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Cherkas E, Kalafatis NE, Marous MR, Shields CL. Iris melanoma: Review of clinical features, risks, management, and outcomes. Clin Dermatol 2024; 42:62-70. [PMID: 37865279 DOI: 10.1016/j.clindermatol.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Primary uveal melanoma is rare and affects approximately 8,000 persons per year worldwide. This malignancy can involve the iris, ciliary body, and choroid. Of these three structures, the iris is the least commonly affected site, representing only 4% of all uveal melanomas. Iris melanoma can arise from iris melanocytic nevus, iris melanocytosis, or de novo. In a longitudinal study of 1,611 patients with iris nevus, transformation into melanoma, using Kaplan-Meier estimates, was found in 2.6% by five years and in 4.1% by 10 years. The factors that predicted growth of iris melanocytic nevus into melanoma are denoted by a letter (ABCDEF) guide: A for age ≤40 years old at presentation (hazard ratio [HR] = 3, P = .01), B for blood (hyphema) (HR = 9, P < .0004), C for clock hour of tumor inferiorly (tumor location) (HR = 9, P = .03), D for diffuse flat tumor configuration (HR = 14, P = .02), E for ectropion uveae (HR = 4, P = .002), and F for feathery ill-defined margins (HR = 3, P = .02). At diagnosis, iris melanoma has a mean cross-sectional diameter of 5.5 mm and thickness of 2.1 mm, often with tumor seeding (28%) and secondary glaucoma (35%). We provide a comprehensive review of iris nevus and melanoma to explore relevant demographic and clinical data, risk factors for tumor growth, management, and prognosis, with the hope that clinicians will be more comfortable in understanding this rare malignant condition.
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Affiliation(s)
- Elliot Cherkas
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas E Kalafatis
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Molly R Marous
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Lescot T, Lebel-Cormier MA, Seniwal B, Gros-Louis P, Bellerive C, Landreville S, Beaulieu L, Fortin MA. Tumor Shape-Specific Brachytherapy Implants by 3D-Printing, Precision Radioactivity Painting, and Biomedical Imaging. Adv Healthc Mater 2023; 12:e2300528. [PMID: 37536742 DOI: 10.1002/adhm.202300528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/18/2023] [Indexed: 08/05/2023]
Abstract
In brachytherapy (BT), or internal radiation therapy, cancer is treated by radioactive implants. For instance, episcleral plaques (EPs) for the treatment of uveal melanoma, are designed according to generic population approximations. However, more personalized implants can enhance treatment precision through better adjustment of dose profiles to the contours of cancerous tissues. An original approach integrating biomedical imaging, 3D printing, radioactivity painting, and biomedical imaging, is developed as a workflow for the development of tumor shape-specific BT implants. First, computer-aided design plans of EP are prepared according to guidelines prescribed by the Collaborative Ocular Melanoma Study protocol. Polyetheretherketone (PEEK), a high-performance polymer suitable for permanent implants, is used to 3D-print plaques and the geometrical accuracy of the printed design is evaluated by imaging. The possibility to modulate the dose distribution in a tridimensional manner is demonstrated by painting the inner surfaces of the EPs with radioactive 103Pd, followed by dose profile measurements. The possibility to modulate dose distributions generated by these 3D-printed plaques through radioactivity painting is therefore confirmed. Ex vivo surgical tests on human eyeballs are performed as an assessment of manipulation ease. Overall, this work provides a solution for the fabrication of tumor-specific radioactive implants requiring higher dose precision.
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Affiliation(s)
- Théophraste Lescot
- Département de Génie des Mines, de la Métallurgie et des Matériaux and Centre de recherche sur les matériaux avancés (CERMA), Université Laval, Québec, G1V 0A6, Canada
- Axe Médecine Régénératrice, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec, G1V 4G2, Canada
- Centre de Recherche sur le Cancer (CRC) de l'Université Laval, Québec, G1R 3S3, Canada
| | - Marie-Anne Lebel-Cormier
- Centre de Recherche sur le Cancer (CRC) de l'Université Laval, Québec, G1R 3S3, Canada
- Département de Physique, de Génie Physique et d'Optique, Université Laval, Québec, G1V 0A6, Canada
- Service de physique médicale et radioprotection and Axe Oncologie, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, G1L 3L5, Canada
| | - Baljeet Seniwal
- Département de Génie des Mines, de la Métallurgie et des Matériaux and Centre de recherche sur les matériaux avancés (CERMA), Université Laval, Québec, G1V 0A6, Canada
- Axe Médecine Régénératrice, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec, G1V 4G2, Canada
- Centre de Recherche sur le Cancer (CRC) de l'Université Laval, Québec, G1R 3S3, Canada
| | - Philippe Gros-Louis
- Axe Médecine Régénératrice, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec, G1V 4G2, Canada
- Centre de Recherche sur le Cancer (CRC) de l'Université Laval, Québec, G1R 3S3, Canada
- Centre Universitaire d'Ophtalmologie (CUO) and Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Québec, G1S 4L8, Canada
| | - Claudine Bellerive
- Axe Médecine Régénératrice, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec, G1V 4G2, Canada
- Centre Universitaire d'Ophtalmologie (CUO) and Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Québec, G1S 4L8, Canada
| | - Solange Landreville
- Axe Médecine Régénératrice, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec, G1V 4G2, Canada
- Centre de Recherche sur le Cancer (CRC) de l'Université Laval, Québec, G1R 3S3, Canada
- Centre Universitaire d'Ophtalmologie (CUO) and Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Québec, G1S 4L8, Canada
| | - Luc Beaulieu
- Centre de Recherche sur le Cancer (CRC) de l'Université Laval, Québec, G1R 3S3, Canada
- Département de Physique, de Génie Physique et d'Optique, Université Laval, Québec, G1V 0A6, Canada
- Service de physique médicale et radioprotection and Axe Oncologie, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, G1L 3L5, Canada
| | - Marc-André Fortin
- Département de Génie des Mines, de la Métallurgie et des Matériaux and Centre de recherche sur les matériaux avancés (CERMA), Université Laval, Québec, G1V 0A6, Canada
- Axe Médecine Régénératrice, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec, G1V 4G2, Canada
- Centre de Recherche sur le Cancer (CRC) de l'Université Laval, Québec, G1R 3S3, Canada
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Karaca BÖ, Türkoğlu EB, Doğan ME. LONG TERM RESULTS OF PHOTODYNAMİC THERAPY IN INTRAOCULAR TUMORS. Photodiagnosis Photodyn Ther 2023; 42:103564. [PMID: 37031899 DOI: 10.1016/j.pdpdt.2023.103564] [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: 08/19/2022] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE To report long term results of photodynamic therapy (PDT) as treatment for intraocular tumors METHODS: Retrospective interventional case series of 15 patients. All patients treated with standard-fluence PDT (83 seconds; 50 J/cm2) using verteporfin. OUTCOME MEASURES Tumor diameter, tumor thickness, subretinal fluid resolution, best-corrected visual acuity,intraocular pressure and PDT complications. RESULTS 10 patients (66.7% of total patients) were diagnosed with choroidal hemangioma, 3 patients (20% of total patients) were diagnosed with choroidal melanoma, and 2 patients (13,3% of total patients) were diagnosed with choroidal osteoma.. Mean follow-up time was 33±18 months. The mean visual acuity was determined as 1.29±0.98 logMAR in the examinations just before the PDT application. At the end of the follow-up period, the mean visual acuity was calculated as 1.41±1.07 logMAR. While VA increased in 3 (20%) patients and decreased in 5 (33.3%) patients; It was determined that VA value did not change after treatment in 7 (46.7%) patients. The mean lesion diameter before PDT was 6573 ±2115 µm (range; 1500-10000µm). The mean tumor thickness before PDT was 3624 ±1404 µm (range; 600-6000µm). The mean lesion diameter after treatment was 6026±2521 µm (range; 0-9000µm), and the mean tumor thickness after treatment was 2280 ±1740 µm (range; 0-6000 µm).After the PDT, tumor size decreased in 8 (53.3%) patients, increased in 3 (20%) patients, and no change in tumor size was observed in 4 (26.7%) patients. Mean IOP values of all patients were 14.06±3.17 mmHg before treatment; after treatment, it was measured as 13.46±1.70 mmHg. After the treatment, geographic atrophy developed in 1 (6.7%) patient, cystoid macular edema developed in 1 (6.7%) patient, Retinal Pigment Epithelium (RPE) and choroidal atrophy developed in 1 (6.7%) patient. CONCLUSION There are not enough cases of each to clearly distinguish between these 3 types of ocular cancers however PDT may be a good option in the treatment of intraocular tumors with the chance of selective treatment and successful responses in selected cases.
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Affiliation(s)
- Berkay Öner Karaca
- Akdeniz University, School of Medicine, Ophthalmology Department, 07058, Antalya, Turkey.
| | - Elif Betül Türkoğlu
- Akdeniz University, School of Medicine, Ophthalmology Department, 07058, Antalya, Turkey
| | - Mehmet Erkan Doğan
- Akdeniz University, School of Medicine, Ophthalmology Department, 07058, Antalya, Turkey
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Incidence and Risk Factors for Secondary Glaucoma in Eyes with Uveal Melanoma. Ophthalmol Glaucoma 2023; 6:29-41. [PMID: 35964940 DOI: 10.1016/j.ogla.2022.08.002] [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: 04/25/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To estimate incidence of and analyze risk factors for developing secondary glaucoma in eyes with uveal melanoma before and after diagnosis. DESIGN A cross-sectional, population-based cohort study. PARTICIPANTS Seven hundred eighty-one patients (median age, 64 years; range, 14-93) consecutively diagnosed with uveal melanoma from 1997 to 2012 in a national ocular oncology service, 708 (91%) of whom received ruthenium (50%) or iodine (50%) brachytherapy. METHODS Patient, tumor, treatment, and follow-up data were collected prospectively. Frequency and associations of melanoma-related glaucoma at tumor diagnosis were assessed. Incidence of developing secondary glaucoma after diagnosis was estimated by Kaplan-Meier analysis. Independent risk factors were modeled using Cox regression. MAIN OUTCOME MEASURES Melanoma-related glaucoma and related risk factors. RESULTS Forty-five patients (5.8%; 95% confidence interval [CI], 4.2-7.6) had tumor-related secondary glaucoma at diagnosis, 34 (76%) from a narrow-to-closed angle (25 had direct angle invasion) and 10 (22%) from anterior neovascularization. Synchronous metastases were common in patients with initial secondary glaucoma (11% vs. 1.2% with incident glaucoma, P = 0.005). Patients with secondary glaucoma were often male (58% vs. 48% without glaucoma; P = 0.010) and had larger tumors (median thickness, 9.1 vs. 4.0 mm; P < 0.001) involving the ciliary body (43% vs. 21%; P < 0.001) with retinal detachment (53% vs. 30%; P < 0.001). One hundred and sixty-eight patients 165 of which were treated with brachytherapy developed incident tumor- or treatment-related secondary glaucoma a median of 1.7 years (range, 0.1-13.6) after tumor diagnosis. Cumulative proportion of developing secondary glaucoma was 23% (95% CI, 20-27) at 5 years. The most common mechanism was neovascularization in 119 patients (71%; 95% CI, 63-78). By multivariable regression, initial retinal detachment 3 to 4 quadrants (hazard ratio [HR], 2.18; P < 0.001), initial intraocular pressure 17 mmHg or higher (HR, 1.64; P = 0.01), and tumor thickness predicted incident secondary glaucoma. CONCLUSIONS Secondary glaucoma at initial uveal melanoma diagnosis predicts high risk of synchronous metastases. Although anterior neovascularization is the most common mechanism for secondary glaucoma after diagnosis, other mechanisms such as angle narrowing and anterior chamber hemorrhage are not infrequent. Initial retinal detachment and intraocular pressure with tumor thickness could inform interim assessments of intraocular pressure and neovascularization.
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Hopkins NS, Kornblau IS, Montes-Sabino CE, Boom A, Wilson MW. Delayed recurrence of an iridociliary malignant melanoma 180° from the primary tumor. Am J Ophthalmol Case Rep 2022; 28:101710. [PMID: 36262689 PMCID: PMC9574778 DOI: 10.1016/j.ajoc.2022.101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose We report the case of a 66-year-old female who returned with a rare recurrence of iridociliary melanoma 180° from the original lesion. Observations Upon initial presentation eleven years prior, a pigmented iris lesion suspicious for primary uveal melanoma was noted in the right eye at 9 o'clock. After one year of observation, inferior growth of the iris lesion prompted treatment via primary iridectomy with excisional biopsy and pupilloplasty. Postoperative biopsy confirmed spindle B type melanoma with epithelial foci, and adjuvant brachytherapy was performed to treat the reported positive anterior ciliary body involvement. Ten years after initial plaque brachytherapy treatment, the patient returned with a pigmented iris lesion in the right eye at 3:30–5 o'clock, which was treated with enucleation. On pathology, the new melanoma was predominantly epithelioid, consistent with a transformed recurrent iridociliary melanoma. The patient remains metastasis free 13 years after initial diagnosis. Conclusions and importance This case describes a rare, late recurrence of an iridociliary melanoma 180° away eleven years after initial presentation, emphasizing the importance of lifelong follow-up for patients with iridociliary melanoma. This rare form of recurrence has not been previously reported in the literature. We hypothesize the original lesion contained radiotherapy resistant epithelioid cells which grew superficially on the posterior iris and anterior ciliary body, ultimately breaking back through the anterior iris 180° away.
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Affiliation(s)
- Nikolas S. Hopkins
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ilyse S. Kornblau
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Surgical Services, Ophthalmology Section, Veterans Health Administration, Memphis, TN, USA,Corresponding author. Department of Ophthalmology Hamilton Eye Institute, University of Tennessee Health Science, Center 930 Madison Ave Memphis, TN, 38103, United States.
| | - Christopher E. Montes-Sabino
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alan Boom
- Department of Pathology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Matthew W. Wilson
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
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Aghaei H, Sedaghat A, Abolfathzadeh N, Mirshahi R, Manafi N, Afshar RK, Naseripour M. Short-term changes of cornea and tear film after ruthenium-106 plaque therapy for intraocular tumors. Indian J Ophthalmol 2021; 69:3469-3472. [PMID: 34826976 PMCID: PMC8837291 DOI: 10.4103/ijo.ijo_3661_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: Plaque therapy is a well-recognized treatment for intraocular tumors. In current study, we aimed to prospectively investigate the short-term effects of ruthenium 106 (Ru-106) plaque therapy on the cornea and ocular surface parameters. Methods: Twenty-five patients diagnosed with choroidal melanoma which undergone Ru-106 plaque therapy from 2016 to 2018 were included. Tear osmolarity, tear film break-up time, Schirmer test I, fluorescein dye staining based on Oxford staining method; Ocular Surface Disease Index (OSDI) questionnaire and corneal specular microscopy were performed. These tests were assessed preoperatively and then 3 months postoperatively. Results: The mean (±SD) age of subjects was 48.52 ± 15.18 years. The patients were followed for a mean(±SD) period of 3.64 ± 2.40 months. Total mean (+SD) delivered radiation dose to the tumor apex and total received radiation by the sclera was 83.20 ± 26.31 and 640.65 ± 472.69 Gray (Gy), respectively. In longitudinal analysis, OSDI score and Oxford staining score increased significantly (P = 0.002 for both variables) and the prevalence of dry eye disease (DED) increased from 20% preoperatively to 72% at 3 months postoperatively (P = 0.001).The changes in the all specular microscopy parameters were statistically nonsignificant (all P values > 0.05). Conclusion: There is a considerable increase in the rate of DED following plaque therapy for the treatment of choroidal melanoma in short-term follow-up. The OSDI questionnaire and fluorescein staining test are valuable tools for early detection of DED postoperatively.
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Affiliation(s)
- Hossein Aghaei
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ahad Sedaghat
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Navid Abolfathzadeh
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Navid Manafi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Kiaee Afshar
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masood Naseripour
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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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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Mazloumi M, Dalvin LA, Abtahi SH, Yavari N, Yaghy A, Mashayekhi A, Shields JA, Shields CL. Photodynamic Therapy in Ocular Oncology. J Ophthalmic Vis Res 2020; 15:547-558. [PMID: 33133446 PMCID: PMC7591845 DOI: 10.18502/jovr.v15i4.7793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 01/10/2023] Open
Abstract
Over the past two decades, we have witnessed the increasing use of photodynamic therapy (PDT) in the field of ocular oncology. Based on a review of the literature and our own experience, we herein review the role of PDT for the management of intraocular tumors. The discussion includes two main topics. First, we discuss the application of PDT for benign tumors, including circumscribed choroidal hemangioma, choroidal osteoma, retinal astrocytoma, retinal capillary hemangioma (retinal hemangioblastoma), and retinal vasoproliferative tumor. Second, we assess the role of PDT for malignant tumors, including choroidal melanoma and choroidal metastasis.
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Affiliation(s)
- Mehdi Mazloumi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | | | - Seyed-Hossein Abtahi
- Isfahan Eye Research Center, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Negin Yavari
- Department of Cardiovascular Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Antonio Yaghy
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | - Arman Mashayekhi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
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Lee HJ, Stacey A, Klesert TR, Wells C, Skalet AH, Bloch C, Fung A, Bowen SR, Wong TP, Shibata D, Halasz LM, Rengan R. Corneal Substructure Dosimetry Predicts Corneal Toxicity in Patients With Uveal Melanoma Treated With Proton Beam Therapy. Int J Radiat Oncol Biol Phys 2019; 104:374-382. [PMID: 30763658 DOI: 10.1016/j.ijrobp.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study examines the relationship between dose to corneal substructures and incidence of corneal toxicity within 6 months of proton beam therapy (PBT) for uveal melanoma. We aim to develop clinically meaningful dose constraints that can be used to mitigate corneal toxicity. METHODS AND MATERIALS Ninety-two patients were treated with PBT between 2015 and 2017 and evaluated for grade 2+ (GR2+) intervention-requiring corneal toxicity in our prospectively maintained database. Most patients were treated with 50 Gy (relative biological effectiveness [RBE]) in 5 fractions, and all had complete six-month follow-up. Analyses included Mann-Whitney, χ2, Fisher exact, and receiver operating curve tests to identify risk factors for GR2+ toxicity. Bivariate logistic regression was used to identify independent dose-volume histogram (DVH) predictors of toxicity after adjustment for the most important clinical risk factor. RESULTS The 6-month PBT GR2+ corneal toxicity rate was 10.9%, with half of patients experiencing grade 2 toxicity and half experiencing grade 3 toxicity, with no grade 4 events. Patients with anterior chamber tumors had a higher risk (58.3%) for toxicity than those with posterior tumors (0%) or posterior tumors extending past the equator (25%, P < .0001). On univariate analysis, larger size according to Collaborative Ocular Melanoma Studies was associated with increased toxicity rate (P < .004). DVH analysis revealed that cutoffs of 58% for V25, 32% for V45, 51.8 Gy (RBE) for maximum dose, and 32 Gy (RBE) for mean dose to the cornea separated patients into groups experiencing and not experiencing toxicity with 90% sensitivity and ≥96% specificity. Bivariate logistic regression indicated that corneal V25, V45, and mean dose independently predicted for toxicity after adjusting for tumor location. CONCLUSIONS Patients receiving PBT for anterior uveal melanomas experience a high rate of GR2+ corneal toxicity because of increased corneal dose. Anterior location and corneal DVH parameters independently predict toxicity risk. We propose dosimetric constraints to facilitate treatment planning and toxicity mitigation.
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Affiliation(s)
- Howard J Lee
- Duke University School of Medicine, Durham, North Carolina.
| | - Andrew Stacey
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington
| | - Todd R Klesert
- Vitreoretinal Associates of Washington, Seattle, Washington
| | - Craig Wells
- Vitreoretinal Associates of Washington, Seattle, Washington
| | - Alison H Skalet
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon; Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Charles Bloch
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Angela Fung
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, Washington
| | - Stephen R Bowen
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington; Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Tony P Wong
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, Washington
| | - Dean Shibata
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Lia M Halasz
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
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Abstract
BACKGROUND Benign iridal tumors rarely necessitate a therapeutic intervention. In contrast, malignant tumors of the iris can threaten the patient's life and eyesight and require early treatment to prevent the development of metastases. OBJECTIVE Presentation of current treatment options for iridal tumors with special emphasis on iridal melanoma. METHODS This article gives an overview of the current literature based on a PubMed search as well as own clinical experience. RESULTS Treatment options for iridal and ciliary body melanomas comprise radiotherapeutic and surgical (eyeball-sparing and non-sparing) approaches. The eyeball-sparing surgical procedure of choice is block excision. While local tumor control rates and metastasis rates of block excision and radiotherapy are comparable, there are distinct differences especially between the spectra of complications. New treatment procedures include immunomodulatory approaches and targeted therapies. Using checkpoint inhibitors, no convincing enhancement of overall survival could be demonstrated for metastatic iridal melanoma, as is the case for cutaneous melanoma. In contrast, tumor vaccination with the help of tumor RNA-laden patient-derived dendritic cells seems to be a promising option for a subgroup of high-risk patients. Targeted therapies aiming to suppress the MAPK and PI3K/Akt pathways could not achieve any improvement in patient survival. CONCLUSION For the primary treatment of iridal melanoma a surgical, eyeball-sparing approach and also when appropriate, radiotherapy can be recommended. In the future, eligible high-risk patients could profit from a tumor vaccination. To date, there is no effective systemic treatment for metastatic iridal melanoma.
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Miguel D, de Frutos-Baraja JM, López-Lara F, Saornil MA, García-Álvarez C, Alonso P, Diezhandino P. Radiobiological doses, tumor, and treatment features influence on outcomes after epiescleral brachytherapy. A 20-year retrospective analysis from a single-institution: part II. J Contemp Brachytherapy 2018; 10:347-359. [PMID: 30237818 PMCID: PMC6142647 DOI: 10.5114/jcb.2018.77955] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/19/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To assess the influence of the radiobiological doses, tumor, and treatment features on retinopathy, cataracts, retinal detachment, optic neuropathy, vitreous hemorrhage, and neovascular glaucoma at the authors' institution after brachytherapy for posterior uveal melanoma. MATERIAL AND METHODS Medical records of 243 eyes with uveal melanoma, treated by iodine brachytherapy between 1996 and 2016 at a single center were analyzed. Clinical and radiotherapy data were extracted from a dedicated database. Biologically effective dose (BED) was included in survival analysis performed using Kaplan-Meier and Cox regressions. Relative survival rates were estimated, and univariate/multivariate regression models were constructed for predictive factors of each item. Hazard ratio and confidence interval at 95% were determined. Variables statistically significant were analyzed and compared by log-rank tests. RESULTS The median follow-up was 73.9 months (range, 3-202 months). Cumulative probabilities of survival by Kaplan-Meier analysis at 3 and 5 years, respectively, were: 59% and 48% for retinopathy; 71% and 55% for cataracts; 63% and 57% for retinal detachment; 88% and 79% for optic neuropathy; 87% and 83% for vitreous hemorrhage; 92% and 89% for neovascular glaucoma, respectively. Using multivariate analysis, statistically significant risk factors were: age, tumor apical height, dose to foveola, and location of anterior border for retinopathy; age, dose to lens, type of plaque, and tumor shape, for cataracts; age, tumor apical height, and size of the plaque for retinal detachment; age, plaque shape, longest basal dimension, and BED to optic nerve for optic neuropathy; age, tumor apical height, and tumor shape for vitreous hemorrhage; tumor apical height and BED to foveola for neovascular glaucoma. CONCLUSIONS Tumor factors in addition to radiation treatment may contribute to secondary effects. Enhanced clinical optimization should evaluate radiobiological doses delivered to the tumor volume and surrounding normal ocular structures.
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Affiliation(s)
- David Miguel
- Intraocular Tumor Unit, Hospital Universitario de Valladolid, Valladolid
- University of Valladolid, Valladolid, Spain
| | - Jesús María de Frutos-Baraja
- Intraocular Tumor Unit, Hospital Universitario de Valladolid, Valladolid
- University of Valladolid, Valladolid, Spain
| | - Francisco López-Lara
- Intraocular Tumor Unit, Hospital Universitario de Valladolid, Valladolid
- University of Valladolid, Valladolid, Spain
| | - María Antonia Saornil
- Intraocular Tumor Unit, Hospital Universitario de Valladolid, Valladolid
- University of Valladolid, Valladolid, Spain
| | - Ciro García-Álvarez
- Intraocular Tumor Unit, Hospital Universitario de Valladolid, Valladolid
- University of Valladolid, Valladolid, Spain
| | - Pilar Alonso
- Intraocular Tumor Unit, Hospital Universitario de Valladolid, Valladolid
- University of Valladolid, Valladolid, Spain
| | - Patricia Diezhandino
- Intraocular Tumor Unit, Hospital Universitario de Valladolid, Valladolid
- University of Valladolid, Valladolid, Spain
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Visual outcome after posterior uveal melanoma episcleral brachytherapy including radiobiological doses. J Contemp Brachytherapy 2018; 10:123-131. [PMID: 29789761 PMCID: PMC5961527 DOI: 10.5114/jcb.2018.75597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/10/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose To assess the long-term influence of radiobiological doses in the evolution of visual acuity (VA) in patients with uveal melanoma treated by episcleral brachytherapy. Material and methods Visual acuity was evaluated prospectively from a case series of 243 patients in 2016 treated with 125I. Data analysis was applied to trend VA outcome and find the accurate best-fit line. Biologically effective dose (BED) was included in survival analysis with the use of Kaplan-Meier and Cox regressions. Hazard ratio (HR) and confidence interval at 95% (CI) were determined. Variables statistically significant were analyzed and compared by log-rank tests. Results The median follow-up was 74.2 months (range, 3-223). Exponential regression shows a 25% reduction and 50% in visual acuity score (VAS) scale for 5 and 27.8 months, respectively. Cumulative probabilities of survival analysis were 57%, 42%, 27%, and 23% at 3, 5, 10, and 15 years, respectively. Multivariable analysis found tumor height (HR = 1.18, 95% CI: 1.07-1.29), applicator size (HR = 1.22, 95% CI: 1.08-1.36), juxtapapillary localization (HR = 1.70, 95% CI: 1.01-2.84), and dose to foveola (HR = 1.01, 95% CI: 1.00-1.01) significantly associated with VA loss. Log-rank tests were significant for all those variables. BED has a strong influence in univariate model, but not statistically significant in the multivariate one. Conclusions Visual acuity changes can be modeled by an exponential function for the first 5 years after treatment. No relation between VA loss and BED has been found; nevertheless, apical height, plaque size, juxtapapillary localization, and dose to fovea were found as statistical significant variables.
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Lemaître S, Lecler A, Lévy-Gabriel C, Reyes C, Desjardins L, Gentien D, Zmuda M, Jacomet PV, Lumbroso-Le Rouic L, Dendale R, Vincent-Salomon A, Pierron G, Galatoire O, Cassoux N. Evisceration and ocular tumors: What are the consequences? J Fr Ophtalmol 2017; 40:93-101. [PMID: 28126270 DOI: 10.1016/j.jfo.2016.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Evisceration can be performed for blind, painful eyes. This surgery can promote the dissemination of tumor cells within the orbit if an ocular tumor has been missed preoperatively. METHODS We reviewed the medical records of patients who were eviscerated for blind, painful eyes between 2009 and 2014 and who were referred after the surgery to the Institut Curie or the Rothschild Foundation in Paris. We included the patients with a histological diagnosis of ocular tumor or orbital recurrence. Cytogenetic analysis was performed whenever possible. RESULTS Four patients turned out to have an ocular tumor after evisceration (two choroidal melanomas, a rhabdoid tumor and an adenocarcinoma of the retinal pigment epithelium); two had a history of prior ocular trauma. The tumors were diagnosed either on histological analysis of the intraocular contents (2 patients) or biopsy of orbital recurrence (2 patients). Prior to evisceration, fundus examination was not performed in 3 patients. One had preoperative imaging but no intraocular tumor was suspected. At the time of this study, 3 patients had had an orbital recurrence and died. We also found 2 patients who had an evisceration despite a past history of choroidal melanoma treated with proton beam therapy. CONCLUSION We showed that evisceration of eyes with unsuspected ocular malignancies was associated with a poor prognosis due to orbital recurrence and metastasis. The evisceration specimen should therefore always be sent for histological analysis in order to perform prompt adjuvant orbital radiotherapy if an ocular tumor is found.
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Affiliation(s)
- S Lemaître
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France.
| | - A Lecler
- Fondation ophtalmologique Adolphe de Rothschild, 25-29, rue Manin, 75019 Paris, France
| | | | - C Reyes
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - L Desjardins
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - D Gentien
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - M Zmuda
- Fondation ophtalmologique Adolphe de Rothschild, 25-29, rue Manin, 75019 Paris, France
| | - P V Jacomet
- Fondation ophtalmologique Adolphe de Rothschild, 25-29, rue Manin, 75019 Paris, France
| | | | - R Dendale
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France; ICPO centre de protonthérapie, 15, rue Georges-Clemenceau, 91400 Orsay, France
| | | | - G Pierron
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - O Galatoire
- Fondation ophtalmologique Adolphe de Rothschild, 25-29, rue Manin, 75019 Paris, France
| | - N Cassoux
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
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Lemaître S, Lévy-Gabriel C, Desjardins L, Plancher C, Asselain B, Vincent-Salomon A, Lumbroso-Le Rouic L, Dendale R, Rouzier R, Delacroix S, Cassoux N. Choroidal melanoma and pregnancy. Acta Ophthalmol 2016; 94:e652-e660. [PMID: 27009598 DOI: 10.1111/aos.12984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 12/09/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Choroidal melanoma is a rare tumour in adults. The mean age at diagnosis is 60, but the tumour can affect women of childbearing age. A negative effect of pregnancy on patients' survival has not been formally excluded to date. The aim of the present study is to evaluate the effect of pregnancy on the prognosis of choroidal melanoma. METHODS We conducted a single-centre retrospective study at the Institut Curie on the population of women of childbearing age who were diagnosed with choroidal melanoma between June 1980 and October 2013. We took a particular interest in the prognosis of those who were pregnant at the time of diagnosis and in the prognosis of those who chose to get pregnant after the treatment. RESULTS We found 27 pregnant patients at the time of diagnosis and 13 patients who became pregnant after the treatment. There was no difference in the survival between these two groups of patients and the group of other women of childbearing age diagnosed with choroidal melanoma (p = 0.52). There was also no difference in metastasis-free survival (p = 0.91). Most women were able to carry their pregnancies to term (67% had a term pregnancy, and only 7% had an abortion). For women who were pregnant when they were diagnosed with choroidal melanoma, a conservative treatment was chosen in 85% of cases, and proton beam therapy was the most widely used treatment. CONCLUSIONS Survival in women of childbearing age does not appear to be influenced by pregnancy. We show that proton beam therapy can be used to treat women who are pregnant at the time of choroidal melanoma diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | - Rémi Dendale
- Protontherapy Center (ICPO); Institut Curie; Paris France
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Rospond-Kubiak I, Groenewald C, Coupland SE, Damato B. Core Endoresection as Neoadjuvant Treatment of Uveal Melanoma. Ocul Oncol Pathol 2016; 2:91-3. [PMID: 27171344 DOI: 10.1159/000439134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 07/29/2015] [Indexed: 11/19/2022] Open
Abstract
AIM To present a case of neoadjuvant treatment of uveal melanoma with a limited core endoresection, which enabled ruthenium plaque radiotherapy to be administered. MATERIAL AND METHODS A 77-year-old woman presented in 2005 with a ciliochoroidal uveal melanoma measuring 7.2 by 6.5 mm basally with a thickness of 6.2 mm. The vision in the affected eye was 6/9. Because of diagnostic uncertainty, we performed a biopsy, which produced a copious sample. The biopsy serendipitously reduced the tumour thickness to 4.4 mm, making ruthenium plaque brachytherapy possible. RESULTS Histopathological examination showed the tumour to be a melanoma predominantly of spindle cell type. Postoperative complications included a dense vitreous haemorrhage, which cleared spontaneously, and raised intraocular pressure, controlled with latanoprost. Seven years after brachytherapy, the vision was 6/5 and the thickness of the residual tumour was 2.5 mm. Nine years after treatment, there was no evidence of any intra- or extraocular seeding or distant metastases. CONCLUSIONS Core endoresection of a ciliochoroidal melanoma may reduce tumour thickness enough to allow subsequent ruthenium plaque radiotherapy.
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Affiliation(s)
- Iwona Rospond-Kubiak
- Liverpool Ocular Oncology Centre, Royal Liverpool University Hospital, Liverpool, UK; Department of Ophthalmology, Poznań University of Medical Sciences, Poznań, Poland
| | - Carl Groenewald
- Liverpool Ocular Oncology Centre, Royal Liverpool University Hospital, Liverpool, UK
| | - Sarah E Coupland
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Bertil Damato
- Ocular Oncology Service, Department of Ophthalmology, San Francisco, Calif., USA; Department of Radiation Oncology, University of California, San Francisco, San Francisco, Calif., USA
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Abstract
Choroidal melanoma is the most common form of eye cancer in adults. Treatments enabling the tumour to be destroyed or removed while preserving the eye socket are mainly based on surgery, proton therapy and brachytherapy.
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The American Brachytherapy Society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma. Brachytherapy 2013; 13:1-14. [PMID: 24373763 DOI: 10.1016/j.brachy.2013.11.008] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/05/2013] [Accepted: 11/21/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To present the American Brachytherapy Society (ABS) guidelines for plaque brachytherapy of choroidal melanoma and retinoblastoma. METHODS AND MATERIALS An international multicenter Ophthalmic Oncology Task Force (OOTF) was assembled to include 47 radiation oncologists, medical physicists, and ophthalmic oncologists from 10 countries. The ABS-OOTF produced collaborative guidelines, based on their eye cancer-specific clinical experience and knowledge of the literature. This work was reviewed and approved by the ABS Board of Directors as well as within the journal's peer-reivew process. RESULTS The ABS-OOTF reached consensus that ophthalmic plaque radiation therapy is best performed in subspecialty brachytherapy centers. Quality assurance, methods of plaque construction, and dosimetry should be consistent with the 2012 joint guidelines of the American Association of Physicists in Medicine and ABS. Implantation of plaque sources should be performed by subspecialty-trained surgeons. Although there exist select restrictions related to tumor size and location, the ABS-OOTF agreed that most melanomas of the iris, ciliary body, and choroid could be treated with plaque brachytherapy. The ABS-OOTF reached consensus that tumors with gross orbital extension and blind painful eyes and those with no light perception vision are unsuitable for brachytherapy. In contrast, only select retinoblastomas are eligible for plaque brachytherapy. Prescription doses, dose rates, treatment durations, and clinical methods are described. CONCLUSIONS Plaque brachytherapy is an effective eye and vision-sparing method to treat patients with intraocular tumors. Practitioners are encouraged to use ABS-OOTF guidelines to enhance their practice.
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Vacchelli E, Vitale I, Tartour E, Eggermont A, Sautès-Fridman C, Galon J, Zitvogel L, Kroemer G, Galluzzi L. Trial Watch: Anticancer radioimmunotherapy. Oncoimmunology 2013; 2:e25595. [PMID: 24319634 PMCID: PMC3850274 DOI: 10.4161/onci.25595] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 06/28/2013] [Indexed: 12/18/2022] Open
Abstract
Radiotherapy has extensively been employed as a curative or palliative intervention against cancer throughout the last century, with a varying degree of success. For a long time, the antineoplastic activity of X- and γ-rays was entirely ascribed to their capacity of damaging macromolecules, in particular DNA, and hence triggering the (apoptotic) demise of malignant cells. However, accumulating evidence indicates that (at least part of) the clinical potential of radiotherapy stems from cancer cell-extrinsic mechanisms, including the normalization of tumor vasculature as well as short- and long-range bystander effects. Local bystander effects involve either the direct transmission of lethal signals between cells connected by gap junctions or the production of diffusible cytotoxic mediators, including reactive oxygen species, nitric oxide and cytokines. Conversely, long-range bystander effects, also known as out-of-field or abscopal effects, presumably reflect the elicitation of tumor-specific adaptive immune responses. Ionizing rays have indeed been shown to promote the immunogenic demise of malignant cells, a process that relies on the spatiotemporally defined emanation of specific damage-associated molecular patterns (DAMPs). Thus, irradiation reportedly improves the clinical efficacy of other treatment modalities such as surgery (both in neo-adjuvant and adjuvant settings) or chemotherapy. Moreover, at least under some circumstances, radiotherapy may potentiate anticancer immune responses as elicited by various immunotherapeutic agents, including (but presumably not limited to) immunomodulatory monoclonal antibodies, cancer-specific vaccines, dendritic cell-based interventions and Toll-like receptor agonists. Here, we review the rationale of using radiotherapy, alone or combined with immunomodulatory agents, as a means to elicit or boost anticancer immune responses, and present recent clinical trials investigating the therapeutic potential of this approach in cancer patients.
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Affiliation(s)
- Erika Vacchelli
- Gustave Roussy; Villejuif, France
- Université Paris-Sud/Paris XI; Le Kremlin-Bicêtre, France
- INSERM, U848; Villejuif, France
| | - Ilio Vitale
- Regina Elena National Cancer Institute; Rome, Italy
- National Institute of Health; Rome, Italy
| | - Eric Tartour
- INSERM, U970; Paris, France
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
- Pôle de Biologie; Hôpital Européen Georges Pompidou; Assistance Publique-Hôpitaux de Paris; Paris, France
| | | | - Catherine Sautès-Fridman
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
- Pôle de Biologie; Hôpital Européen Georges Pompidou; Assistance Publique-Hôpitaux de Paris; Paris, France
- Equipe 13, Centre de Recherche des Cordeliers; Paris, France
| | - Jérôme Galon
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
- Equipe 15, Centre de Recherche des Cordeliers; Paris, France
- INSERM, U872; Paris, France
- Université Pierre et Marie Curie/Paris VI; Paris, France
| | - Laurence Zitvogel
- Université Paris-Sud/Paris XI; Le Kremlin-Bicêtre, France
- INSERM, U1015; Villejuif, France
| | - Guido Kroemer
- INSERM, U848; Villejuif, France
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
- Pôle de Biologie; Hôpital Européen Georges Pompidou; Assistance Publique-Hôpitaux de Paris; Paris, France
- Equipe 11 labelisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers; Paris, France
- Metabolomics and Cell Biology Platforms; Institut Gustave Roussy; Villejuif, France
| | - Lorenzo Galluzzi
- Gustave Roussy; Villejuif, France
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
- Equipe 11 labelisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers; Paris, France
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Tumor-related Lipid Exudation and Associated Tumor-related Complications after Plaque Radiotherapy of Posterior Uveal Melanoma. Eur J Ophthalmol 2013; 23:399-409. [DOI: 10.5301/ejo.5000236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 11/20/2022]
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Kaliki S, Shields CL, Rojanaporn D, Badal J, Devisetty L, Emrich J, Komarnicky L, Shields JA. Scleral necrosis after plaque radiotherapy of uveal melanoma: a case-control study. Ophthalmology 2013; 120:1004-11. [PMID: 23347983 DOI: 10.1016/j.ophtha.2012.10.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/16/2012] [Accepted: 10/16/2012] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To identify risk factors and outcome of scleral necrosis after plaque radiotherapy of uveal melanoma. DESIGN Case-control study. PARTICIPANTS A total of 73 cases with scleral necrosis and 73 controls without necrosis after plaque radiotherapy. Controls were matched for anteroposterior tumor epicenter and follow-up duration. INTERVENTION Plaque radiotherapy with iodine-125, cobalt-60, iridium-192, or ruthenium-106. MAIN OUTCOME MEASURES Scleral necrosis. RESULTS Of 5057 patients treated with plaque radiotherapy for uveal melanoma, 73 (1%) developed radiotherapy-induced scleral necrosis. Scleral necrosis occurred in <1% of patients (3/1140) when plaque radiotherapy was used for tumors <3 mm in thickness, 1% of patients (33/3155) with 3- to 8-mm tumor thickness, and 5% of patients (37/762) with >8-mm-thick tumors. On the basis of tumor location, scleral necrosis was detected after plaque radiotherapy of iris melanoma in 0% of patients (0/91), ciliary body melanoma in 29% of patients (67/235), and choroid melanoma in <1% of patients (6/4731). The mean time interval between plaque radiotherapy and scleral necrosis was 32 months (median, 23 months; range, 4-126 months). The mean basal dimension of scleral necrosis was 4 mm (median, 3 mm; range, 1-15 mm), equivalent to 29% of mean tumor base (median, 24%; range, 6%-100%) and 22% of mean plaque size (median, 19%; range, 5%-75%). Multivariate analysis of factors that predicted clinically evident scleral necrosis included ciliary body (P = 0.0001) and pars plana to ora serrata (P < 0.0001) locations of anterior tumor margin, tumor thickness ≥ 6 mm (P = 0.0001), and radiation dose ≥ 400 Gy to the outer sclera (P = 0.0455). Scleral necrosis remained stable in 48% of patients (35/73), increased in size/severity in 48% of patients (35/73), or progressed to scleral perforation in 4% of patients (3/73) over a mean follow-up of 79 months (median, 54 months; range, 5-351 months). Treatment of scleral necrosis included observation in 81% of patients (59/73), scleral patch graft in 14% of patients (10/73), and enucleation in 5% of patients (4/73). CONCLUSIONS Scleral necrosis after plaque radiotherapy of uveal melanoma was detected in 1% of cases. Factors predictive of scleral necrosis included increasing tumor thickness, ciliary body and peripheral choroidal location, and higher radiation dose to sclera. Most patients (81%) did not require treatment, and 4% evolved to full-thickness perforation. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Swathi Kaliki
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Brachytherapy for Choroidal Melanoma. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Prognosis of Posterior Uveal Melanoma. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00140-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Khan N, Khan MK, Bena J, Macklis R, Singh AD. Plaque Brachytherapy for Uveal Melanoma: A Vision Prognostication Model. Int J Radiat Oncol Biol Phys 2012; 84:e285-90. [DOI: 10.1016/j.ijrobp.2012.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 03/16/2012] [Accepted: 04/05/2012] [Indexed: 10/27/2022]
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Iris melanoma management with iodine-125 plaque radiotherapy in 144 patients: impact of melanoma-related glaucoma on outcomes. Ophthalmology 2012; 120:55-61. [PMID: 22980742 DOI: 10.1016/j.ophtha.2012.06.053] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 06/26/2012] [Accepted: 06/28/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the outcomes of iris melanoma managed with plaque radiotherapy on the basis of the initial presence or absence of glaucoma. DESIGN Retrospective, comparative case series. PARTICIPANTS A total of 144 patients. INTERVENTION Custom-designed iodine-125 plaque radiotherapy delivering planned 8000 cGy to melanoma apex using transcorneal application. MAIN OUTCOME MEASURES Tumor control and treatment-related complications. RESULTS Of 144 patients with iris melanoma, glaucoma was present at the initial visit in 58 (40%). Causes of elevated intraocular pressure included angle infiltration by melanoma in 50 patients (86%), angle neovascularization in 4 patients (7%), and hyphema in 4 patients (7%). At presentation, the eyes displaying iris melanoma with glaucoma (vs. without glaucoma) were statistically more likely to display angle tumor (66% vs. 43%), with minimal thickness (1.9 vs. 2.9 mm), and melanoma seeding in iris stroma (7 vs. 3 clock hours) and angle (5 vs. 2 clock hours). Plaque radiotherapy was performed in all cases. Kaplan-Meier estimates at 7 years post-treatment revealed no statistical differences in outcomes of local recurrence (14% vs. 15%), enucleation (14% vs. 11%), or metastasis (2% vs. 0%) comparing eyes with and without glaucoma. Of the entire group, multivariate analysis for factors predictive of recurrence included partial (vs. complete) anterior segment irradiation and postradiotherapy glaucoma. Factors related to enucleation included diabetes mellitus, poor initial visual acuity, higher radiation dose to tumor apex, and tumor recurrence. There were no factors predictive of metastasis. CONCLUSIONS Iodine-125 plaque radiotherapy provides adequate tumor control for iris melanoma with a low metastatic potential of 1% at 7 years. Iris melanoma with secondary glaucoma showed a statistically significant greater likelihood of flat tumor with iris and angle seeding and no difference in outcomes compared with eyes without glaucoma. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Shah SU, Shields CL, Bianciotto C, Emrich J, Komarnicky L, Shields JA. Plaque radiotherapy for residual or recurrent iris melanoma after surgical resection in 32 cases. Ophthalmology 2011; 119:838-842.e2. [PMID: 22133794 DOI: 10.1016/j.ophtha.2011.09.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/14/2011] [Accepted: 09/19/2011] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate plaque radiotherapy for management of residual or recurrent iris melanoma after surgical resection. DESIGN Retrospective, nonrandomized interventional case series. PARTICIPANTS We included 32 patients with residual or recurrent iris melanoma after surgical resection. INTERVENTION Custom designed iodine-125 plaque radiotherapy. MAIN OUTCOME MEASURES Tumor control, recurrence, poor visual acuity, enucleation, metastasis, and radiation complications. RESULTS There were 32 eyes with residual (n = 12) or recurrent (n = 20) iris melanoma after surgical resection that were treated with iodine-125 plaque radiotherapy. The residual melanoma was evident clinically in 3 cases and histopathologically in 9; plaque radiotherapy was delivered at a mean interval of 2 months after resection. For the recurrent cases, the mean interval from initial tumor resection to detection of recurrence was 58 months, at which time plaque radiotherapy was applied. For all cases, the mean tumor basal diameter was 6 mm (range, 1-13) and thickness was 2 mm (range, 0.8-4.0) at the time of radiotherapy. Anterior chamber seeding was present in 26 (81%) eyes and glaucoma in 11 (34%) eyes. Visual acuity at presentation was good (20/20-20/50) in 27 (84%), intermediate (20/60-20/150) in 3 (9%), and poor (≤20/200) in 2 eyes (6%). At 6 years after plaque radiotherapy, outcomes included complete tumor control in 87%, poor visual acuity in 9%, enucleation in 13% (for reasons of tumor recurrence [n = 3] and severe glaucoma [n = 1]), and metastasis in 3%. At 6 years, radiation complications included corneal epitheliopathy in 6%, scleral necrosis in 3%, cataract in 53%, elevated intraocular pressure (from tumor or radiotherapy) in 19%, and macular edema in 6%. CONCLUSIONS Iodine-125 plaque radiotherapy is effective in the management of residual or recurrent iris melanoma after surgical resection, providing tumor control in 87% of patients at 6 years and avoiding enucleation in most cases.
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Affiliation(s)
- Sanket U Shah
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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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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Finger PT, Chin KJ, Yu GP, Patel NS. Risk Factors for Cataract After Palladium-103 Ophthalmic Plaque Radiation Therapy. Int J Radiat Oncol Biol Phys 2011; 80:800-6. [DOI: 10.1016/j.ijrobp.2010.02.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 02/18/2010] [Indexed: 11/17/2022]
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Comparing plaque brachytherapy and proton therapy for choroidal melanoma: a review of the literature. JOURNAL OF RADIOTHERAPY IN PRACTICE 2010. [DOI: 10.1017/s1460396909990197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe aims of conservative treatment in patients with ocular melanoma are globe retention, good visual acuity (VA) and local control. Two well-established radiation conservative treatment options are proton beam radiotherapy and episcleral plaque brachytherapy (EPB). Patients who receive treatment with either of these options will experience some degree of radiation-related ocular complications and poor VA. The purpose of this review of the literature is to establish whether there is a significant clinical difference in normal tissue morbidity and local tumour control between proton therapy and EPB, and whether this difference can justify the purchase and implementation of additional proton therapy facilities. Based on this review, evidence suggested that both treatment options are comparable, and that neither proton therapy nor EPB is clinically superior than the other regarding normal tissue morbidity and local tumour control. This review highlighted the need for further research on a larger scale in order to bridge the gap that is apparent within the literature.
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Krema H, Simpson ER, Pavlin CJ, Payne D, Vasquez LM, McGowan H. Management of ciliary body melanoma with iodine-125 plaque brachytherapy. Can J Ophthalmol 2009; 44:395-400. [DOI: 10.3129/i09-097] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Wen JC, Oliver SC, McCannel TA. Ocular complications following I-125 brachytherapy for choroidal melanoma. Eye (Lond) 2009; 23:1254-68. [DOI: 10.1038/eye.2009.43] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Incidence of cataract and outcomes after cataract surgery in the first 5 years after iodine 125 brachytherapy in the Collaborative Ocular Melanoma Study: COMS Report No. 27. Ophthalmology 2007; 114:1363-71. [PMID: 17337065 DOI: 10.1016/j.ophtha.2006.10.039] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 10/24/2006] [Accepted: 10/24/2006] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the effect of the radiation dose to the lens on cataract formation and effect of cataract surgery on visual acuity (VA) among patients with choroidal melanoma treated with iodine 125 (I125) brachytherapy. DESIGN Prospective study of patients enrolled in one arm of a randomized clinical trial. PARTICIPANTS Patients enrolled in the Collaborative Ocular Melanoma Study (COMS) who received I125 brachytherapy as randomly assigned and also were phakic, with no history of cataract in the study eye at the time of enrollment (n = 532). METHODS Each follow-up examination included an interim ocular history and full ophthalmic examination. Lens status (phakic, pseudophakic, or aphakic) and best-corrected VA were recorded. For the purpose of this analysis, the date of the first examination at which an eye was reported to be aphakic or pseudophakic, to have vision-limiting lenticular opacities, or to have had cataract surgery was defined as the observed time of cataract development. Date of cataract surgery was defined as the date of the first follow-up examination at which cataract surgery was reported. MAIN OUTCOME MEASURES Incidence of cataract and outcomes after cataract surgery. RESULTS During the first 5 years of follow-up, cataracts developed in 362 (68%) of the 532 study eyes, including 49 (9%) that had had cataract surgery. By 5 years, 83% of study eyes were reported to have a cataract (95% confidence interval [CI], 79%-87%), and 12% had undergone cataract surgery (CI, 9%-15%) in the study eye. Eighteen percent of eyes that received a dose of 24 Gy or higher to the lens underwent cataract surgery, whereas only 4% of patients with <12 Gy to the lens underwent cataract surgery. Median VAs were 20/125 before cataract surgery and 20/50 after cataract surgery. After cataract surgery, VA improved by 2 lines or more in 32 (66%) patients and remained stable in 13 (26%) patients. The most common cause of lack of visual improvement after cataract surgery was presence of radiation retinopathy. CONCLUSION Although cataract surgery was infrequent among COMS patients, VA remained stable or improved in the majority of these eyes after cataract surgery.
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