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Laliscia C, Perrone F, Cresti F, Guido F, Fuentes T, Trippa C, Paiar F, Pellegrini G, Ebert FG. Iodine Plaque Brachytherapy a Customized Conservative Approach to the Management of Medium/Large-sized Uveal Melanoma. In Vivo 2024; 38:1814-1822. [PMID: 38936895 PMCID: PMC11215617 DOI: 10.21873/invivo.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/28/2024] [Accepted: 05/03/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND/AIM The objective of this study was to assess the role of iodine (125I) plaque brachytherapy in the management of uveal melanoma. PATIENTS AND METHODS This is a retrospective study of 50 patients (median age 67 years; range=33-86 years) with uveal melanoma, treated with 125I plaque brachytherapy at the University Hospital of Pisa. Uveal melanoma was diagnosed with A-scan and B-scan standardized echography, fluorescein angiography, indocyanine green-angiography, optical coherence tomography, and/or magnetic resonance imaging. The primary outcomes assessed were local control, overall survival, disease progression, globe preservation, and metastases. Secondary outcomes were acute and late radiation adverse effects. RESULTS Inclusion criteria comprised Eastern Cooperative Oncology Group performance status ≤2, life expectancy >6 months, and tumor thickness ≤10 mm and\or diameter ≤20 mm. All the patients were treated with 125I plaque brachytherapy, with a prescription dose of 85 Gy to the tumor apex. The 5-year rate of local control, progression-free survival, metastasis-free survival, enucleation-free survival, and overall survival were 83.0%, 81.4%, 90.3%, 83.1%, and 92.1% respectively. Twenty-four patients (48.0%) had one or more acute and late toxicities. The most common acute adverse events (CTCAE vs. 5.0) grade 1-3 were conjunctivitis and eye pain (6.0%). Regarding late events, radiation retinopathy grade 1-3 occurred in 18.0% of cases, while grade 1-3 vitreous hemorrhage in 2.5%. CONCLUSION 125I plaque brachytherapy offers an effective and safe approach for selected cases of uveal melanoma, due to the reported satisfactory results in terms of local control, eye conservation and survival.
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Affiliation(s)
- Concetta Laliscia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy;
| | - Franco Perrone
- Department of Medical Physics, Division of Medical Physics, University Hospital of Pisa, Pisa, Italy
| | - Federica Cresti
- Department of Ophthalmic Surgery, Division of Ophthalmic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Francesca Guido
- Department of Ophthalmic Surgery, Division of Ophthalmic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Taiusha Fuentes
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy
| | - Cecilia Trippa
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy
| | - Guglielmo Pellegrini
- Department of Ophthalmic Surgery, Division of Ophthalmic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Federica Genovesi Ebert
- Department of Ophthalmic Surgery, Division of Ophthalmic Surgery, University Hospital of Pisa, Pisa, Italy
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Ehret F, Fürweger C, Liegl R, Schmelter V, Priglinger S, Subedi G, Grimm D, Foerster P, Muacevic A, Grimm J. Tumor Control Probability and Time-Dose-Response Modeling for Stereotactic Radiosurgery of Uveal Melanoma. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00688-6. [PMID: 38838993 DOI: 10.1016/j.ijrobp.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/10/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Uveal melanoma (UM), although a rare malignancy, stands as the most prevalent intraocular malignancy in adults. Controversies persist regarding the dose dependency of local control (LC) through radiation therapy. This study sought to elucidate the significance of the prescription dose by employing time-dose-response models for patients with UM receiving photon-based stereotactic radiosurgery (SRS). METHODS AND MATERIALS The analysis included patients with UM treated between 2005 and 2019. All patients underwent single-fraction SRS. Datapoints were separated into 3 dose groups, with Kaplan-Meier analysis performed on each group, from which time-dose-response models for LC were created at 2, 4, and 7 years after SRS using maximum-likelihood fitted logistic models. RESULTS Outcomes from 594 patients with 594 UMs were used to create time-dose-response models. The prescribed doses and the number of patients were as follows: 17 to 19 Gy (24 patients), 20 Gy (122 patients), 21 Gy (442 patients), and 22 Gy (6 patients). Averaged over all patients and doses, LC rates at 2, 4, and 7 years were 94.4%, 88.2%, and 69.0%, respectively. Time-dose-response models for LC demonstrated a dose-dependent effect, showing 2-year LC rates of more than 90% with 20 Gy and 95% with 22 Gy. For 4 years and a LC of 90%, a dose of approximately 21 Gy was required. After 7 years, the 21 Gy prescription dose was predicted to maintain a LC above 70%, sharply declining to less than 60% LC with 19 Gy and less than 40% with 18 Gy. CONCLUSIONS In contrast to prior findings, the time-dose-response models for UM undergoing photon-based SRS emphasize the critical role of the prescription dose in achieving lasting LC. The dose selection must be carefully balanced against toxicity risks, considering tumor geometry and individual patient characteristics to tailor treatments accordingly.
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Affiliation(s)
- Felix Ehret
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany; European Radiosurgery Center Munich, Munich, Germany.
| | - Christoph Fürweger
- European Radiosurgery Center Munich, Munich, Germany; Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany
| | - Raffael Liegl
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Valerie Schmelter
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gopal Subedi
- Department of Radiation Oncology, Wellstar Kennestone Hospital, Marietta, Georgia
| | - David Grimm
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul Foerster
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Jimm Grimm
- Department of Radiation Oncology, Wellstar Kennestone Hospital, Marietta, Georgia
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Sokolenko EA, Flühs D, Lalos F, Meyer P, Fiorentzis M, Lindziute M, Gemmecke J, Berchner-Pfannschmidt U, Hendgen-Cotta U, Bechrakis NE, Tsimpaki T, Dubicanac M, Wißmann A, Hilken G. Wolfram-silicone implants as effective radiation shielding for ocular brachytherapy: dosimetric features and in vivo animal study on biocompatibility. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00124-8. [PMID: 38815956 DOI: 10.1016/j.jcjo.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/18/2024] [Accepted: 04/14/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To evaluate wolfram as a photon and beta absorber in the management of uveal melanoma with radiotherapy, examining its potential ocular adverse effects and physiologic tolerance using an in vivo rabbit ocular model. METHODS A method of manufacturing implants from mixtures of wolfram and silicone was developed. Their shielding effect on the radiation of sources used in ocular brachytherapy was investigated by dosimetric measurement in an eye phantom as well as numerical simulations. Different wolfram implantation techniques, such as extraocular fixation of a wolfram-silicone implant (n = 1), vitrectomy with silicone oil and intravitreal injection of a wolfram-silicone oil suspension (n = 2), and concurrent attachment of a wolfram implant onto the sclera (n = 2), were tested to investigate the long-term effects of wolfram. A vitrectomy with silicone oil without wolfram implantation was carried out in 2 rabbits (n = 2), constituting the control group. The eyes were enucleated after 3 months for histologic analysis. RESULTS Wolfram-silicone mixtures have been dosimetrically proven to be very effective radiation absorbers for use in ocular brachytherapy. Severe complications, such as endophthalmitis, secondary glaucoma, cornea decompensation, and vessel occlusion, were not documented in the tested rabbit eyes after the application of wolfram. Histologic examination of the bulbi after enucleation showed epiretinal gliosis without further pathologic findings in all eyes after vitrectomy. CONCLUSIONS The results of this study show that wolfram and wolfram-silicone implants constitute a promising candidate as potential radiation shielding substrates.
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Affiliation(s)
- Ekaterina A Sokolenko
- Institute of Ophthalmology, University Eye Hospital, Hannover Medical School, Hannover, Germany.
| | - Dirk Flühs
- Department of Radiotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fotis Lalos
- MVZ Private Clinic of Ophthalmology, Altenessen GmbH, Essen, Germany
| | - Peter Meyer
- Ophthalmology Department, University Hospital Basel, Basel, Switzerland
| | - Miltiadis Fiorentzis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Migle Lindziute
- Institute of Ophthalmology, University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Justine Gemmecke
- Department of Physics, Technical University Dortmund, Dortmund, Germany
| | | | - Ulrike Hendgen-Cotta
- West German Heart and Vascular Center, Clinic for Cardiology and Angiology, University Hospital Essen, Essen, Germany
| | - Nikolaos E Bechrakis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Theodora Tsimpaki
- Ophthalmology Department, University Hospital Basel, Basel, Switzerland
| | - Marko Dubicanac
- Central Animal Laboratory, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Wißmann
- Central Animal Laboratory, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Gero Hilken
- Central Animal Laboratory, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Arjmand M, Ghassemi F, Rafiepour P, Zeinali R, Riazi-Esfahani H, Beiki-Ardakani A. Dosimetric Investigation of Six Ru-106 Eye Plaques by EBT3 Radiochromic Films and Monte Carlo Simulation. J Biomed Phys Eng 2023; 13:309-316. [PMID: 37609514 PMCID: PMC10440413 DOI: 10.31661/jbpe.v0i0.2010-1206] [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: 10/11/2020] [Accepted: 02/10/2021] [Indexed: 08/24/2023]
Abstract
Background Ophthalmic brachytherapy using radioactive plaques is an effective technique for the treatment of uveal melanoma. Ru-106 eye plaques are considered as interesting issue due to their steep gradient dose. The pre-planning evaluation of dosimetric parameters is essential for the treatment planning system. Objective The current study aims at providing dose distributions of six Ru-106 eye plaques (CCA, CCB, CGD, CIB, COB and COD) using radiochromic EBT3 film, Geant4 Monte Carlo toolkit and the treatment planning software (Plaque Simulator). Material and Methods In this experimental study, an in-house phantom was employed for depth dose measurements with EBT3 films. Also, Geant4.10.5 scoring mesh was implemented to obtain the 2D dose distribution of the plaques. The results were compared with Plaque Simulator software and the manufacturer's (BEBIG) data. The gamma index criterion (3%/3 mm) was used to evaluate dose distributions obtained by the film measurements and Geant4 simulation. Results A good agreement was achieved between simulation and experimental results. Gamma index passing rate was 94.2%, 89.3%, 88.2%, 82.2%, 92.2% and 90.1% for CCA, CCB, CGD, CIB, COB and COD plaques, respectively. Absolute dose rate (mGy/min) obtained by EBT3 film at the depth of 2 mm was 79.4 mGy/min, 81.0 mGy/min, 78.6 mGy/min, 62.2 mGy/min, 75.2 mGy/min and 81.2 mGy/min for CCA, CCB, CGD, CIB, COB and COD plaques, respectively. Conclusion The measured dose distributions and lateral dose profiles may be utilized in the treatment planning system to cover clinical volumes such as the clinical target volume and the gross tumor volume.
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Affiliation(s)
- Mojtaba Arjmand
- Ocular Oncology service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghassemi
- Retina & Vitreous Service- Ocular Oncology Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Payman Rafiepour
- Department of Nuclear Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reyhaneh Zeinali
- Department of Medical Physics, Tabriz University of Medical Science, Tabriz, Iran
| | - Hamid Riazi-Esfahani
- Ocular Oncology service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Beiki-Ardakani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Jarczak J, Karska-Basta I, Romanowska-Dixon B. Deterioration of Visual Acuity after Brachytherapy and Proton Therapy of Uveal Melanoma, and Methods of Counteracting This Complication Based on Recent Publications. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1131. [PMID: 37374335 DOI: 10.3390/medicina59061131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. The eyeball is the most common extracutaneous location of melanoma. UM is a huge threat to a patient's life. It metastasizes distantly via blood vessels, but it can also spread locally and infiltrate extraocular structures. The treatment uses surgical methods, which include, among others, enucleation and conservative methods, such as brachytherapy (BT), proton therapy (PT), stereotactic radiotherapy (SRT), stereotactic radiosurgery (SRS), transpupillary thermotherapy (TTT) and photodynamic therapy. The key advantage of radiotherapy, which is currently used in most patients, is the preservation of the eyeball with the risk of metastasis and mortality comparable to that of enucleation. Unfortunately, radiotherapy very often leads to a significant deterioration in visual acuity (VA) as a result of radiation complications. This article is a review of the latest research on ruthenium-106 (Ru-106) brachytherapy, iodine-125 (I-125) brachytherapy and proton therapy of uveal melanoma that took into account the deterioration of eye function after therapy, and also the latest studies presenting the new concepts of modifications to the applied treatments in order to reduce radiation complications and maintain better visual acuity in treated patients.
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Affiliation(s)
- Jakub Jarczak
- Department of Ophthalmology, Division of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland
- Jagiellonian University Medical College, Doctoral School of Medical and Health Sciences, 31-530 Krakow, Poland
| | - Izabella Karska-Basta
- Department of Ophthalmology, Division of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland
| | - Bożena Romanowska-Dixon
- Department of Ophthalmology, Division of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland
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Yazici G, Kiratli H, Ozyigit G, Sari SY, Elmali A, Yilmaz MT, Koc I, Deliktas O, Gumeler E, Cengiz M, Zorlu F. Every other day stereotactic radiation therapy for the treatment of uveal melanoma decreases toxicity. Radiother Oncol 2022; 176:39-45. [PMID: 36184996 DOI: 10.1016/j.radonc.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE To report the long-term results of stereotactic radiosurgery and fractionated stereotactic radiation therapy (SRS/FSRT) in patients with uveal melanoma (UM). MATERIALS AND METHODS We retrospectively evaluated the results of patients treated between 2007 and 2019. The primary endpoints were local control (LC), local recurrence-free survival (LRFS), enucleation-free survival (EFS) and treatment toxicity. RESULTS 443 patients with 445 UMs were treated via CyberKnife®. According to the COMS classification, 70% of the tumors were small/medium and 30% were large. Median total RT dose was 54 Gy, median BED10 was 151 Gy. After a median 74-months follow-up, SRS/FSRT yielded an 83% overall LC rate. The 5- and 10-year LRFS rate was 74% and 56%, respectively. Patient age and the COMS size were prognostic for all survival endpoints. An increased SRS/FSRT dose was associated with higher LRFS and EFS rates. SRS/FSRT-related toxicity was observed in 49% of the eyes. Median visual acuity (VA) significantly deteriorated after SRS/FSRT in 76% of the treated eyes. The overall eye preservation rate was 62%, and the 5- and 10-year EFS rate was 64% and 36%, respectively. The delivery of FSRT every other day resulted in a significantly lower rate of toxicity and enucleation compared to FSRT on consecutive days. CONCLUSION A total dose of ≥45 Gy and BED10Gy ≥ 112.5 SRS/FSRT is associated with a higher LC rate in patients with UM. Despite the favorable outcomes, treatment toxicity is the major limitation of this treatment. Toxicity and enucleation can be minimized by treating the eye every other day.
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Affiliation(s)
- Gozde Yazici
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - Hayyam Kiratli
- Hacettepe University, Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey.
| | - Gokhan Ozyigit
- 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
| | - Aysenur Elmali
- Elazig Fethi Sekin City Hospital, Department of Radiation Oncology, Elazig, Turkey
| | - Melek Tugce Yilmaz
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Irem Koc
- Hacettepe University, Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ozge Deliktas
- Tunceli State Hospital, Department of Ophthalmology, Tunceli, Turkey
| | - Ekim Gumeler
- Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | - Mustafa Cengiz
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Faruk Zorlu
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
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Characteristics, Treatments, and Survival of Uveal Melanoma: A Comparison between Chinese and American Cohorts. Cancers (Basel) 2022; 14:cancers14163960. [PMID: 36010953 PMCID: PMC9406112 DOI: 10.3390/cancers14163960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/30/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary This retrospective comparative cohort study aimed to determine whether there were racial or national differences in UM, by comparing the demographic and clinical characteristics, such as tumor size, onset age, trend and proportion of treatment modalities, and overall survival. In the two cohorts, we found that Chinese patients have a younger onset age and a better survival rate. The survival advantage was likely secondary to younger onset age. In addition, a greater proportion of Chinese patients received brachytherapy as opposed to enucleation compared with American patients. This study was the first time comparing patients from different countries and races, which may help ophthalmologists better understand the clinical characteristics of the disease and suggests the importance of early diagnosis and treatment. Abstract Uveal melanoma (UM) is the most common intraocular malignant carcinoma. This study aimed to compare the clinical features, treatment modalities, and prognosis of UM patients in China with those in America over a 15-year period. In the study, 4088 American patients with primary UM from the Surveillance, Epidemiology, and End Results (SEER) database and 1508 Chinese patients from Tongren-ophthalmology Research Association of Clinical Evaluation (TRACE) were included. Univariable and multivariable analyses were performed to determine prognostic factors and propensity score matching (PSM) and sensitivity analyses were applied to adjust for confounders and identify independent prognostic factors. Chinese patients were diagnosed at a younger age (mean ± SD, 47.3 ± 12.5 years vs. 59.7 ± 14.8 years) and tumors at diagnosis were larger (diameter: 12.0 ± 3.54 mm vs. 11.3 ± 8.27 mm; thickness: 7.13 ± 3.28 mm vs. 4.91 ± 3.01 mm). Chinese patients were more likely to undergo brachytherapy than American patients. Chinese patients had better overall survival than American patients while no significant differences exhibited after adjusting for age through PSM. In conclusion, compared with American patients, Chinese patients had younger onset age, larger tumors at diagnosis and better prognosis, mainly because of their younger age.
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Kheir WJ, Stinnett SS, Meltsner S, Semenova E, Mowery YM, Craciunescu O, Kirsch DG, Materin MA. Preliminary Results of Uveal Melanoma Treated With Iodine-125 Plaques: Analysis of Disease Control and Visual Outcomes With 63 Gy to the Target Volume. Adv Radiat Oncol 2022; 7:100869. [PMID: 35387419 PMCID: PMC8977858 DOI: 10.1016/j.adro.2021.100869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/26/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Our purpose was to review the preliminary outcomes of patients with uveal melanoma treated with iodine-125 plaques using a novel treatment planning approach. Methods and Materials This was a single institution, retrospective review of patients treated with iodine-125 brachytherapy for uveal melanoma from November 2016 to February 2019. We used 3-dimensional treatment planning with the Eye Physics Plaque Simulator to ensure that a minimum of 63 Gy covered a 2-mm circumferential tumor margin and the apex height of the tumor over 94 hours. Primary endpoints were local failure, systemic metastasis, final visual acuity (VA), and radiation retinopathy. Associations between primary endpoints and tumor characteristics/radiation dose were performed using univariate analysis. Results Sixty-nine patients were included in the analysis. Mean largest basal diameter was 11.67 mm (range, 6-18; median, 12), and the average tumor thickness to the inner sclera was 3.18 mm (range, 0.5-9.3; median, 2.8). Molecular testing that was successfully performed in 59 patients revealed that 27% (16 of 59) had class 2 gene expression profile designation. Average follow-up posttreatment was 28.3 months (range, 4-46; median, 29), with 6% (4 of 69) developing local failure and 6% (4 of 69) developing metastasis over this duration. Average final VA (0.57 logMAR [Snellen 20/74]; range, 0-2.9; median, 0.3) was decreased from baseline (0.34 logMAR [Snellen 20/44]; range, 0-2.3; median, 0.1), and 48% (33 of 69) developed radiation retinopathy. Fifty percent of patients had a final VA 20/40 or better and 22% had a final VA 20/200 or worse. Conclusions In patients with uveal melanoma, preliminary results with brachytherapy using Eye Physics plaques with a treatment plan that delivers 63 Gy to a 2-mm circumferential tumor margin and the tumor apex suggest effective disease control and favorable VA outcomes.
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Affiliation(s)
| | | | | | | | | | | | - David G. Kirsch
- Radiation Oncology
- Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina
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Bolling JP, Dagan R, Rutenberg M, Mamalui-Hunter M, Buskirk SJ, Heckman MG, Hochwald AP, Slopsema R. Treatment of Uveal Melanoma With Radioactive Iodine 125 Implant Compared With Proton Beam Radiotherapy. Mayo Clin Proc Innov Qual Outcomes 2022; 6:27-36. [PMID: 35005435 PMCID: PMC8715138 DOI: 10.1016/j.mayocpiqo.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective To review the current state of radiation therapy for uveal melanoma and compare particle radiation and brachytherapy. Patients and Methods The medical records of 156 patients treated for uveal melanoma between May 30, 2012, and March 16, 2020, were retrospectively reviewed. Treatments consisted of either radioactive iodine 125 implant (RAI) or fractionated proton radiation (proton beam therapy [PBT]). Baseline characteristics were compared using a Wilcoxon rank sum test or χ2 test. Outcomes were compared using Cox proportional hazards regression models or logistic regression models. Results The median length of follow-up after treatment was 2.7 years (range, 0.5 to 9.0 years). Patients who underwent treatment with RAI were older (median age, 67 vs 59 years; P<.001) and had a lower tumor classification (American Joint Commission on Cancer; P=.001) compared with those who underwent PBT. There was no significant difference between RAI and PBT in the outcomes of liver metastases, death, enucleation, tearing, vision loss, retinal detachment, tumor thickness, conjunctivitis, optic neuropathy, iris neovascularization, or neovascular glaucoma (all P>.05). Patients who underwent RAI treatment had significantly higher risk of diplopia (P<.001), cataract progression (P<.001), and maculopathy (P=.03) compared with those who received PBT. Patients who underwent RAI were at higher risk of eyelash loss (P=.006) compared with the PBT group. Conclusion Treatment with PBT and RAI has similar efficacy; however, there are differences in the adverse outcomes associated with these 2 modalities.
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Affiliation(s)
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville
| | - Michael Rutenberg
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville
| | - Maria Mamalui-Hunter
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville
| | | | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
| | - Alexander P Hochwald
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
| | - Roelf Slopsema
- Department of Radiation Oncology, Emory University Proton Therapy Center, Winship Cancer Institute, Atlanta, GA
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Buonanno F, Conson M, de Almeida Ribeiro C, Oliviero C, Itta F, Liuzzi R, Pacelli R, Cella L, Clemente S. Local tumor control and treatment related toxicity after plaque brachytherapy for uveal melanoma: A systematic review and a data pooled analysis. Radiother Oncol 2021; 166:15-25. [PMID: 34774654 DOI: 10.1016/j.radonc.2021.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 01/02/2023]
Abstract
Uveal melanoma (UM) represents the most common primary intraocular tumor, and nowadays eye plaque brachytherapy (EPB) is the most frequently used visual acuity preservation treatment option for small to medium sized UMs. The excellent local tumor control (LTC) rate achieved by EPB may be associated with severe complications and adverse events. Several dosimetric and clinical risk factors for the development of EPB-related ocular morbidity can be identified. However, morbidity predictive models specifically developed for EPB are still scarce. PRISMA methodology was used for the present systematic review of articles indexed in PubMed in the last sixteen years on EPB treatment of UM which aims at determining the major factors affecting local tumor control and ocular morbidities. To our knowledge, for the first time in EPB field, local tumor control probability (TCP) and normal tissue complication probability (NTCP) modelling on pooled clinical outcomes were performed. The analyzed literature (103 studies including 21,263 UM patients) pointed out that Ru-106 EPB provided high local control outcomes while minimizing radiation induced complications. The use of treatment planning systems (TPS) was the most influencing factor for EPB outcomes such as metastasis occurrence, enucleation, and disease specific survival, irrespective of radioactive implant type. TCP and NTCP parameters were successfully extracted for 5-year LTC, cataract and optic neuropathy. In future studies, more consistent recordings of ocular morbidities along with accurate estimation of doses through routine use of TPS are needed to expand and improve the robustness of toxicity risk prediction in EPB.
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Affiliation(s)
- Francesca Buonanno
- University Federico II, Post Graduate School in Medical Physics, Department of Advanced Biomedical Sciences, Napoli, Italy
| | - Manuel Conson
- University Federico II, Department of Advanced Biomedical Sciences, Napoli, Italy
| | | | - Caterina Oliviero
- University Hospital Federico II, Unit of Medical Physics and Radioprotection, Napoli, Italy
| | - Francesca Itta
- University Federico II, Post Graduate School in Medical Physics, Department of Advanced Biomedical Sciences, Napoli, Italy
| | - Raffaele Liuzzi
- National Research Council (CNR), Institute of Biostructures and Bioimaging, Napoli, Italy
| | - Roberto Pacelli
- University Federico II, Department of Advanced Biomedical Sciences, Napoli, Italy
| | - Laura Cella
- National Research Council (CNR), Institute of Biostructures and Bioimaging, Napoli, Italy.
| | - Stefania Clemente
- University Hospital Federico II, Unit of Medical Physics and Radioprotection, Napoli, Italy
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11
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Torkashvand A, Riazi-Esfahani H, Ghassemi F, Khalili Pour E, Masoomian B, Zarei M, Fadakar K, Arjmand M, Tayebi F, Ekradi L, Abrishami Moghaddam H, Mahmoudi T, Daneshmand R, Faghihi H. Evaluation of radiation maculopathy after treatment of choroidal melanoma with ruthenium-106 using optical coherence tomography angiography. BMC Ophthalmol 2021; 21:385. [PMID: 34727878 PMCID: PMC8562000 DOI: 10.1186/s12886-021-02140-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/06/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To assess the impact of brachytherapy on macular microvasculature utilizing optical coherence tomography angiography (OCTA) in treated choroidal melanoma. METHODS In this retrospective observational case series, we reviewed the recorded data of the patients with unilateral extramacular choroidal melanoma treated with ruthenium - 106 (106Ru) plaque radiotherapy with a follow-up period of more than 6 months. Automatically measured OCTA retinal parameters were analysed after image processing. RESULTS Thirty-one eyes of 31 patients with the mean age of 51.1 years were recruited. Six eyes had no radiation maculopathy (RM). From 25 eyes with RM, nine eyes (36%) revealed a burnout macular microvasculature with imperceptible vascular details. Twenty-one non-irradiated fellow eyes from the enrolled patients were considered as the control group. Foveal and optic disc radiation dose had the highest value to predict the burnout pattern (ROC, AUC: 0.763, 0.727). Superficial and deep foveal avascular zone (FAZ) were larger in irradiated eyes in comparison to non-irradiated fellow eyes (1629 μm2 vs. 428 μm2, P = 0.005; 1837 μm2 vs 268 μm2, P = 0.021; respectively). Foveal and parafoveal vascular area density (VAD) and vascular skeleton density (VSD) in both superficial and deep capillary plexus (SCP and DCP) were decreased in all irradiated eyes in comparison with non-irradiated fellow eyes (P < 0.001). Compared with non-irradiated fellow eyes, irradiated eyes without RM had significantly lower VAD and VSD at foveal and parafoveal DCP (all P < 0.02). However, these differences at SCP were not statistically significant. CONCLUSION The OCTA is a valuable tool for evaluating RM. Initial subclinical microvascular insult after 106Ru brachytherapy is more likely to occur in DCP. The deep FAZ area was identified as a more critical biomarker of BCVA than superficial FAZ in these patients.
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Affiliation(s)
- Ali Torkashvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Ocular Oncology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran. .,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. .,Ocular Oncology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elias Khalili Pour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Masoomian
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Fadakar
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Arjmand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Tayebi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Ekradi
- Machine Vision and Medical Image Processing (MVMIP) Lab, Faculty of Electrical Engineering, K.N. Toosi University of Technology, Tehran, Iran
| | - Hamid Abrishami Moghaddam
- Machine Vision and Medical Image Processing (MVMIP) Lab, Faculty of Electrical Engineering, K.N. Toosi University of Technology, Tehran, Iran
| | - Tahereh Mahmoudi
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences and Research Center for Science and Technology in Medicine, Tehran, Iran
| | - Reihaneh Daneshmand
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Hooshang Faghihi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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12
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Hassan MK, Fleury E, Shamonin D, Fonk LG, Marinkovic M, Jaarsma-Coes MG, Luyten GP, Webb A, Beenakker JW, Stoel B. An Automatic Framework to Create Patient-specific Eye Models From 3D Magnetic Resonance Images for Treatment Selection in Patients With Uveal Melanoma. Adv Radiat Oncol 2021; 6:100697. [PMID: 34660938 PMCID: PMC8503565 DOI: 10.1016/j.adro.2021.100697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/26/2020] [Accepted: 03/25/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The optimal treatment strategy for uveal melanoma (UM) relies on many factors, the most important being tumor size and location. Building on recent developments in high-resolution 3D ocular magnetic resonance imaging (MRI), we developed an automatic image-processing framework to create patient-specific eye models and to subsequently determine the full 3D tumor shape and size automatically. METHODS AND MATERIALS From 15 patients with UM, 3D inversion-recovery gradient-echo (T1-weighted) and 3D fat-suppressed spin-echo (T2-weighted) images were acquired with a 7T MRI scanner. First, the sclera and cornea were segmented from the T2-weighted image by mesh-fitting. The T1- and T2-weighted images were then coregistered. From the registered T1-weighted image, the lens, vitreous body, retinal detachment, and tumor were segmented. Fuzzy C-means clustering was used to differentiate the tumor from retinal detachments. The tumor model was verified and (if needed) edited by an ophthalmic MRI specialist. Subsequently, the prominence and largest basal diameter of the tumor were measured automatically based on the verified contours. These results were compared with manual assessments on the original images and with ultrasound measurements to show the errors in manual analysis. RESULTS The framework successfully created an eye model fully automatically in 12 cases. In these cases, a Dice similarity coefficient (mean surface distance) of 97.7%±0.84% (0.17±0.11 mm) was achieved for the sclera, 96.8%±1.05% (0.20±0.06 mm) for the vitreous body, 91.6%±4.83% (0.15±0.06 mm) for the lens, and 86.0%±7.4% (0.35±0.27 mm) for the tumor. The manual assessments deviated, on average, 0.39±0.31 mm in prominence and 1.7±1.22 mm in basal diameter from the automatic measurements. CONCLUSIONS The described framework combined information from T1- and T2-weighted images to accurately determine tumor boundaries in 3D. The proposed process may have a direct effect on clinical workflow, as it enables an accurate 3D assessment of tumor dimensions, which directly influences therapy selection.
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Affiliation(s)
| | - Emmanuelle Fleury
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiation Oncology, HollandPTC, Delft, The Netherlands
| | - Denis Shamonin
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lorna Grech Fonk
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Myriam G. Jaarsma-Coes
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gregorius P.M. Luyten
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew Webb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan-Willem Beenakker
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berend Stoel
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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13
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Qu Z, Liu J, Zhu L, Zhou Q. A Comprehensive Understanding of Choroidal Metastasis from Lung Cancer. Onco Targets Ther 2021; 14:4451-4465. [PMID: 34408441 PMCID: PMC8367201 DOI: 10.2147/ott.s315532] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/27/2021] [Indexed: 02/05/2023] Open
Abstract
The incidence of lung cancer with intraocular metastasis is low, of which choroidal metastasis is the most painful metastatic lesion. The clinical symptoms resulting from choroidal metastasis from lung cancer easily detected although they are rarely identified prior to the diagnosis of the primary malignancy. The quality of life of patients is inevitably impaired. Some lung cancer patients complain of ocular symptoms as the first manifestation of lung cancer. Early diagnosis and treatment can significantly overcome or delay the visual impairment and improve prognosis. The main therapeutic modalities include systemic and local treatments, while observation is also a treatment option. Currently, the feasibility and effectiveness of various treatment options are controversial worldwide. Herein, we summarize the underlying mechanisms, epidemiology, clinical features, auxiliary examinations, diagnosis, and recent treatment options for intraocular metastases.
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Affiliation(s)
- Zihan Qu
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiewei Liu
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lingling Zhu
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
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14
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Bechrakis NE, Bornfeld N, Heindl LM, Skoetz N, Leyvraz S, Joussen AM. Uveal Melanoma - Standardised Procedure in Diagnosis, Therapy and Surveillance. Klin Monbl Augenheilkd 2021; 238:761-772. [PMID: 34376006 DOI: 10.1055/a-1534-0198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Uveal melanoma is a rare intraocular tumour, for which there is currently no national evidence-based guideline in Germany. The aim of this project was to provide a common standard operating procedure (SOP) for the diagnosis, treatment and follow-up care of uveal melanoma, within the network of German leading oncology centres funded by German Cancer Aid. The SOP was created as part of a moderated consensus process. RESULTS AND CONCLUSION In a multistage process, a common SOP was developed for the diagnosis, therapy and follow-up of uveal melanoma, as based on current knowledge of the subject.
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Affiliation(s)
| | - Norbert Bornfeld
- Zentrum für Erkrankungen des hinteren Augenabschnitts, Universitätsklinikum Essen, Deutschland
| | - Ludwig M Heindl
- Klinik und Poliklinik für Augenheilkunde, Uniklinik Köln, Deutschland
| | - Nicole Skoetz
- Centrum für integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Medizinische Fakultät und Uniklinik Köln, Deutschland
| | - Serge Leyvraz
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Deutschland
| | - Antonia M Joussen
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Deutschland
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15
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Domínguez-Varela IA, Ancona-Lezama DA, Dalvin LA, Pérez-Ramos EE. Choroidal melanoma treatment in times of coronavirus disease 2019. Melanoma Res 2021; 31:194-195. [PMID: 33625101 DOI: 10.1097/cmr.0000000000000718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Irving A Domínguez-Varela
- Ocular Oncology Service, Institute of Ophthalmology and Visual Sciences/Tecnologico de Monterrey/Hospital Zambrano-Hellion, Monterrey, Nuevo Leon, Mexico
| | - David A Ancona-Lezama
- Ocular Oncology Service, Institute of Ophthalmology and Visual Sciences/Tecnologico de Monterrey/Hospital Zambrano-Hellion, Monterrey, Nuevo Leon, Mexico
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Erik E Pérez-Ramos
- Radiation Oncology Service, Tecnologico de Monterrey/Hospital Zambrano-Hellion, Monterrey, Nuevo Leon, Mexico
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16
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Parker T, Rigney G, Kallos J, Stefko ST, Kano H, Niranjan A, Green AL, Aziz T, Rath P, Lunsford LD. Gamma knife radiosurgery for uveal melanomas and metastases: a systematic review and meta-analysis. Lancet Oncol 2020; 21:1526-1536. [PMID: 33152286 DOI: 10.1016/s1470-2045(20)30459-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/29/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gamma knife radiosurgery is regarded as the gold-standard stereotactic radiosurgery modality for the treatment of intracranial tumours, and its use has been expanded for the treatment of intraocular malignancies. The aim of this study was to systematically evaluate the efficacy, outcomes, and complications of gamma knife radiosurgery for uveal melanomas and metastases. METHODS We did a systematic review and meta-analysis to aggregate the clinical outcomes of patients with uveal melanomas or intraocular metastases treated primarily with gamma knife radiosurgery. We searched MEDLINE and Embase for studies published between Sept 1, 1960, and Feb 1, 2020, reporting the use of gamma knife radiosurgery as primary treatment for uveal melanoma or uveal metastases. The search was restricted to clinical studies and relevant grey literature published in English. Studies reporting treatment of benign tumours, extraocular tumours, or other forms of stereotactic radiosurgery were excluded to reduce heterogeneity. No restrictions were placed on participant criteria. Local tumour control and tumour regression were extracted as the primary outcomes and analysed via a random-effects meta-analysis of proportions using the DerSimonian and Laird method with a Freeman-Tukey double arcsine transformation. This study is registered with PROSPERO, CRD42019148165. FINDINGS Our search returned 454 studies, of which 109 were assessed for full-text eligibility. 52 studies, reporting on 1010 patients with uveal melanoma and 34 intraocular metastases, were eligible for systematic review. 28 studies were included in the meta-analysis. 840 of 898 patients (0·96, 95% CI 0·94-0·97; I2=16%) from 19 studies had local control, and 378 of 478 patients (0·81, 0·70-0·90; I2=83%) from 16 studies experienced tumour regression. INTERPRETATION Gamma knife radiosurgery is an efficacious primary method of treating uveal melanomas and intraocular metastases, with reliable tumour control rates. Randomised controlled trials should further evaluate the safety and efficacy of gamma knife radiosurgery in this setting. FUNDING The Rhodes Trust and the Howard Brain Sciences Foundation.
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Affiliation(s)
- Tariq Parker
- Nuffield Department of Surgery, University of Oxford, Oxford, UK.
| | - Grant Rigney
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Justiss Kallos
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - S Tonya Stefko
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hideyuki Kano
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ajay Niranjan
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Tipu Aziz
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Pamela Rath
- Everett and Hurite Ophthalmic Association, Pittsburgh, PA, USA
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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17
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Systematic Review and Meta-Analysis on the Use of Photon-based Stereotactic Radiosurgery Versus Fractionated Stereotactic Radiotherapy for the Treatment of Uveal Melanoma. Am J Clin Oncol 2020; 44:32-42. [DOI: 10.1097/coc.0000000000000775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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18
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Yupari RJ, Bena J, Wilkinson A, Suh J, Singh A. Small choroidal melanoma: outcomes following apical height dose brachytherapy. Br J Ophthalmol 2020; 105:1161-1165. [DOI: 10.1136/bjophthalmol-2020-316873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 12/19/2022]
Abstract
AimTo assess the outcomes of small choroidal melanoma following iodine-125 episcleral brachytherapy (apical height dose of 85 Gy).MethodsPatients with small choroidal melanoma that underwent iodine-125 episcleral brachytherapy between January 2004 and December 2017 were reviewed. Inclusion criterion for this study was the COMS small tumour size (tumour apical height of 1.0–2.5 mm and largest basal diameter (LBD) <16.0 mm). Patients that received any form of prior therapy or adjuvant transpupillary thermotherapy were excluded. Outcome measures were visual acuity (VA), recurrence, ocular survival and metastasis at 3 years. Kaplan-Meier estimation was calculated for VA, recurrence, ocular survival and survival outcome (overall and metastasis-free survival rate) at 3 years.Results161 cases of choroidal melanoma were included in this study, with the mean (SD) age of 59.6 (14.1) years, and 93 (58%) were males. The mean (SD) apical height for the tumours were 2.1 (0.4) mm and mean (SD) LBD was 8.3 (2.2) mm. The mean (SD, median) follow-up was 40.7 months (37.1, 25 months). The VA was 20/50 or better in 69%. Only one recurrence event (1%) and one enucleation event (1%) were observed. Overall survival was 97%, and no metastatic events were observed at 3 years.ConclusionSmall choroidal melanomas treated with iodine-125 episcleral brachytherapy have excellent outcomes. The majority (69%) of patients retained VA of 20/50 or better with very high local control and ocular survival rate (99.3%) with the absence of metastasis (100%).
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19
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Sayan M, Mamidanna S, Oncel D, Jan I, Vergalasova I, Weiner J, Ohri N, Acikalin B, Chundury A. Clinical management of uveal melanoma: a comprehensive review with a treatment algorithm. Radiat Oncol J 2020; 38:162-169. [PMID: 33012143 PMCID: PMC7533402 DOI: 10.3857/roj.2020.00318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/19/2020] [Indexed: 12/12/2022] Open
Abstract
Uveal melanoma (UM), the most frequently occurring non-cutaneous melanoma and most common primary intraocular malignancy in adults, arises from the melanocytes of the choroid in approximately 95% of cases. Prompt diagnosis and treatment is vital as primary tumor size is one of the key factors associated with survival. Despite recent advances in management, more than half of the patients develop metastatic disease which portends poor survival. Currently, treatment options for UM include local resection, enucleation, plaque brachytherapy, and/or particle beam radiotherapy (RT). Enucleation was initially the standard of care in the management of UM, but a shift towards eye-preserving therapeutic choices such as RT and local resection has been noted in recent decades. Plaque brachytherapy, a form of localized RT, is the most popular option and is now the preferred treatment modality for a majority of UM cases. In this review we discuss the etiopathogenesis, clinical presentation and diagnosis of UM and place a special emphasis on its therapeutic options. Furthermore, we review the current literature on UM management and propose a functional treatment algorithm for non-metastatic disease.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Swati Mamidanna
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Damla Oncel
- Department of Biochemistry, University of California, Los Angeles, CA, USA
| | - Imraan Jan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Irina Vergalasova
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Joseph Weiner
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Nisha Ohri
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Banu Acikalin
- Department of Ophthalmology, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Anupama Chundury
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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20
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Filì M, Trocme E, Herrspiegel C, Seregard S, Stålhammar G. Effect of plaque brachytherapy dose and dose rate on risk for disease-related mortality in 1238 patients with choroidal melanoma. Br J Ophthalmol 2020; 105:57-62. [PMID: 32430342 DOI: 10.1136/bjophthalmol-2019-315722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/17/2020] [Accepted: 03/11/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Episcleral brachytherapy is the most common treatment for medium-sized choroidal melanomas. Although controversial, inadequate brachytherapy dose and dose rates have at least a hypothetical implication on patient survival. METHODS All patients who received ruthenium-106 or iodine-125 brachytherapy for choroidal melanoma at St. Erik Eye Hospital 1996 to 2016 were included (n=1238). Cox regression hazard ratios for melanoma-related mortality across deciles, quartiles and individual integers of apex radiation doses (Gy) and dose rates (Gy/hour) were calculated, adjusted for tumour size and location. RESULTS The average radiation dose at the tumour apex ranged from 73.0 Gy in the first decile to 108.6 Gy in the tenth. Decreasing apex dose by 1 Gy increments or by decile or quartile group was not associated with melanoma-related mortality (p>0.2) The average radiation dose rate at the tumour apex ranged from 0.5 Gy/hour in the first decile to 2.8 Gy/hour in the tenth. Similarly, decreasing apex dose rate by 1 Gy/hour increments or by decile or quartile groups was not associated with melanoma-related mortality (p>0.5). CONCLUSION There are no increased hazards for choroidal melanoma-related mortality after brachytherapy with decreasing doses between 108.6 and 73.0 Gy, or with decreasing dose rates between 2.8 and 0.5 Gy/hour.
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Affiliation(s)
- Maria Filì
- St. Erik Eye Hospital, Stockholm, Sweden .,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eric Trocme
- St. Erik Eye Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Christina Herrspiegel
- St. Erik Eye Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Seregard
- St. Erik Eye Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Stålhammar
- St. Erik Eye Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Kowal J, Markiewicz A, Dębicka-Kumela M, Bogdali A, Jakubowska B, Karska-Basta I, Romanowska-Dixon B. Analysis of local recurrence causes in uveal melanoma patients treated with 125I brachytherapy - a single institution study. J Contemp Brachytherapy 2019; 11:554-562. [PMID: 31969914 PMCID: PMC6964341 DOI: 10.5114/jcb.2019.90985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/30/2019] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To perform a retrospective analysis of factors which might affect the occurrence of a relapse of uveal melanoma after 125I brachytherapy. MATERIAL AND METHODS The analysis concerned 343 patients treated in the years 2001-2012. The effect on local recurrence of such factors as patient's sex, age, tumour size, shape, pigmentation, location, presence of orange pigment or petechiae on tumour surface, retinal detachment, and blood or dispersed pigment in vitreous body were studied. Additional analysis concerned physical properties of brachytherapy (total dose, irradiation dose applied to tumour apex and base and irradiation time). Two groups of patients were distinguished: with and without a relapse. The diagnostic criterion for the relapse was growth of the tumour base or height by 0.5 mm. RESULTS Local recurrence of the uveal melanoma was observed in 29 patients (8.5%). Recurrences occurred with significantly higher frequency (p < 0.001), when the anterior tumour edge involved the ciliary body. Patients' survival in relation to the moment the occurrence of the relapse was statistically significant for application time (p = 0.004) and tumour pigmentation (p = 0.010). The deaths of patients with a local relapse were most rare when brachytherapy lasted from 72 to 95.9 hours and most frequent in cases of brownish tumour pigmentation. Patient sex, tumour shape and size, presence of orange pigment, retinal detachment, petechiae and bleeding to vitreous body as well as the dose of irradiation to tumour top and base did not have any significant effect on relapse occurrence. CONCLUSIONS Treatment of uveal melanomas with 125I applicators allows for a high rate of positive local results. Nonetheless, the recurrence probability always exists. The involvement of the ciliary body could influence this. The survival depending on the time of relapse could be statistically significant for application time and dark-brown tumour pigmentation.
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Affiliation(s)
- Joanna Kowal
- Department of Ophthalmology and Ocular Oncology of the Jagiellonian University, Medical College, Kraków, Poland
- Department of Ophthalmology and Ocular Oncology of University Hospital, Kraków, Poland
| | - Anna Markiewicz
- Department of Ophthalmology and Ocular Oncology of the Jagiellonian University, Medical College, Kraków, Poland
- Department of Ophthalmology and Ocular Oncology of University Hospital, Kraków, Poland
| | - Magdalena Dębicka-Kumela
- Department of Ophthalmology and Ocular Oncology of the Jagiellonian University, Medical College, Kraków, Poland
- Department of Ophthalmology and Ocular Oncology of University Hospital, Kraków, Poland
| | - Anna Bogdali
- Department of Ophthalmology and Ocular Oncology of the Jagiellonian University, Medical College, Kraków, Poland
- Department of Ophthalmology and Ocular Oncology of University Hospital, Kraków, Poland
| | - Barbara Jakubowska
- Department of Ophthalmology and Ocular Oncology of University Hospital, Kraków, Poland
| | - Izabella Karska-Basta
- Department of Ophthalmology and Ocular Oncology of the Jagiellonian University, Medical College, Kraków, Poland
- Department of Ophthalmology and Ocular Oncology of University Hospital, Kraków, Poland
| | - Bożena Romanowska-Dixon
- Department of Ophthalmology and Ocular Oncology of the Jagiellonian University, Medical College, Kraków, Poland
- Department of Ophthalmology and Ocular Oncology of University Hospital, Kraków, Poland
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Abstract
Abstract
The halogens bromine and iodine have similar chemical properties and undergo similar reactions due to their closeness in Group 17 of the periodic chart. There are a number of bromine and iodine radionuclides that have properties useful for diagnosis and therapy of human diseases. The emission properties of radiobromine and radioiodine nuclides with half-lives longer than 1 h are summarized along with properties that make radionuclides useful in PET/SPECT imaging and β/Auger therapy, such that the reader can assess which of the radionuclides might be useful for medical applications. An overview of chemical approaches that have been used to radiolabel molecules with radiobromine and radioiodine nuclides is provided with examples. Further, references to a large variety of different organ/cancer-targeting agents utilizing the radiolabeling approaches described are provided.
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Affiliation(s)
- D. Scott Wilbur
- Department of Radiation Oncology, Box 355016 , University of Washington , 616 N.E. Northlake Place , Seattle, WA 98105 , USA
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23
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Markiewicz A, Brożyna AA, Podgórska E, Elas M, Urbańska K, Jetten AM, Slominski AT, Jóźwicki W, Orłowska-Heitzman J, Dyduch G, Romanowska-Dixon B. Vitamin D receptors (VDR), hydroxylases CYP27B1 and CYP24A1 and retinoid-related orphan receptors (ROR) level in human uveal tract and ocular melanoma with different melanization levels. Sci Rep 2019; 9:9142. [PMID: 31235702 PMCID: PMC6591242 DOI: 10.1038/s41598-019-45161-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/23/2019] [Indexed: 12/27/2022] Open
Abstract
In recent years, a significant number of studies have investigated the preventive role of vitamin D in a number of different neoplasms. In this study, we analyze various components of the vitamin D signaling pathways in the human uveal tract and uveal melanoma, including analysis of the expression of vitamin D receptors (VDR), the activating and inactivating hydroxylases, respectively, CYP27B1 and CYP24A1, and the retinoic acid-related orphan receptors (ROR) α (RORα) and γ (RORγ) in these tissues. We further analyzed the expression of VDR, CYP27B1, CYP24A1, and ROR in relation to melanin levels, clinical stage and prognosis. Our study indicated that the uveal melanoma melanin level inversely correlated with VDR expression. We further showed that vitamin D is metabolized in uveal melanoma. This is significant because until now there has been no paper published, that would describe presence of VDR, hydroxylases CYP27B1 and CYP24A1, and RORα and RORγ in the human uveal tract and uveal melanomas. The outcomes of our research can contribute to the development of new diagnostic and therapeutic methods in uveal tract disorders, especially in uveal melanoma. The presented associations between vitamin D signaling elements and uveal melanoma in comparison to uveal tract encourage future clinical research with larger patients' population.
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Affiliation(s)
- Anna Markiewicz
- Department of Ophthalmology and Ocular Oncology, Medical College, Jagiellonian University in Kraków, 31-501, Kraków, Poland.
| | - Anna A Brożyna
- Department of Human Biology, Faculty of Biology and Environmental Protection, Nicolaus Copernicus University, 87-100, Toruń, Poland
| | - Ewa Podgórska
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007, Kraków, Poland
| | - Martyna Elas
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007, Kraków, Poland
| | - Krystyna Urbańska
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007, Kraków, Poland
| | - Anton M Jetten
- Cell Biology Section, Immunity, Inflammation, and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, 27709, USA
| | - Andrzej T Slominski
- Department of Dermatology, Comprehensive Cancer Center, Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
- VA Medical Center, Birmingham, AL, 35294, USA
| | - Wojciech Jóźwicki
- Department of Tumor Pathology and Pathomorphology, Oncology Centre - Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
- Department of Tumor Pathology and Pathomorphology, Faculty of Health Sciences, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, 85-796, Bydgoszcz, Poland
| | - Jolanta Orłowska-Heitzman
- Clinical and Experimental Pathomorphology, Jagiellonian University, Medical College, 31-531, Kraków, Poland
| | - Grzegorz Dyduch
- Clinical and Experimental Pathomorphology, Jagiellonian University, Medical College, 31-531, Kraków, Poland
| | - Bożena Romanowska-Dixon
- Department of Ophthalmology and Ocular Oncology, Medical College, Jagiellonian University in Kraków, 31-501, Kraków, Poland
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24
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Filì M, Trocme E, Bergman L, See TRO, André H, Bartuma K, Girnita L, All-Eriksson C, Seregard S, Stålhammar G. Ruthenium-106 versus iodine-125 plaque brachytherapy of 571 choroidal melanomas with a thickness of ≥5.5 mm. Br J Ophthalmol 2019; 104:26-32. [DOI: 10.1136/bjophthalmol-2018-313419] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/08/2019] [Accepted: 03/05/2019] [Indexed: 02/03/2023]
Abstract
BackgroundEpiscleral brachytherapy is the most common eye-preserving treatment for medium-sized choroidal melanomas. γ-emitting iodine-125 (125I) and β-emitting ruthenium-106 (106Ru) are widely used. The latter is however generally reserved for thinner tumours (<6 mm). In this study, we compare ocular and patient survival in thicker tumours treated with the respective radioisotope.MethodsAll patients with ≥5.5 mm thick choroidal melanomas who were treated with plaque brachytherapy at a single institution between 1 November 1979 and 31 December 2015 were included (n=571). Size-controlled Cox regression HRs for postbrachytherapy enucleation, repeated brachytherapy and melanoma-related mortality were calculated, as well as Kaplan-Meier disease-specific survival and relative 10-year survival in matched subgroups.Results317 patients were treated with 106Ru and 254 with 125I. The rate of repeated brachytherapy was significantly higher among patients treated with 106Ru (8%) than with 125I (1%, p<0.001). Size-controlled Cox regression HRs for postbrachytherapy enucleation (125I vs 106Ru 0.7, p=0.083) and melanoma-related mortality were not significant (125I vs 106Ru 1.1, p=0.63). Similarly, Kaplan-Meier disease-specific and relative 10-year survival was comparable in matched groups of 5.5–7.4 mm (relative survival 106Ru 59%, 125I 56%) and ≥7.5 mm thick tumours (relative survival 106Ru 46%, 125I 44%).ConclusionsRates of repeated brachytherapy were significantly higher among patients treated with 106Ru versus 125I for thick choroidal melanomas. There were, however, no significant differences in rates of enucleation or patient survival.
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Ramos MS, Echegaray JJ, Kuhn-Asif S, Wilkinson A, Yuan A, Singh AD, Browne AW. Animal models of radiation retinopathy - From teletherapy to brachytherapy. Exp Eye Res 2019; 181:240-251. [PMID: 30716328 DOI: 10.1016/j.exer.2019.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/09/2019] [Accepted: 01/30/2019] [Indexed: 12/20/2022]
Abstract
Radiation retinopathy is a serious vision-impairing complication of radiation therapy used to treat ocular tumors. Characterized by retinal vasculopathy and subsequent retinal damage, the first sign of radiation retinopathy is the preferential loss of vascular endothelial cells. Ensuing ischemia leads to retinal degradation and late stage neovascularization. Despite the established disease progression, the pathophysiology and cellular mechanisms contributing to radiation retinopathy remain unclear. Clinical experience and basic research for other retinal vasculopathies, such as diabetic retinopathy and retinopathy of prematurity, can inform our understanding of radiation retinopathy; however, the literature investigating the fundamental mechanisms in radiation retinopathy is limited. Treatment trials have shown modest success but, ultimately, fail to address the cellular events that initiate radiation retinopathy. Animal models of radiation retinopathy could provide means to identify effective therapies. Here, we review the literature for all animal models of radiation retinopathy, summarize anatomical highlights pertaining to animal models, identify additional physiological factors to consider when investigating radiation retinopathy, and explore the use of clinically relevant tests for studying in vivo models of radiation retinopathy. We encourage further investigation into the mechanistic characterization of radiation retinopathy in the hope of discovering novel treatments.
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Affiliation(s)
- Michael S Ramos
- Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44131, USA
| | - Jose J Echegaray
- Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44131, USA
| | - Sonia Kuhn-Asif
- Animal Eye Center, 2864 Acton Road, Birmingham, AL, 35243, UK
| | - Allan Wilkinson
- Taussig Cancer Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44131, USA
| | - Alex Yuan
- Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44131, USA
| | - Arun D Singh
- Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44131, USA
| | - Andrew W Browne
- Gavin Herbert Eye Institute, 850 Health Sciences Road, Irvine, CA, 92697, USA.
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26
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Outcomes of I-125 brachytherapy for uveal melanomas depending on irradiation dose applied to the tumor apex - a single institution study. J Contemp Brachytherapy 2018; 10:532-541. [PMID: 30662476 PMCID: PMC6335559 DOI: 10.5114/jcb.2018.79886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/08/2018] [Indexed: 12/28/2022] Open
Abstract
Purpose The aim of the study was an evaluation of I-125 brachytherapy patients with uveal melanoma with special consideration for the relationship of the treatment results and the irradiation dose applied to the tumor apex. Material and methods Medical records of 344 adults with uveal melanoma treated with I-125 brachytherapy in the Department of Ophthalmology and Ocular Oncology of the Jagiellonian University, Medical College in Cracow, Poland were retrospectively analyzed. The study was conducted between 2003 and 2012, and the study group was divided into two subgroups depending on the irradiation dose applied to the top of the tumor: 80 Gy to 100 Gy (n = 177) and 100 Gy to 120 Gy (n = 167). Results It was found that the height of the tumor and the largest diameter of the tumor base decreased with every consecutive follow-up measurement and differed significantly in all comparisons (p < 0.0001). No significant correlation between frequency of complications was found between both study groups (χ2 = 0.27; p = 0.6067). The correlation between survival and the irradiation dose as applied to the tumor top was statistically irrelevant (χ2 = 0.44; p = 0.5084). A logistic regression model showed that patient survival depended on the largest diameter of the base and the height of tumor (p = 0.0216), and the risk of death was larger as these dimensions increased (IR, 1.17). An increase of the largest diameter of the base by 1 mm meant a 17% increase in chances of death. In 13.4% of cases, an enucleation was necessary. Conclusions The treatment of choroidal melanomas with I-125 iodine isotope brachytherapy is an efficient and recommended method of treatment and in many cases, an alternative to the enucleation of an eyeball.
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Mathis T, Jardel P, Loria O, Delaunay B, Nguyen AM, Lanza F, Mosci C, Caujolle JP, Kodjikian L, Thariat J. New concepts in the diagnosis and management of choroidal metastases. Prog Retin Eye Res 2018; 68:144-176. [PMID: 30240895 DOI: 10.1016/j.preteyeres.2018.09.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 12/17/2022]
Abstract
The most frequent site of ocular metastasis is the choroid. The occurrence of choroidal metastases has increased steadily due to the longer survival of metastatic patients and the improvement of diagnostic tools. Fundoscopy, ultrasonography, and fluorescein angiography are now complemented by indocyanine green angiography and optical coherence tomography. Choroidal tumor biopsy may also confirm the metastatic nature of the tumor and help to determine the site of the primary malignancy. There is currently no consensus on the treatment strategy. Most patients have a limited life expectancy and for these complex treatments are generally not recommended. However, recent advances in systemic therapy have significantly improved survival of certain patients who may benefit from an aggressive ocular approach that could preserve vision. Although external beam radiation therapy is the most widely used treatment, more advanced forms of radiotherapy that are associated with fewer side effects can be proposed in select cases. In patients with a shorter life expectancy, systemic therapies such as those targeting oncogenic drivers, or immunotherapy can induce a regression of the choroidal metastases, and may be sufficient to temporarily decrease visual symptoms. However, they often acquire resistance to systemic treatment and ocular relapse usually requires radiotherapy for durable control. Less invasive office-based treatments, such as photodynamic therapy and intravitreal injection of anti-VEGF, may also help to preserve vision while reducing time spent in medical settings for patients in palliative care. The aim of this review is to summarize the current knowledge on choroidal metastases, with emphasis on the most recent findings in epidemiology, pathogenesis, diagnosis and treatment.
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Affiliation(s)
- Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Pauline Jardel
- Department of Radiation Oncology, Chicoutimi Hospital, Saguenay, QC, Canada
| | - Olivier Loria
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Benoit Delaunay
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Anh-Minh Nguyen
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Francesco Lanza
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | - Carlo Mosci
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Juliette Thariat
- Department of Radiation Therapy, Centre François Baclesse - ARCHADE, Unicaen - Normandie University, 14000, Caen, France.
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Le BHA, Kim JW, Deng H, Rayess N, Jennelle RL, Zhou SY, Astrahan MA, Berry JL. Outcomes of choroidal melanomas treated with eye physics plaques: A 25-year review. Brachytherapy 2018; 17:981-989. [PMID: 30082188 DOI: 10.1016/j.brachy.2018.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To review long-term outcomes of the University of Southern California Plaque Simulator (PS) software and Eye Physics (EP) plaques. We hypothesize that the PS/EP system delivers lower doses to critical ocular structures, resulting in lower rates of radiation toxicity and favorable visual outcomes compared to Collaborative Ocular Melanoma Study plaques, while maintaining adequate local tumor control. METHODS AND MATERIALS Retrospective review of 133 patients treated for choroidal melanoma with 125I brachytherapy, using PS software and EP plaques, from 1990 through 2015. A dose of 85 Gy at a rate of 0.6 Gy/h was prescribed to the tumor apex (with a typical margin of 2 mm) over 7 days. Primary outcomes were local tumor recurrence, globe salvage, and metastasis. Secondary outcomes were changes in visual acuity and radiation complications. RESULTS With median followup of 42 months, 5-year Kaplan-Meier estimated rates for tumor control, globe salvage, and metastatic-free survival were 98.3%, 96.4%, and 88.2%, respectively. Median doses to the macula and optic nerve were 39.9 Gy and 30.0 Gy, respectively. Forty-three percent of patients developed radiation retinopathy, and 20% developed optic neuropathy; 39% lost ≥6 Snellen lines of vision. CONCLUSIONS The PS/EP system is designed to improve the accuracy and conformality of the radiation dose, creating a steep dose gradient outside the melanoma to decrease radiation to surrounding ocular structures. We report favorable rates of local tumor control, globe salvage, metastases, and radiation complications when compared to the Collaborative Ocular Melanoma Study and other studies. Overall, the PS/EP system results in excellent tumor control and appears to optimize long-term visual and radiation-related outcomes after brachytherapy.
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Affiliation(s)
- Bao Han A Le
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA; John A. Burns School of Medicine at the University of Hawaii, Honolulu, HI
| | - Jonathan W Kim
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA; The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA
| | - Hao Deng
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Nadim Rayess
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Richard L Jennelle
- Department of Radiation Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Sue Y Zhou
- Department of Radiation Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Melvin A Astrahan
- Department of Radiation Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Jesse L Berry
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA; The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA.
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29
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Plaque brachytherapy for posterior uveal melanoma in 2018: improved techniques and expanded indications. Curr Opin Ophthalmol 2018. [PMID: 29538180 DOI: 10.1097/icu.0000000000000468] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Plaque brachytherapy remains the dominant globe-sparing therapy of uveal melanoma. This report highlights recent advances, which have expanded plaque brachytherapy's uses as well as improved the surgical technique. RECENT FINDINGS Plaque brachytherapy is effective for tumors that may previously have demanded enucleation. Plaque brachytherapy can be used to control large melanomas as well as melanomas touching the optic nerve. Improvements in planning and design have made plaque therapy simpler for the surgical operator and may reduce collateral radiation damage to normal ocular structures. The COMS implies a required dose of 85 Gy to the tumor apex for treatment of uveal melanoma. However, multiple reports indicate that lower doses may be equally effective for tumor control while reducing radiation dose to uninvolved structures. Vitreoretinal surgeons can be called upon safely to treat long-term side effects of radiation or tumor death such as intractable vitreous hemorrhage or inflammation. Further, vitreoretinal surgeons have employed tumor endoresection as primary local tumor control or in combination with plaque brachytherapy. SUMMARY Plaque brachytherapy for uveal melanoma remains highly effective for local tumor control and prevention of metastasis. Indications for plaque brachytherapy have expanded, and the technique has improved.
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