapy for Posterior Uveal Melanoma: Patterns, Risk Factors, and Management. Am J Ophthalmol 2017; 177:9-16. [PMID: 28163118 DOI: 10.1016/j.ajo.2017.01.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/21/2017] [Accepted: 01/24/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the patterns, the risk factors, and the management of recurrence following brachytherapy in patients with posterior uveal melanoma, given that an understanding of the recurrence patterns can improve early recognition and management of local treatment failure in such patients. DESIGN Retrospective cohort study. METHODS Setting: Multispecialty tertiary care center. PARTICIPANTS A total of 375 eyes treated with episcleral brachytherapy for posterior uveal melanoma from January 2004 to December 2014. Exclusion criteria included inadequate follow-up (<1 year) and previous radiation therapy. Main Outcomes and Measures: Local control rate and time to recurrence were the primary endpoints. Kaplan-Meier estimation and Cox proportional hazards models were conducted to identify risk factors for recurrence. RESULTS Twenty-one patients (5.6%) experienced recurrence (follow-up range 12-156 months; median 47 months). The median time to recurrence was 18 months (range 4-156 months). Five-year estimated local recurrence rate was 6.6%. The majority (90.5%) of the recurrences occurred within the first 5 years. The predominant site of recurrence was at the tumor margin (12 patients, 57.1%). Univariate analysis identified 3 statistically significant recurrence risk factors: advanced age, largest basal diameter, and the use of adjuvant transpupillary thermotherapy (TTT). Recurrent tumors were managed by repeat brachytherapy, TTT, or enucleation. CONCLUSIONS Local recurrences following brachytherapy are uncommon 5 years after episcleral brachytherapy. Follow-up intervals can be adjusted to reflect time to recurrence. Most of the eyes with recurrent tumor can be salvaged by conservative methods.
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Affiliation(s)
- Claudine Bellerive
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hassan A Aziz
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - James Bena
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan Wilkinson
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - John H Suh
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Plesec
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Arun D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
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Weichselbaum RR, Liang H, Deng L, Fu YX. Radiotherapy and immunotherapy: a beneficial liaison? Nat Rev Clin Oncol 2017; 14:365-379. [DOI: 10.1038/nrclinonc.2016.211] [Citation(s) in RCA: 564] [Impact Index Per Article: 80.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Clinical Outcomes of Proton Radiotherapy for Uveal Melanoma. Clin Oncol (R Coll Radiol) 2016; 28:e17-27. [PMID: 26915706 DOI: 10.1016/j.clon.2016.01.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/20/2015] [Accepted: 01/05/2016] [Indexed: 02/03/2023]
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Verma V, Mishra MV, Mehta MP. A systematic review of the cost and cost-effectiveness studies of proton radiotherapy. Cancer 2016; 122:1483-501. [DOI: 10.1002/cncr.29882] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/10/2015] [Accepted: 12/16/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology; University of Nebraska Medical Center; Omaha Nebraska
| | - Mark V. Mishra
- Department of Radiation Oncology; University of Maryland Medical Center; Baltimore Maryland
| | - Minesh P. Mehta
- Department of Radiation Oncology; University of Maryland Medical Center; Baltimore Maryland
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Local Recurrence Significantly Increases the Risk of Metastatic Uveal Melanoma. Ophthalmology 2015; 123:86-91. [PMID: 26505803 DOI: 10.1016/j.ophtha.2015.09.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/11/2015] [Accepted: 09/11/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess of the effect of local recurrence of uveal melanoma on metastasis using a multicenter international tumor registry. DESIGN Retrospective study using an online tumor registry. PARTICIPANTS Patients with uveal melanoma diagnosed between 2001 and 2011. METHODS A committee was formed to create uveal melanoma patient-specific data fields. Ten subspecialty ophthalmic oncology centers from 4 continents shared data. Patient selection criteria included diagnosis of uveal melanoma and adequate records to allow tumor staging by American Joint Committee on Cancer (AJCC) criteria and follow-up for metastatic melanoma. MAIN OUTCOME MEASURES Local tumor recurrence and metastatic uveal melanoma. RESULTS Of 3809 total entries, 3217 patients with ciliary body and choroidal (CBC) melanoma and 160 with iris melanoma were evaluated. There was a median follow-up of 3.7 years (95% confidence interval [CI], 3.5-3.8). One hundred fifty-two patients (4.7%) with CBC melanoma experienced local recurrence, with a cumulative incidence of 11%. Kaplan-Meier point estimates for remaining free of local recurrence were 99% (95% CI, 99-99) at 1 year, 93% (95% CI, 92-94) at 5 years, and 89% (95% CI, 86-91) at 10 years. Five- and 10-year metastasis-free Kaplan-Meier estimates for the recurrence-free group were 87% (95% CI, 86-89) and 82% (95% CI, 79-84), and those for the local recurrence group were 71% (95% CI, 62-78) and 62% (95% CI, 49-72). The difference between these 2 groups was statistically significant (P < 0.001). Furthermore, local tumor recurrence increased the risk of metastasis by a hazard ratio (HR) of 6.28 (95% CI, 4.4-8.9; P < 0.001). Local recurrence was detected up to 9.8 years after treatment. Extrascleral extension also was associated with local recurrence (HR, 3.2; 95% CI, 1.5-6.7; P = 0.003), but higher AJCC T-size category was not (P = 0.63). Five patients (n = 5/161 [3.1%]) with iris melanoma demonstrated local recurrence and 1 metastasized. CONCLUSIONS International multicenter data sharing was used to evaluate the effect of local tumor recurrence on metastatic rate. In that local tumor recurrence was associated with a significantly higher risk of systemic metastasis, effective initial treatment and long-term surveillance of treated uveal melanoma patients is necessary.
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Rüegsegger MB, Geiser D, Steiner P, Pica A, Aebersold DM, Kowal JH. Noninvasive referencing of intraocular tumors for external beam radiation therapy using optical coherence tomography: A proof of concept. Med Phys 2014; 41:081704. [DOI: 10.1118/1.4885975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Outcomes and control rates for I-125 plaque brachytherapy for uveal melanoma: a community-based institutional experience. ISRN OPHTHALMOLOGY 2014; 2014:950975. [PMID: 24734198 PMCID: PMC3964762 DOI: 10.1155/2014/950975] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 02/11/2014] [Indexed: 12/25/2022]
Abstract
Purpose. To evaluate our community-based institutional experience with plaque brachytherapy for uveal melanomas with a focus on local control rates, factors impacting disease progression, and dosimetric parameters impacting treatment toxicity. Methods and Materials. Our institution was retrospectively reviewed from 1996 to 2011; all patients who underwent plaque brachytherapy for uveal melanoma were included. Follow-up data were collected regarding local control, distant metastases, and side effects from treatment. Analysis was performed on factors impacting treatment outcomes and treatment toxicity. Results. A total of 107 patients underwent plaque brachytherapy, of which 88 had follow-up data available. Local control at 10 years was 94%. Freedom from progression (FFP) and overall survival at 10 years were 83% and 79%, respectively. On univariate analysis, there were no tumor or dosimetric treatment characteristics that were found to have a prognostic impact on FFP. Brachytherapy treatment was well tolerated, with clinically useful vision (>20/200) maintained in 64% of patients. Statistically significant dosimetric relationships were established with cataract, glaucoma, and retinopathy development (greatest P = 0.05). Conclusions. Treatment with plaque brachytherapy demonstrates excellent outcomes in a community-based setting. It is well tolerated and should remain a standard of care for COMS medium sized tumors.
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Takiar V, Gombos DS, Mourtada F, Rechner LA, Lawyer AA, Morrison WH, Garden AS, Beadle BM. Disease control and toxicity outcomes using ruthenium eye plaque brachytherapy in the treatment of uveal melanoma. Pract Radiat Oncol 2013; 4:e189-94. [PMID: 25012839 DOI: 10.1016/j.prro.2013.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 07/29/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Ruthenium-106 ((106)Ru) eye plaques have the potential to achieve excellent tumor control with acceptable radiation toxicity. We evaluated our experience in the management of uveal melanoma treated with (106)Ru brachytherapy. METHODS AND MATERIALS The records of 40 patients with uveal melanoma treated with brachytherapy using (106)Ru plaques from 2003 to 2007 at University of Texas MD Anderson Cancer Center were reviewed. Endpoints assessed included tumor control and toxicity. RESULTS Median ophthalmologic follow-up was 67 months. Actuarial 5-year rates of local control (LC), progression-free survival (PFS), and overall survival (OS) were 97%, 94%, and 92%. There were 3 deaths, 2 related to melanoma. Fifteen patients experienced clinically significant visual loss; no patients were diagnosed with neovascular glaucoma, and 1 patient developed a clinically significant radiation-associated cataract. No patient required enucleation. CONCLUSIONS We report the largest published US cohort of patients treated with (106)Ru plaque brachytherapy for uveal melanoma. Tumor control was excellent, and toxicity was acceptably low. These data support the reintroduction of (106)Ru into clinical practice for ocular melanoma.
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Affiliation(s)
- Vinita Takiar
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dan S Gombos
- Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Firas Mourtada
- Department of Radiation Oncology, Christiana Care Health System, Helen F. Graham Cancer Center, Wilmington, Delaware and Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA; Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laura A Rechner
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ann A Lawyer
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth M Beadle
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
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Tumor control, eye preservation, and visual outcomes of ruthenium plaque brachytherapy for choroidal melanoma. Brachytherapy 2013; 12:235-9. [DOI: 10.1016/j.brachy.2012.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 01/27/2012] [Accepted: 01/31/2012] [Indexed: 11/23/2022]
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Liang H, Deng L, Chmura S, Burnette B, Liadis N, Darga T, Beckett MA, Lingen MW, Witt M, Weichselbaum RR, Fu YX. Radiation-induced equilibrium is a balance between tumor cell proliferation and T cell-mediated killing. THE JOURNAL OF IMMUNOLOGY 2013; 190:5874-81. [PMID: 23630355 DOI: 10.4049/jimmunol.1202612] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Local failures following radiation therapy are multifactorial, and the contributions of the tumor and the host are complex. Current models of tumor equilibrium suggest that a balance exists between cell birth and cell death due to insufficient angiogenesis, immune effects, or intrinsic cellular factors. We investigated whether host immune responses contribute to radiation-induced tumor equilibrium in animal models. We report an essential role for immune cells and their cytokines in suppressing tumor cell regrowth in two experimental animal model systems. Depletion of T cells or neutralization of IFN-γ reversed radiation-induced equilibrium, leading to tumor regrowth. We also demonstrate that PD-L1 blockade augments T cell responses, leading to rejection of tumors in radiation-induced equilibrium. We identify an active interplay between tumor cells and immune cells that occurs in radiation-induced tumor equilibrium and suggest a potential role for disruption of the PD-L1/PD-1 axis in increasing local tumor control.
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Affiliation(s)
- Hua Liang
- Department of Radiation and Cellular Oncology, The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL 60637, USA
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Lee CS, Jun IH, Kim TI, Byeon SH, Koh HJ, Lee SC. Expression of 12 cytokines in aqueous humour of uveal melanoma before and after combined Ruthenium-106 brachytherapy and transpupillary thermotherapy. Acta Ophthalmol 2012; 90:e314-20. [PMID: 22429778 DOI: 10.1111/j.1755-3768.2012.02392.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the aqueous humour levels of 12 cytokines in eyes with uveal melanoma and whether their expression changes after combined Ru-106 brachytherapy and transpupillary thermotherapy (TTT). METHODS Aqueous humour samples were collected from 20 patients with previously untreated uveal melanoma undergoing combined Ru-106 brachytherapy and TTT, both at the time of plaque placement and removal. Using multiplex biochip array technology, 12 different cytokines were measured, including interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), tumour necrosis factor (TNF)-α, interferon (IFN)-γ, epidermal growth factor (EGF) and monocyte chemoattractant protein (MCP)-1. Aqueous humour from 20 patients undergoing cataract surgery was used as control. RESULTS IL-6, IL-8, IFN-γ and MCP-1 were highly expressed in uveal melanoma, whereas IL-2, IL-10 and TNF- α were low in expression. There was a positive correlation between tumour height and IL-8 level (p = 0.020). Vascular endothelial growth factor tends to be highly expressed in melanoma-containing eyes (p = 0.056). Levels of IL-6, IL-8 and IL-1β increased after the mean 117 ± 38 hrs of brachytherapy and adjunctive TTT with a tumour apex dose of 61 ± 28 Gy and a scleral contact dose of 786 ± 226 Gy. Increase in levels of IL-6 (p = 0.003) and IL-8 (p = 0.046) positively correlated with scleral contact dose. CONCLUSIONS Cytokines such as IL-6, IL-8, IFN-γ and MCP-1 may be implicated in the progression of uveal melanoma. Ocular irradiation from a Ru-106 plaque promoted an increase in the levels of IL-6, IL-8 and IL-1β, modulation of which could be useful in managing radiation-related side effects.
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Affiliation(s)
- Christopher Seungkyu Lee
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
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Fassi A, Riboldi M, Forlani CF, Baroni G. Optical eye tracking system for noninvasive and automatic monitoring of eye position and movements in radiotherapy treatments of ocular tumors. APPLIED OPTICS 2012; 51:2441-2450. [PMID: 22614424 DOI: 10.1364/ao.51.002441] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 03/06/2012] [Indexed: 06/01/2023]
Abstract
A noninvasive eye tracking system based on infrared 3-D video-oculographic techniques is proposed for the automatic monitoring of eye position and orientation in external beam radiotherapy of ocular tumors. The presented method can be applied for the real-time estimation of lesion position and tumor-beam misalignments, allowing automatic patient setup and eye movement gated treatments. A prototypal eye tracker was developed and tested on five subjects, achieving gaze estimation errors of 0.5° and eye monitoring frequencies of 125 Hz. The proposed application can potentially improve quality and efficacy of ocular radiotherapy treatments, currently based on invasive, qualitative, and manual control procedures.
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Affiliation(s)
- Aurora Fassi
- Department of Bioengineering, Politecnico di Milano, 20133 Milano, Italy.
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A Five-Year Study of Slotted Eye Plaque Radiation Therapy for Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve. Ophthalmology 2012; 119:415-22. [DOI: 10.1016/j.ophtha.2011.08.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 07/28/2011] [Accepted: 08/09/2011] [Indexed: 11/24/2022] Open
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Leonard KL, Gagne NL, Mignano JE, Duker JS, Bannon EA, Rivard MJ. A 17-year retrospective study of institutional results for eye plaque brachytherapy of uveal melanoma using 125I, 103Pd, and 131Cs and historical perspective. Brachytherapy 2011; 10:331-9. [DOI: 10.1016/j.brachy.2011.01.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 01/14/2011] [Accepted: 01/17/2011] [Indexed: 10/18/2022]
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Caujolle JP, Mammar H, Chamorey E, Pinon F, Herault J, Gastaud P. Proton Beam Radiotherapy for Uveal Melanomas at Nice Teaching Hospital: 16 Years' Experience. Int J Radiat Oncol Biol Phys 2010; 78:98-103. [DOI: 10.1016/j.ijrobp.2009.07.1688] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 07/09/2009] [Accepted: 07/15/2009] [Indexed: 11/27/2022]
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Corrêa ZMS, Harbour JW. Retina Congress 2009: ocular oncology. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.09.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Isager P, Ehlers N, Urbak SF, Overgaard J. Visual outcome, local tumour control, and eye preservation after 106Ru/Rh brachytherapy for choroidal melanoma. Acta Oncol 2009; 45:285-93. [PMID: 16644571 DOI: 10.1080/02841860500468950] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To study the visual outcome, local tumour control, and eye preservation 5 years after ruthenium/rhodium 106 brachytherapy for choroidal melanoma. The study included 55 consecutive patients treated by 106Ru/Rh brachytherapy for a choroidal melanoma during the period 1988-2000 and followed through 2004. The 5-year probability for not losing at least 5 Snellen lines was 59% (n = 45), for retaining a visual acuity of 0.33 or better was 28% (n = 34), and for retaining better than 0.1 was 40% (n = 45). The 5-year probability for no local recurrence was 73% and for eye preservation 72% (n = 55). 106Ru/Rh brachytherapy for choroidal melanoma resulted in a clinically significant vision loss, no local recurrence, and eye preservation in most patients after 5 years. 106Ru/Rh brachytherapy can be regarded as a good treatment option for small and medium-sized tumours but not for large tumours.
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Affiliation(s)
- Peter Isager
- Department of Ophthalmology, Arhus University Hospital, Denmark.
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The effectiveness and safety of proton radiation therapy for indications of the eye : a systematic review. Strahlenther Onkol 2009; 185:211-21. [PMID: 19370423 DOI: 10.1007/s00066-009-1900-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 12/10/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE : Proton radiation has been used for the treatment of uveal melanoma since 1975, but few studies have been conducted to assess its efficacy and safety. This paper aims to systematically review the effects and side effects of proton therapy for any indication of the eye. MATERIAL AND METHODS : A range of databases were searched from inception to 2007. All studies that included at least ten patients and that assessed the efficacy or safety of proton therapy for any indication of the eye were included. RESULTS : The search generated 2,385 references, of which 37 met the inclusion criteria. Five controlled trials, two comparative studies and 30 case series were found, most often reporting on uveal melanoma, choroidal melanoma and age-related macular degeneration (AMD). Methodological quality of these studies was poor. Studies were characterized by large differences in radiation techniques applied within the studies, and by variation in patient characteristics within and between studies. Results for uveal melanoma and choroidal melanoma suggest favorable survival, with, however, significant rates of side effects. Results for choroidal hemangioma and AMD did not reveal beneficial effects from proton radiation. CONCLUSION : There is limited evidence on the effectiveness and safety of proton radiation due to the lack of well-designed and well-reported studies. There is a need to lift evidence on proton therapy to a higher level by performing dose-finding randomized controlled trials (RCTs), comparative studies of proton radiation versus standard given alternatives and prospective case studies enrolling only patients treated with up-to-date techniques, allowing extrapolation of results to similar patient groups.
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Sturtewagen E, Fuß M, Paelinck L, De Wagter C, Georg D. Multi-dimensional dosimetric verification of stereotactic radiotherapy for uveal melanoma using radiochromic EBT film. Z Med Phys 2008; 18:27-36. [DOI: 10.1016/j.zemedi.2007.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lodge M, Pijls-Johannesma M, Stirk L, Munro AJ, De Ruysscher D, Jefferson T. A systematic literature review of the clinical and cost-effectiveness of hadron therapy in cancer. Radiother Oncol 2007; 83:110-22. [PMID: 17502116 DOI: 10.1016/j.radonc.2007.04.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Accepted: 04/17/2007] [Indexed: 12/25/2022]
Abstract
BACKGROUND In view of the continued increase in the number of hadron (i.e. neutron, proton and light or heavy ion) therapy (HT) centres we performed a systematic literature review to identify reports of the efficacy of HT. METHODS Eleven databases were searched systematically. No limit was applied to language or study design. Established experts were contacted for unpublished data. Data on outcomes were extracted and summarised in tabular form. RESULTS Seven hundred and seventy three papers were identified. For proton and heavy ion therapy, the number of RCTs was too small to draw firm conclusions. Based on prospective and retrospective studies, proton irradiation emerges as the treatment of choice for some ocular and skull base tumours. For prostate cancer, the results were comparable with those from the best photon therapy series. Heavy ion therapy is still in an experimental phase. CONCLUSION Existing data do not suggest that the rapid expansion of HT as a major treatment modality would be appropriate. Further research into the clinical and cost-effectiveness of HT is needed. The formation of a European Hadron Therapy Register would offer a straightforward way of accelerating the rate at which we obtain high-quality evidence that could be used in assessing the role of HT in the management of cancer.
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Finger PT. Finger's "slotted" eye plaque for radiation therapy: treatment of juxtapapillary and circumpapillary intraocular tumours. Br J Ophthalmol 2007; 91:891-4. [PMID: 17327263 PMCID: PMC1955638 DOI: 10.1136/bjo.2007.114082] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To create "slotted eye plaques" for the treatment of juxtapapillary and circumpapillary intraocular tumours. METHODS Eye plaques were altered such that 8 mm-wide slots (variable length) were created to accommodate the orbital portion of the optic nerve. Thus, as the nerve entered the slot, the plaque's posterior margin extended beyond the optic disc. Radioactive seeds were affixed around the slot, surrounding the juxtapapillary and posterior tumour margins. RESULTS As proof of principle, three patients with choroidal melanomas that encircled or were in contact with the optic disc (considered untreatable with a notched eye plaque) were considered to be initial candidates for slotted-plaque radiotherapy. Preoperative three-dimensional C-scan imaging of their optic nerve sheath diameters insured that they would fit in the slotted plaque. Intraoperative ultrasound imaging was used to confirm proper plaque placement. Radiation dosimetry modelling showed that all tumour tissue received a minimum of 85 Gy (despite the gap created by the slot). With relatively short-term follow-up, there has been no evidence of ocular ischaemia, tumour growth or complications attributable to the use of slotted-plaque radiation therapy. CONCLUSION Slotted plaques accommodate the retrobulbar optic nerve into the device and thereby shift the treatment zone to improve coverage of both juxtapapillary and circumpapillary intraocular tumours.
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Affiliation(s)
- Paul T Finger
- The New York Eye Cancer Centre, 115 East 61st Street, New York City, NY 10065, USA.
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Optimizing LINAC-based stereotactic radiotherapy of uveal melanomas: 7 years’ clinical experience. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bechrakis NE, Foerster MH. Neoadjuvant proton beam radiotherapy combined with subsequent endoresection of choroidal melanomas. Int Ophthalmol Clin 2006; 46:95-107. [PMID: 16365558 DOI: 10.1097/01.iio.0000195856.31324.00] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nikolaos E Bechrakis
- Department of Ophthalmology, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Germany
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van Ginderdeuren R, van Limbergen E, Spileers W. 18 years' experience with high dose rate strontium-90 brachytherapy of small to medium sized posterior uveal melanoma. Br J Ophthalmol 2005; 89:1306-10. [PMID: 16170122 PMCID: PMC1772893 DOI: 10.1136/bjo.2005.068460] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To analyse local tumour control, radiation related complications, visual acuity, enucleation rate, and survival after brachytherapy of small to medium sized choroidal melanoma (CM) with a high dose rate (HDR) strontium-90 (Sr-90) applicator. METHODS From 1983 until 2000, 98 eyes with CM were treated with Sr-90 brachytherapy. The main outcome measures were actuarial rates of the patients' survival, ocular conservation rate, tumour regression, complication rates, and preservation of visual acuity. End point rates were estimated using Kaplan-Meier analysis. RESULTS The median follow up time was 6.7 years (0.5-18.8 years). Actuarial melanoma free patient survival rate was 85% (SE 4.8%) after 18 years. Actuarial rate of ocular conservation and complete tumour regression was 90% (SE 3.8%) after 15 years. In 93% local tumour control was achieved, 88% showed a stable scar. Recurrence of the tumour on the border caused enucleation of six eyes (7%). In three cases (4%) retinal detachment was the end point. No cases of optic atrophy or of sight impairing retinopathy outside the treated area were found. Actuarial rate of preservation of visual acuity of 1/10 was 65% at 5 years and 45% at 15 years of follow up (SE 5.9% and 8.8%). CONCLUSIONS Sr-90 brachytherapy is as effective as iodine or ruthenium brachytherapy for small to medium sized CM but causes fewer complications. The preservation of vision is better than with all other described radioisotopes. HDR Sr-90 brachytherapy can therefore safely be recommended for small to medium sized CM.
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Affiliation(s)
- R van Ginderdeuren
- Department of Ophthalmology, Kapucijnenvoer 33, UZ Leuven, B3000 Leuven, Belgium.
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Jensen AW, Petersen IA, Kline RW, Stafford SL, Schomberg PJ, Robertson DM. Radiation complications and tumor control after 125I plaque brachytherapy for ocular melanoma. Int J Radiat Oncol Biol Phys 2005; 63:101-8. [PMID: 16111577 DOI: 10.1016/j.ijrobp.2005.01.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Revised: 01/04/2005] [Accepted: 01/11/2005] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the outcome of 125I plaque brachytherapy at our institution and identify the risk factors associated with the development of radiation complications, tumor recurrence, and metastasis. PATIENTS AND METHODS From 1986 to 2000, 156 patients underwent 125I episcleral plaque (COMS design) application for the treatment of ocular melanoma. Chart analysis of follow-up ophthalmologic appointments assessed the incidence of ocular side effects after therapy. Statistical analysis assessed outcomes and significant influencing factors. RESULTS With a median follow-up of 6.2 years, the 5-year overall survival was 83%. The 5-year disease-specific survival was 91%. Initial local control at 5 years was 92%, with 100% ultimate local control after secondary therapy that included 9 enucleations. The risk of metastasis was 10% at 5 years and 27% at 10 years. Vision stayed the same or improved in 25% of patients, and 44% of patients maintained visual acuity better than 20/200. Thirteen percent of patients experienced chronic pain or discomfort in the treated eye. Dose rates to the tumor apex greater than 90 to 100 cGy/h were associated with increased systemic control but worse radiation toxicity. CONCLUSION Patients in our series experienced excellent local tumor control. Higher dose rates to the tumor apex were associated with reduced rates of distant metastases but worse ocular function.
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Affiliation(s)
- Ashley W Jensen
- Department of Radiation Oncology, Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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