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Gollrad J, Rabsahl C, Joussen AM, Stroux A, Budach V, Böhmer D, Böker A. Impact of Adjuvant Ocular Interventions on the Quality of Life of Patients with Uveal Melanoma after Proton Beam Therapy. Ocul Oncol Pathol 2022; 8:110-119. [PMID: 35959158 PMCID: PMC9218619 DOI: 10.1159/000520524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/27/2021] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Proton beam therapy is an established primary treatment for patients with nonmetastasized uveal melanoma. Adjuvant local interventions, like intravitreal injections or surgery, were shown to improve long-term eye preservation; however, their impact on the patient's quality of life (QOL) remains unknown. METHODS In a post-radiotherapeutic follow-up, we prospectively collected data on QOL, visual acuity, and interventional adjuvant procedures. QOL was measured with QOL-C30 questionnaire and quality of life questionnaire OPT30 at baseline, and at 3 and 12 months after proton therapy. Patients were grouped by the type of adjuvant treatment. The impact on QOL was analyzed by comparing changes in the mean score values and visual acuity for different interventional subgroups, with generalized linear mixed models and Wilcoxon signed-rank tests. RESULTS We received 108 (100%) and 95 (88.0%) questionnaires at 3 and 12 months post-therapy, respectively. Adjuvant interventions included observation (n = 61, 56.5%), intravitreal injections (n = 17, 15.7%), and an intraocular surgical procedure (n = 30, 27.8%). In the latter group, several QOL items significantly declined after the 3-month adjuvant interval, but they partially recovered at the 12-month follow-up. In all adjuvant-intervention groups, global QOL scores returned to baseline levels at 12 months. CONCLUSION Posttreatment adjuvant interventions had no long-lasting effects on QOL in patients with uveal melanoma.
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Affiliation(s)
- Johannes Gollrad
- Department of Radiation Oncology and Radiotherapy, Charité − Universitätsmedizin Berlin, Berlin, Germany
| | - Christopher Rabsahl
- Department of Radiation Oncology and Radiotherapy, Charité − Universitätsmedizin Berlin, Berlin, Germany
| | - Antonia M. Joussen
- Department of Ophthalmology, Charité − Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Stroux
- Institute of Biometry and Clinical Epidemiology, Charité − Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology and Radiotherapy, Charité − Universitätsmedizin Berlin, Berlin, Germany
| | - Dirk Böhmer
- Department of Radiation Oncology and Radiotherapy, Charité − Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Böker
- Department of Ophthalmology, Charité − Universitätsmedizin Berlin, Berlin, Germany
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Romano MR, Catania F, Confalonieri F, Zollet P, Allegrini D, Sergenti J, Lanza FB, Ferrara M, Angi M. Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review. Int J Mol Sci 2021; 22:ijms221810066. [PMID: 34576231 PMCID: PMC8467120 DOI: 10.3390/ijms221810066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 01/15/2023] Open
Abstract
Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.
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Affiliation(s)
- Mario R. Romano
- Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (M.R.R.); (F.C.); (F.C.); (P.Z.)
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Fiammetta Catania
- Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (M.R.R.); (F.C.); (F.C.); (P.Z.)
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Filippo Confalonieri
- Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (M.R.R.); (F.C.); (F.C.); (P.Z.)
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Piero Zollet
- Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (M.R.R.); (F.C.); (F.C.); (P.Z.)
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Davide Allegrini
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Jessica Sergenti
- Ocular Oncology Service, Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (J.S.); (F.B.L.)
| | - Francesco B. Lanza
- Ocular Oncology Service, Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (J.S.); (F.B.L.)
| | - Mariantonia Ferrara
- Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy; (D.A.); (M.F.)
| | - Martina Angi
- Ocular Oncology Service, Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (J.S.); (F.B.L.)
- Correspondence: ; Tel.: +39-(0)2-2390-3896
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Breakdown of the blood-eye barrier in choroidal melanoma after proton beam radiotherapy. Graefes Arch Clin Exp Ophthalmol 2019; 257:2323-2328. [PMID: 31300898 DOI: 10.1007/s00417-019-04413-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Irradiation of choroidal melanoma is a safe and globe preserving procedure. Chronic inflammatory processes and ischemia are the main reasons for secondary enucleation in the long run. The aim of this study was to determine whether intraocular inflammation and especially inflammatory response after proton beam therapy (PBT) is related to primary tumor characteristics such as height, tumor volume, and initial flare values. METHODS Twenty-six patients treated for uveal melanoma using PBT were included. All patients were examined for signs of inflammation using laser flare photometry (LFP). Each examination included assessment of the melanoma and fellow eye (which acted as the control) and imaging of the melanoma. RESULTS Significant differences of flare values between melanoma eyes and control group were found both at baseline (median 17.65 ph/ms (min 4, max 37.10), 7.45 ph/ms (min 0.80, max 16.40), respectively) and during follow-up (median 21.45 ph/ms (min 4.5, max 70.90); 6.05 ph/ms (min 2.40, max 16.40), respectively) (p < 0.001, Wilcoxon test). Flare values in melanoma eyes increased significantly after PBT (p = 0.005, Wilcoxon test) and after a follow-up of 94 days (median, 7-420 days). Flare values of the control group did not change (p = 0.946, Wilcoxon test). The increase of flare values correlated significantly with maximum tumor height and volume (Spearman-Rho 0.633, p = 0.001 and 0.519, p = 0.007, respectively). CONCLUSION LFP has proven to show significantly higher flare values in melanoma eyes as compared with the control group and provides data on the course of the inflammatory response after treatment. It may ease treatment planning both at baseline and during follow-up.
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Adjuvant Ab Interno Tumor Treatment After Proton Beam Irradiation. Am J Ophthalmol 2017; 178:94-100. [PMID: 28365241 DOI: 10.1016/j.ajo.2017.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/17/2017] [Accepted: 03/22/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE This study was performed to show long-term outcomes concerning globe preservation in uveal melanoma patients after proton beam therapy with the main focus on outcomes according to different adjuvant ab interno surgical procedures. DESIGN Retrospective cohort study. METHODS All patients treated with primary proton beam therapy for choroidal or ciliary body melanoma between June 1998 and June 2015 were included. RESULTS A total of 2499 patients underwent primary proton beam therapy, with local tumor control and globe preservation rates of 95.9% and 94.8% after 5 years, respectively. A total of 110 (4.4%) patients required secondary enucleation. Unresponsive neovascular glaucoma was the leading cause of secondary enucleation in 78 of the 2499 patients (3.1%). The 5-year enucleation-free survival rate was 94.8% in the endoresection group, 94.3% in the endodrainage group, and 93.5% in the comparator group. The log-rank test showed P = .014 (comparator group vs endoresection group) and P = .06 (comparator group vs endodrainage-vitrectomy group). Patients treated with endoresection or endodrainage-vitrectomy developed less radiation retinopathy (30.5% and 37.4% after 5 years, P = .001 and P = .048 [Kaplan-Meier], respectively) and less neovascular glaucoma (11.6% and 21.3% after 5 years, P = .001 and P = .01 [Kaplan-Meier], respectively) compared with the comparator group (52.3% radiation retinopathy and 57.8% neovascular glaucoma after 5 years). CONCLUSION This study suggests that in larger tumors the enucleation and neovascular glaucoma rates might be reduced by adjuvant surgical procedures. Although endoresection is the most promising adjuvant treatment option, the endodrainage-vitrectomy is recommended in patients who are ineligible for endoresection.
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Seibel I, Cordini D, Hager A, Tillner J, Riechardt AI, Heufelder J, Davids AM, Rehak M, Joussen AM. Predictive risk factors for radiation retinopathy and optic neuropathy after proton beam therapy for uveal melanoma. Graefes Arch Clin Exp Ophthalmol 2016; 254:1787-92. [PMID: 27376824 DOI: 10.1007/s00417-016-3429-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/04/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This study was performed in order to evaluate the incidence of radiation retinopathy and optic neuropathy occurring after proton beam therapy for uveal melanoma. METHODS Included in this study were all patients who had been treated with primary proton beam therapy for uveal melanoma at the oncology service between May 1998 and June 2014 with a minimum follow-up of 12 months. Excluded were all patients who underwent re-irradiation, or vitrectomy due to exudative retinal detachment or for tumor-resection. RESULTS During this period, 1127 patients matched the inclusion criteria, of whom 768 (68.1 %) and 463 (41.0 %) developed radiation retinopathy and optic neuropathy after a median time of 18.9 months (2.0-99.84 months) and 19.8 months (0.2-170.4 months), respectively. Mean follow-up was 53.4 months (12-170.4 months). Included were 558 men (49.5 %) and 569 women (50.5 %). Mean age was 61 years (16-89 years). Visual acuity slightly decreased from initial levels of 0.3 logMAR-0.4 logMAR in patients without developing any radiation-induced complication but severely decreased to 1.0 logMAR or 1.5 logMAR in the case of developing radiation retinopathy only or optic neuropathy, respectively. Independent risk factors for radiation retinopathy were a centrally (<2.5 mm from sensitive structures) located tumor or a thick tumor located more than 2.5 mm from sensitive structures, while those for radiation optic neuropathy comprised a short distance and applied dose to the optic disk. CONCLUSION The risk for radiation retinopathy is higher in central uveal melanoma. Mid-/peripheral tumors are at high risk for radiation retinopathy and maculopathy if presenting with increased thickness.
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Affiliation(s)
- Ira Seibel
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Dino Cordini
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.,Berlin Protonen am Helmholtz-Zentrum Berlin für Materialien und Energie, Charité Universitätsmedizin Berlin, Lise-Meitner-Campus, Berlin, Germany
| | - Annette Hager
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Johanna Tillner
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Aline I Riechardt
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Jens Heufelder
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.,Berlin Protonen am Helmholtz-Zentrum Berlin für Materialien und Energie, Charité Universitätsmedizin Berlin, Lise-Meitner-Campus, Berlin, Germany
| | - Anja M Davids
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Matus Rehak
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Antonia M Joussen
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
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