1
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Tseng YH, Hsu CA, Chou YB. Comparing efficacy of charged-particle therapy with brachytherapy in treatment of uveal melanoma. Eye (Lond) 2024; 38:1882-1890. [PMID: 38565600 PMCID: PMC11226678 DOI: 10.1038/s41433-024-03035-y] [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: 08/13/2023] [Revised: 02/08/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Uveal melanoma (UM) is the most common primary ocular tumour in adults. The most used eye-preserving treatments are charged-particle therapy (CPT) and brachytherapy. We performed a systematic review and meta-analysis to compare efficacies and complications of these two radiotherapies. METHODS We searched EMBASE, PubMed, MEDLINE, and the Cochrane Library from January 2012 to December 2022. Two independent reviewers identified controlled studies comparing outcomes of CPT versus brachytherapy. Case series that utilize either treatment modality were also reviewed. RESULTS One hundred fifty studies met the eligibility criteria, including 2 randomized control trials, 5 controlled cohort studies, and 143 case series studies. We found significant reduction in local recurrence rate among patients treated with CPT compared to brachytherapy (Odds ratio[OR] 0.38, 95% Confidence interval [CI] 0.24-0.60, p < 0.01). Analysis also showed a trend of increased risks of secondary glaucoma after CPT. No statistically significant differences were found in analyzing risks of mortality, enucleation, and cataract. CONCLUSIONS Our study suggested no difference in mortality, enucleation rate and cataract formation rate comparing the two treatments. Lower local recurrence rate and possibly higher secondary glaucoma incidence was noted among patients treated with CPT. Nevertheless, the overall level of evidence is limited, and further high-quality studies are necessary to provide a more definitive conclusion.
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Affiliation(s)
- Yu-Hsuan Tseng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Chia-An Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, 11217, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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2
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Manke H, Fluehs D, Stroth M, Bechrakis NE, Foerster AMH, Albrecht J. Measurements regarding a combined therapy concept for ophthalmic tumors consisting of brachytherapy and x-rays. Biomed Phys Eng Express 2024; 10:045056. [PMID: 38588642 DOI: 10.1088/2057-1976/ad3bbb] [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: 09/11/2023] [Accepted: 04/08/2024] [Indexed: 04/10/2024]
Abstract
Objective.We present a novel concept to treat ophthalmic tumors which combines brachytherapy and low-energy x-ray therapy. Brachytherapy with106Ru applicators is inadequate for intraocular tumors with a height of 7 mm or more. This results from a steep dose gradient, and it is unfeasible to deliver the required dose at the tumor apex without exceeding the maximum tolerable sclera dose of usually 1000 Gy to 1500 Gy. Other modalities, such as irradiation with charged particles, may be individually contraindicated. A dose boost at the apex provided by a superficial x-ray therapy unit, performed simultaneously with the brachytherapy, results in a more homogeneous dose profile than brachytherapy alone. This avoids damage to organs at risk. The applicator may also serve as a beam stop for x-rays passing through the target volume, which reduces healthy tissue dosage. This study aims to investigate the suitability of the applicator to serve as a beam stop for the x-rays.Approach.A phantom with three detector types comprising a soft x-ray ionization chamber, radiochromic films, and a self-made scintillation detector was constructed to perform dosimetry. Measurements were performed using a conventional x-ray unit for superficial therapy to investigate the uncertainties of the phantom and the ability of the applicator to absorb x-rays. The manufacturer provided a dummy plaque to obtain x-ray dose profiles without noise from106Ru decays.Results.The phantom is generally feasible to obtain dose profiles with three different detector types. The interaction of x-rays with the silver of the applicator leads to an increased dose rate in front of the applicator. The dose rate of the x-rays is reduced by up to 90% behind a106Ru applicator. Therefore, a106Ru applicator can be used as a beam stop in combined x-ray and brachytherapy treatment.
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Affiliation(s)
- H Manke
- Department of Physics, TU Dortmund University, Otto-Hahn-Str. 4a, 44227 Dortmund, Germany
| | - D Fluehs
- Radiation and Tumor Clinic, Essen University Hospital, Hufelandstr. 55, 45147 Essen, Germany
| | - M Stroth
- Department of Physics, TU Dortmund University, Otto-Hahn-Str. 4a, 44227 Dortmund, Germany
| | - N E Bechrakis
- Radiation and Tumor Clinic, Essen University Hospital, Hufelandstr. 55, 45147 Essen, Germany
| | - A M H Foerster
- Radiation and Tumor Clinic, Essen University Hospital, Hufelandstr. 55, 45147 Essen, Germany
| | - J Albrecht
- Department of Physics, TU Dortmund University, Otto-Hahn-Str. 4a, 44227 Dortmund, Germany
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3
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Flanagan JPM, Fog LS, Astrahan MA, Talbot LJ, McKay D, Phillips C, McKenzie JD, O'Day R. Apical dose versus volume dose of Ruthenium-106 brachytherapy for uveal melanoma. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00074-7. [PMID: 38582499 DOI: 10.1016/j.jcjo.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/09/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE Ruthenium-106 brachytherapy is commonly used to treat uveal melanomas. Most centres prescribe a radiation dose to the tumour apex that is calculated with the tumour located in the centre of the plaque. Recent work suggests that D99%-the minimum radiation dose delivered to 99% of tumour volume-may be a better predictor of tumour control than apex dose. Both dosing regimens may be affected by tumour and treatment variables differently. We explored the effect of differences in these variables on volume and apex dose using a 3-dimensional planning model. METHODS The time required to deliver 100 Gy to the tumour apices of representative tumours ranging from 2- to 6-mm thickness with central plaque positioning was calculated in Plaque Simulator™. This treatment time was used for further calculations, including D99% with central plaque placement, and apical and tumour volume doses when tumour and plaque characteristics were altered, including eccentric plaque placement, either away from (tilt) or along (offset) scleral surface, tumour shape, and plaque type. RESULTS D99% was always greater than the apex dose when plaques were placed centrally, and the difference increased with tumour thickness. Increasing degrees of tumour offset reduced apical dose and D99%, with a greater effect on apical dose for thicker and D99% for thinner tumours, respectively. Differences in tumour shape and plaque type had idiosyncratic effects on apical and volume dosing. CONCLUSION D99% and apex dose are affected by tumour and treatment characteristics in different ways, highlighting the complexity of radiation delivery to uveal tumours.
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Affiliation(s)
- Jeremy P M Flanagan
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne (Victoria), Australia; Ocular Oncology Research Unit, Centre for Eye Research Australia, Melbourne (Victoria), Australia
| | - Lotte S Fog
- Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia
| | - Melvin A Astrahan
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lachie J Talbot
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne (Victoria), Australia
| | - Daniel McKay
- Ocular Oncology Research Unit, Centre for Eye Research Australia, Melbourne (Victoria), Australia; Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia
| | - Claire Phillips
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne (Victoria), Australia
| | - John D McKenzie
- Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia
| | - Roderick O'Day
- Ocular Oncology Research Unit, Centre for Eye Research Australia, Melbourne (Victoria), Australia; Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia. roderick.o'
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Hasegawa N, Teh BS, Tran K, Ivey F, Olek D, Pino R, Chuang AZ, Bretana ME, Butler EB, Schefler AC. Retrospective Analysis of Radiation-Induced Complications of Uveal Melanoma Patients Treated With Brachytherapy in the Era of Anti-VEGF. Am J Ophthalmol 2024; 260:49-59. [PMID: 38081570 DOI: 10.1016/j.ajo.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/19/2023] [Accepted: 12/07/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE To associate clinical factors and radiation doses delivered by iodine-125 plaque brachytherapy to visual outcomes and development of radiation-induced ocular complications in patients with uveal melanoma in the era of anti-vascular endothelial growth factor (anti-VEGF) injections. DESIGN Retrospective cohort study. METHODS A retrospective chart review was performed for 225 patients treated with iodine-125 brachytherapy for uveal melanoma. The effects of radiation doses (focal doses, average dose to the entire eye, and integral dose) on visual outcomes and development of radiation complications (radiation retinopathy, radiation optic neuropathy, vitreous hemorrhage, and neovascular glaucoma) were analyzed using multivariate Cox regression snalysis. RESULTS Median follow-up was 33.6 months (range, 12-105.6 months). Radiation retinopathy was associated with younger age, tumor distance to optic nerve <6 mm, and maximum radiation dose to fovea. Radiation optic neuropathy was associated with White race, tumor distance to optic nerve <6 mm, and integral radiation dose. Vitreous hemorrhage was associated with White race and integral radiation dose. Incidence of neovascular glaucoma was low in our study, with 2 patients (0.9%) developing the complication. Of the 123 patients who developed radiation retinopathy, 82 patients (66.7% of radiation retinopathy patients, 37.3% of total patients) received anti-VEGF injections. CONCLUSIONS Our study found multiple associations between radiation doses and complications as well as visual outcomes on multivariate analysis. Given that the majority of our patients who developed radiation retinopathy received anti-VEGF injections, our study helps to illustrate the course and progression of radiation-induced complications in the new era of anti-VEGF.
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Affiliation(s)
- Naomi Hasegawa
- From the Department of Ophthalmology (N.H., A.Z.C.), University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Bin S Teh
- Department of Radiation Oncology (B.S.T., F.I., D.O., R.P., E.B.B.), Houston Methodist Hospital, Houston, Texas, USA
| | - Kevin Tran
- Department of Radiation Oncology (K.T.), University of Texas Medical Branch, Galveston, Texas, USA
| | - Forrest Ivey
- Department of Radiation Oncology (B.S.T., F.I., D.O., R.P., E.B.B.), Houston Methodist Hospital, Houston, Texas, USA
| | - Devin Olek
- Department of Radiation Oncology (B.S.T., F.I., D.O., R.P., E.B.B.), Houston Methodist Hospital, Houston, Texas, USA
| | - Ramiro Pino
- Department of Radiation Oncology (B.S.T., F.I., D.O., R.P., E.B.B.), Houston Methodist Hospital, Houston, Texas, USA
| | - Alice Z Chuang
- From the Department of Ophthalmology (N.H., A.Z.C.), University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Maria E Bretana
- Retina Consultants of Texas (M.E.B., A.C.S.), Houston, Texas, USA
| | - Edward Brian Butler
- Department of Radiation Oncology (B.S.T., F.I., D.O., R.P., E.B.B.), Houston Methodist Hospital, Houston, Texas, USA
| | - Amy C Schefler
- Retina Consultants of Texas (M.E.B., A.C.S.), Houston, Texas, USA; Blanton Eye Institute, Houston Methodist Hospital (A.C.S.), Houston, Texas, USA.
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De Brabandere M, Placidi E, Siebert FA, Carlsson Tedgren Å, Slocker Escarpa A, Tagliaferri L, Andrássy M, Schulz C, Fog LS. GEC-ESTRO survey of 106Ru eye applicator practice for ocular melanoma - Physicist survey. Radiother Oncol 2024; 193:110114. [PMID: 38309583 DOI: 10.1016/j.radonc.2024.110114] [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: 11/10/2023] [Revised: 01/16/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
AIM 106Ru eye plaque brachytherapy (BT, interventional radiotherapy) is an eye-preserving treatment for uveal melanoma performed in about 100 clinics worldwide. Despite this relatively low number, there is a considerable variation in clinical practice. In 2022, the BRAPHYQS and Head & Neck and Skin GEC-ESTRO working groups conducted a survey to map the current clinical practice. The survey consisted of a physicist and a physician part. This paper describes the physicist results. However, three physician questions with overlapping interest are included here as well. MATERIALS AND METHODS The survey questions pertained to commissioning and quality control (QC) of the plaques, treatment planning, radiobiological correction, as well as more general questions on practice improvement. The questions overlapping with the physician survey were related to dose prescription and margins. RESULTS Sixty-five physicist responses were included. A majority of the centres do not perform an independent measurement of the absorbed dose at reference depth, percentage depth dose (PDD) and off-axis data. A lack of calibration services and suitable equipment are the main reasons. About one third of the centres indicated that they do image based treatment planning. The use of margins and dose prescription showed a large variability, despite the availability of guidelines [1]. Many respondents expressed a strong wish for improvement in a wide range of aspects of clinical practice. CONCLUSION The physics survey showed a wide variability regarding quality control of the 106Ru sources and treatment planning practice.
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Affiliation(s)
| | - Elisa Placidi
- UOC Physics for Life Sciences, Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Frank-André Siebert
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Åsa Carlsson Tedgren
- Radiation Physics, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Rome, Italy
| | - Michael Andrássy
- Eckert & Ziegler BEBIG GmbH, Robert-Rössle-Straße 10, 13125 Berlin, Germany
| | - Carmen Schulz
- Eckert & Ziegler BEBIG GmbH, Robert-Rössle-Straße 10, 13125 Berlin, Germany
| | - Lotte S Fog
- Ocular oncology unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Alfred Health Radiation Oncology, Melbourne, VIC, Australia
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6
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Chang X, Huang L, Liu J, Cao Y, Chang J. Monte Carlo dosimetry of a novel Yttrium-90 disc source for episcleral brachytherapy. J Appl Clin Med Phys 2023; 24:e14140. [PMID: 37708092 PMCID: PMC10691622 DOI: 10.1002/acm2.14140] [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: 02/24/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/16/2023] Open
Abstract
PURPOSE To calculate the dose distribution using Monte Carlo simulations for a novel high-dose-rate Yttrium-90 (Y-90) disc source recently developed for episcleral brachytherapy and provide a lookup table for treatment planning. METHODS Monte Carlo simulations were performed to calculate the in-water dose distribution of the Y-90 disc source using the "GATE", a software based on the "Geant4" Monte Carlo simulation toolkit developed by the international OpenGATE collaboration. The geometry of this novel beta source, its capsule, and the surrounding water medium were accurately modeled in the simulation input files. The standard Y-90 element beta spectrum from ICRU 72 was used, and the physics processes for beta and photon interactions with matters were all included. The dose distribution of this Y-90 disc source was measured in a separate study using Gafchromic EBT-3 films and the results were reported elsewhere. To match the setup of the experiment, a Gafchromic EBT-3 film was also included in the simulation geometry. The simulated dose profiles were exported from the 3D dose distribution results and compared with the measured dose profiles. Transverse dose profiles at different distances from the seed surface were also obtained to study the lateral coverage of the source. RESULTS The measured percent depth dose (PDD) curves along the central axis perpendicular to the surface of the Y-90 disc were constructed from the experimental and simulated data, and normalized to the reference point at 1 mm from the source capsule. Both PDD curves agreed well up to 4 mm from the source surface (maximum difference ± 10%) but deviated from each other beyond 4 mm. The deviation might be caused by the increased measurement uncertainty in the low-dose region. The dose rate at the reference point calculated from the Monte Carlo simulation was 1.09 cGy/mCi-s and agreed very well with the measured dose rate of 1.05 cGy/mCi-s. If the 80% isodose line is selected as the lateral coverage, the lateral dose coverage is maximal (∼4.5 mm) at the plane next to the source surface, and gradually decreases with the increasing distance, approaching 3.5 mm when the plane is 5 mm from the 6-mm diameter source surface. CONCLUSION Monte Carlo simulations were successfully performed to confirm the measured PDD curve of the novel Y-90 disc source. This simulation work laid a solid foundation for characterizing the full dosimetry parameters of this source for episcleral brachytherapy applications.
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Affiliation(s)
- Xiangyun Chang
- MS in Medical Physics Program, Department of Physics and AstronomyHofstra UniversityHempsteadNew YorkUSA
- Radiation MedicineNorthwell HealthLake SuccessNew YorkUSA
| | - Lyu Huang
- Radiation MedicineNorthwell HealthLake SuccessNew YorkUSA
| | - Jian Liu
- Radiation OncologyRhode Island HospitalProvidenceRhode IslandUSA
| | - Yijian Cao
- MS in Medical Physics Program, Department of Physics and AstronomyHofstra UniversityHempsteadNew YorkUSA
- Radiation MedicineNorthwell HealthLake SuccessNew YorkUSA
- Radiation MedicineZucker School of Medicine at Hofstra/NorthwellLake SuccessNew YorkUSA
| | - Jenghwa Chang
- MS in Medical Physics Program, Department of Physics and AstronomyHofstra UniversityHempsteadNew YorkUSA
- Radiation MedicineNorthwell HealthLake SuccessNew YorkUSA
- Radiation MedicineZucker School of Medicine at Hofstra/NorthwellLake SuccessNew YorkUSA
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Miguel D, de Frutos JM, Alonso P, García-Álvarez C, Saornil MA, Diezhandino P, Garavis MI, Valencia P. A study comparing baseline and best-corrected visual acuity after iodine-125 episcleral brachytherapy in uveal melanoma. J Contemp Brachytherapy 2023; 15:350-356. [PMID: 38026075 PMCID: PMC10669921 DOI: 10.5114/jcb.2023.132658] [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: 07/21/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The aim of this study was to analyze the course of visual acuity (VA) in visual outcomes of patients treated with iodine-125 (125I) brachytherapy in our center, based on original VA before treatment. Material and methods Visual acuity was prospectively assessed using a case series of 305 patients treated with 125I between 1996 and 2022. To examine how VA behaves over time, we divided patient sample into 4 groups: (1) Patients with visual acuity of less than V ≤ 0.1 at baseline; (2) Patients with low to moderate VA, ranging 0.1 < V < 0.4; (3) Patients with moderate-high VA, ranging 0.4 < V < 0.8; (4) Patients with very high VA of V > 0.8. Each of the four groups was studied separately over a 60-month period to determine the percentage of patients with VA improvement, worsening, or with the same VA status. Finally, visual outcomes over time were estimated with 95% confidence interval (CI) using Kaplan-Meier analysis, and VA maintenance rates were reported at 1, 3, 5, 10, 15, and 20 years of follow-up. Results The median follow-up time was 78.2 months (range, 6-254 months). The cumulative probabilities of survival analysis at 1, 3, 5, and 10 years were 16%, 3%, 2%, and none for the first sub-group; 46%, 20%, 17%, and 14% for the second; 65%, 53%, 29%, and 15% for the third; and 86%, 56%, 48%, and 41% for the fourth sub-group. The median survival in years was 0.30, 0.80, 3.10, and 4.40 for each sub-cohort, respectively. Conclusions The decrease and maintenance of VA depends on the initial VA of patients. Most patients experience a marked worsening of their VA, regardless of their VA status before treatment with episcleral brachytherapy. Patients with a higher baseline VA retain VA best over time.
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Affiliation(s)
- David Miguel
- Address for correspondence: David Miguel Pérez, Intraocular Tumors Unit, Valladolid University Hospital, Valladolid, Spain, C/Manuel Azaña n 45 7J 47014, phone: +34-609965860, ⌧ e-mail:
| | - Jesús María de Frutos
- Intraocular Tumors Unit, Valladolid University Hospital, Valladolid, Spain
- Institution address: Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
| | - Pilar Alonso
- Intraocular Tumors Unit, Valladolid University Hospital, Valladolid, Spain
- Institution address: Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
| | - Ciro García-Álvarez
- Intraocular Tumors Unit, Valladolid University Hospital, Valladolid, Spain
- Institution address: Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
| | - María Antonia Saornil
- Intraocular Tumors Unit, Valladolid University Hospital, Valladolid, Spain
- Institution address: Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
| | - Patricia Diezhandino
- Intraocular Tumors Unit, Valladolid University Hospital, Valladolid, Spain
- Institution address: Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
| | - Maria Isabel Garavis
- Intraocular Tumors Unit, Valladolid University Hospital, Valladolid, Spain
- Institution address: Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
| | - Patricia Valencia
- Intraocular Tumors Unit, Valladolid University Hospital, Valladolid, Spain
- Institution address: Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
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O'Day RFJ, Roelofs KA, Negretti GS, Hay G, Arora AK, Stoker I, Damato BE, Sagoo MS, Cohen VML. Long-term visual outcomes after ruthenium plaque brachytherapy for posterior choroidal melanoma. Eye (Lond) 2023; 37:959-965. [PMID: 35140328 PMCID: PMC10050407 DOI: 10.1038/s41433-022-01944-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To assess the long-term visual outcomes in patients with posteriorly located choroidal melanoma treated with ruthenium plaque brachytherapy between January 2013 and December 2015. METHODS A retrospective review was conducted on consecutive patients treated with ruthenium plaque brachytherapy for post-equatorial choroidal melanoma with available Snellen visual acuity before and after treatment, and the development and treatment of radiation complications. RESULTS There were 219 patients with posterior choroidal melanoma treated with ruthenium plaque brachytherapy. Median follow up was 56.5 months, range 12-81 months. Final visual acuity was ≥6/12 in 97 (44.3%) patients, 6/12 to 6/60 in 57 (26.0%), <6/60 in 55 (25.1%) and 10 (4.6%) eyes were enucleated. Radiation maculopathy was the most common radiation complication encountered, occurring in 53 (24.2%) patients. Of these, final visual acuity was 6/12 in 10 patients (18.9%), 6/12 to 6/60 in 26 (49.1%), <6/60 in 16 (30.2%) and 1 eye (1.9%) was enucleated. Twenty-five (47%) with radiation maculopathy were treated with intravitreal anti-angiogenic therapy, 27 (51%) were monitored and one (2%) was treated with scatter photocoagulation. Eyes treated with intravitreal anti-angiogenic therapy had better final vision than those observed or treated with retinal laser (chi-square, p = 0.04). On multivariate analysis, close proximity to the optic nerve and fovea, and large or notched plaque type was associated with final vision worse than 6/12. CONCLUSION Most patients treated with ruthenium plaque brachytherapy for posterior choroidal melanoma retain 6/60 vision, with almost half retaining 6/12 vision at long term follow up.
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Affiliation(s)
- Roderick F J O'Day
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK.
- Ocular Oncology Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
| | - Kelsey A Roelofs
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, USA
| | - Guy S Negretti
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
| | - Gordon Hay
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Amit K Arora
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Ian Stoker
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
| | - Bertil E Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
| | - Mandeep S Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Victoria M L Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
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Liegl R, Schmelter V, Fuerweger C, Ehret F, Priglinger S, Muacevic A, Foerster P. Robotic CyberKnife Radiosurgery for the Treatment of Choroidal and Ciliary Body Melanoma. Am J Ophthalmol 2023; 250:177-185. [PMID: 36642391 DOI: 10.1016/j.ajo.2022.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/15/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To present the results of robotic-assisted radiosurgery in choroidal and ciliary body melanomas treated at the Department of Ophthalmology of Ludwig-Maximilians-University and the European CyberKnife Center in Munich, Germany. DESIGN Interventional case series METHODS: This retrospective study included 594 consecutive patients referred to our clinic for the treatment of choroidal and ciliary body melanomas with robotic radiosurgery (CyberKnife) from 2005 to 2019. Eye retention, local control and disease-specific survival rates were calculated as Kaplan-Meier and actuarial estimates. The impact of prescription dose, tumor size, and ciliary body involvement was assessed by likelihood ratio tests and Cox regression. RESULTS Among all patients who were staged according to the TNM classification system (8th edition), 22.7% were I, 57.9% were II, 18.9% were III, and 0.5% were IV. Median apical tumor height and base diameter were 5.8 and 11.4 mm. The mean follow-up was 41.7 months. Local control after 3 and 5 years was 92.0% (95% CI = 88.2%-94.7%) and 84.3% (95% CI = 77.9%-89.0%), respectively, for 21 to 22 Gy and 86.9% (95% CI = 79.7%-91.7%) and 77.7% (95% CI = 68.5%-84.6%), respectively, when treated with 20 Gy or less. Eye retention was achieved in 89.9% and 81.0% after 3 and 5 years with 21 to 22 Gy and 85.9% and 80.0% for 20 Gy or less. Disease-specific survival rates were 93.1% (95% CI = 90.2%-95.2%) after 3 years, 89.8% (95% CI = 86.0%-92.6%) after 5 years, and 87.8% (95% CI = 82.8%-91.4%) after 7 years. CONCLUSIONS This is the largest series of patients treated for choroidal and ciliary body melanomas with CyberKnife. Our results reflect an improvement in the outcome of CyberKnife therapy for patients with choroidal and ciliary body melanoma treated with single-session radiosurgery in the last decade.
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Affiliation(s)
- Raffael Liegl
- From the Department of Ophthalmology (R.L., V.S., S.P., P.F.), Ludwig-Maximilians University Munich, Munich, Germany.
| | - Valerie Schmelter
- From the Department of Ophthalmology (R.L., V.S., S.P., P.F.), Ludwig-Maximilians University Munich, Munich, Germany
| | - Christoph Fuerweger
- European Radiosurgery Center Munich (C.F., F.E., A.M.), Munich, Germany; Center for Neurosurgery (C.F.), Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany
| | - Felix Ehret
- European Radiosurgery Center Munich (C.F., F.E., A.M.), Munich, Germany
| | - Siegfried Priglinger
- From the Department of Ophthalmology (R.L., V.S., S.P., P.F.), Ludwig-Maximilians University Munich, Munich, Germany
| | | | - Paul Foerster
- From the Department of Ophthalmology (R.L., V.S., S.P., P.F.), Ludwig-Maximilians University Munich, Munich, Germany
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10
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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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11
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Mirshahi R, Sedaghat A, Jaberi R, Azma Z, Mazloumi M, Naseripour M. Ruthenium-106 plaque radiotherapy for uveal melanoma: analysis of tumor dimension and location on anatomical and functional results. BMC Ophthalmol 2022; 22:309. [PMID: 35842619 PMCID: PMC9288719 DOI: 10.1186/s12886-022-02521-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background To report the long-term outcomes of Ru-106 plaque radiotherapy in eyes with uveal melanoma (UM) and to assess the effect of tumor thickness and location on final outcomes. Methods Medical records of 234 patients undergoing Ru-106 plaque radiotherapy for UM were reviewed, and the visual outcome, globe preservation, and patient survival were evaluated. The results of 2 groups were compared: 1. between thin (small and medium-sized, thickness < 7 mm, 148 eyes [63.2%]) and thick (thickness ≥ 7 mm, 86 eyes [36.8%]) tumors, and 2. between large (largest basal diameter [LBD] > 12 mm, 109 eyes [46.6%]) and medium/small (LBD ≤ 12 mm, 125 eyes [53.4%]). In addition, a comparison of the juxtapapillary location in 46 eyes (19.7%) versus tumors arising elsewhere and between tumors with and without ciliary involvement in 48 eyes (21.5%) were done. Results The patients were followed for a median of 54.2 months (range: 6–194.5 months). After adjusting for baseline visual acuity (VA), there was no significant association between final VA and different dimension and tumor location groups. Final globe preservation was 91.9%, and there was no significant difference between different dimension- and ciliary body involvement groups regarding anatomical success rate. The juxtapapillary tumors had lower globe preservation (80.4% vs .94.7%, p = 0.002). The hazard ratio (HR) for enucleation in juxtapapillary tumors was HR = 6.58 (95-CI: 3.84 to 11.21). The overall metastasis rate was 6.8%, with no significant difference in juxtapapillary tumors (4.3% vs.7.4%, p = 0.455). Conclusions Ru-106 plaque radiotherapy is an effective treatment for thick and large UM. With this type of treatment, the globe preservation rate is lower in juxtapapillary tumors, but there is no significant difference in the metastasis rate.
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Affiliation(s)
- Reza Mirshahi
- Eye Research Center, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahad Sedaghat
- Eye Research Center, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ramin Jaberi
- Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Azma
- Radiation Medicine Department, Shahid Beheshti University, Tehran, Iran
| | - Mehdi Mazloumi
- Eye Research Center, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masood Naseripour
- Eye Research Center, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. .,Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran.
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12
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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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13
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Cennamo G, Montorio D, D' Andrea L, Farella A, Matano E, Giuliano M, Liuzzi R, Breve MA, De Placido S, Cennamo G. Long-Term Outcomes in Uveal Melanoma After Ruthenium-106 Brachytherapy. Front Oncol 2022; 11:754108. [PMID: 35047387 PMCID: PMC8763327 DOI: 10.3389/fonc.2021.754108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/26/2021] [Indexed: 11/13/2022] Open
Abstract
Uveal melanoma is the most common primary intraocular malignancy. The aim of this retrospective study was to report the results after ruthenium-106 (Ru-106) plaque brachytherapy for uveal melanoma in terms of tumor control, visual acuity, radiation-related complications, tumor recurrence, metastases, and patients’ survival rate during 4 years’ follow-up. A total of 355 eyes from 355 patients have been treated with Ru-106 plaque brachytherapy for uveal melanoma between February 2011 and March 2020. Five patients were lost to follow-up, and then 350 eyes of 350 patients (mean age 58 ± 11 years) were enrolled in this retrospective study. All patients underwent a complete ophthalmic examination including echography and spectral domain–optical coherence tomography. The mean follow-up was 4 years (3 months to 9 years). After treatment, the mean tumor thickness was reduced to 1.75 ± 0.21 mm. Radiation complications were found in 63% of patients: 38% showed radiation maculopathy, 11% had optic neuropathy, and 14% developed cataracts. Cancer-free survival was 99%, 97%, and 85%, respectively, at 5, 7, and 9 years. Ru-106 plaque brachytherapy represents a reliable treatment of uveal melanoma. This technique is valid and safe with a low rate of ocular complications during a long-term follow-up.
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Affiliation(s)
- Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples "Federico II", Naples, Italy
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Luca D' Andrea
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Antonio Farella
- Radiotherapy Unit, University of Naples "Federico II", Naples, Italy
| | - Elide Matano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Rare Cancer Coordinating Center - Campania Region, Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Rare Cancer Coordinating Center - Campania Region, Naples, Italy
| | - Raffaele Liuzzi
- Institute of Biostructure and Bioimaging, National Research Council (CNR), Naples, Italy
| | - Maria Angelica Breve
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Rare Cancer Coordinating Center - Campania Region, Naples, Italy
| | - Giovanni Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
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14
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On measuring the 3D dose distribution for notched and circular Ru-106 plaque shapes through Gafchromic film dosimetry approach. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2021.109792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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New Perspectives for Eye-Sparing Treatment Strategies in Primary Uveal Melanoma. Cancers (Basel) 2021; 14:cancers14010134. [PMID: 35008296 PMCID: PMC8750035 DOI: 10.3390/cancers14010134] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Uveal melanoma is the most common intraocular cancer. The current eye-sparing treatment options include mostly plaque brachytherapy. However, the effectiveness of these methods is still unsatisfactory. In this article, we review several possible new treatment options. These methods may be based on the physical destruction of the cancerous cells by applying ultrasounds. Another approach may be based on improving the penetration of the anti-cancer agents. It seems that the most promising technologies from this group are based on enhancing drug delivery by applying electric current. Finally, new advanced nanoparticles are developed to combine diagnostic imaging and therapy (i.e., theranostics). However, these methods are mostly at an early stage of development. More advanced studies on experimental animals and clinical trials would be needed to introduce some of these techniques to routine clinical practice. Abstract Uveal melanoma is the most common intraocular malignancy and arises from melanocytes in the choroid, ciliary body, or iris. The current eye-sparing treatment options include surgical treatment, plaque brachytherapy, proton beam radiotherapy, stereotactic photon radiotherapy, or photodynamic therapy. However, the efficacy of these methods is still unsatisfactory. This article reviews several possible new treatment options and their potential advantages in treating localized uveal melanoma. These methods may be based on the physical destruction of the cancerous cells by applying ultrasounds. Two examples of such an approach are High-Intensity Focused Ultrasound (HIFU)—a promising technology of thermal destruction of solid tumors located deep under the skin and sonodynamic therapy (SDT) that induces reactive oxygen species. Another approach may be based on improving the penetration of anti-cancer agents into UM cells. The most promising technologies from this group are based on enhancing drug delivery by applying electric current. One such approach is called transcorneal iontophoresis and has already been shown to increase the local concentration of several different therapeutics. Another technique, electrically enhanced chemotherapy, may promote drug delivery from the intercellular space to cells. Finally, new advanced nanoparticles are developed to combine diagnostic imaging and therapy (i.e., theranostics). However, these methods are mostly at an early stage of development. More advanced and targeted preclinical studies and clinical trials would be needed to introduce some of these techniques to routine clinical practice.
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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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17
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Efficacy and complications of ruthenium-106 brachytherapy for uveal melanoma: a systematic review and meta-analysis. J Contemp Brachytherapy 2021; 13:358-364. [PMID: 34122577 PMCID: PMC8170514 DOI: 10.5114/jcb.2021.106191] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/26/2021] [Indexed: 02/03/2023] Open
Abstract
Purpose The aim of this study was to evaluate the efficacy and vision-threatening complications of brachytherapy with ruthenium-106 (106Ru) plaque to treat uveal melanoma. Material and methods A literature review was performed based on results from searching PubMed, Embase, Web of Science, Scopus, and Cochrane databases, using the following key words: “choroidal melanoma”, “uveal melanoma”, “brachytherapy”, and “ruthenium-106”. We included studies performed on more than 30 patients since 1986, reporting on local control rate, complications rate, mean radiation dose, and mean tumor thickness. The cumulative analysis was performed using Metaprop command of Stata v.16, and meta-regression was conducted based on mean tumor thickness and mean radiation dose to tumor’s apex. Results Twenty-one retrospective studies were selected, involving 3,913 patients treated primarily with 106Ru plaque brachytherapy. The range of radiation dose to tumor apex was from 70 Gy to 250 Gy. The local control rate following brachytherapy ranged from 59% to 98%, and the overall weighted mean of local control was 84%. However, the heterogeneity between studies’ reports was remarkable (I2 = 95.40%). Meta-regression based on tumor thickness and mean dose of radiation to the apex showed that the studies’ heterogeneity was minimally related to the difference in mean tumor size (I2 = 92%). The correlation between larger tumor size and lower local control rate was statistically significant (p-value = 0.024). There was no significant correlation between the mean radiation dose and local control rate (p-value = 0.679). The most commonly reported complications were cataract and radiation-related retinopathy. Conclusions Although the studies’ heterogeneity was high, in a prescription dose ranging from 70 Gy to 250 Gy to the tumor apex, 106Ru brachytherapy seems to be successful in local control of uveal melanoma. The efficacy of 106Ru in controlling uveal melanomas decreased with the increase in tumor thickness. However, these outcomes should be verified in randomized comparative studies.
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18
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Kuzmanović Elabjer B, Bušić M, Pleše A, Bjeloš M, Miletić D, Vukojević N. Ultrasound Biomicroscopy Documented Anterior Uveal Melanoma Regression after Ruthenium-106 Plaque Therapy. Ocul Oncol Pathol 2021; 7:224-232. [PMID: 34307336 DOI: 10.1159/000512030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/03/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). Objective Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. Methods This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (D) and the largest basal dimension (B) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial D and B values. Results The study involved 10 patients with a mean age of 64.4 years (yr) (range 46-80 yr). D ranged from 1.82 to 5.5 mm (median 2.99 mm) and B from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for D was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for B it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. Conclusion The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.
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Affiliation(s)
- Biljana Kuzmanović Elabjer
- Faculty of Dental Medicine and Health Care Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,University Eye Clinic - WHO Collaborating Center, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Mladen Bušić
- Faculty of Dental Medicine and Health Care Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,University Eye Clinic - WHO Collaborating Center, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Andrej Pleše
- Faculty of Dental Medicine and Health Care Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,University Eye Clinic - WHO Collaborating Center, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Mirjana Bjeloš
- Faculty of Dental Medicine and Health Care Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,University Eye Clinic - WHO Collaborating Center, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Daliborka Miletić
- Faculty of Dental Medicine and Health Care Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,University Eye Clinic - WHO Collaborating Center, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Nenad Vukojević
- University Eye Clinic, University Hospital Centre Zagreb, Zagreb, Croatia
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Naseripour M, Ghasemi Falavarjani K, Mirshahi R, Sedaghat A. Optical coherence tomography angiography (OCTA) applications in ocular oncology. Eye (Lond) 2020; 34:1535-1545. [PMID: 32127654 PMCID: PMC7608304 DOI: 10.1038/s41433-020-0819-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 12/12/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) is a revolutionary method in the visualization of the vascular system in different retinal and choroidal layers. During the last 4 years since the commercial availability of different OCTA devices, attempts have been made to utilize this technology in various aspects of ocular oncology from the differentiation of benign and malignant lesions to assisting in evaluation of post-treatment complications, such as radiation retinopathy. However, current OCTA technology is restricted by various artefacts and inherent limitations, some of which are more pronounced in the presence of elevated tumoural lesions. Imminent advancements in OCTA systems and image acquisition processes promise a great potential for application of OCTA in ocular oncology.
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Affiliation(s)
- Masood Naseripour
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ahad Sedaghat
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Itta F, Liuzzi R, Farella A, Porri G, Pacelli R, Conson M, Oliviero C, Buonanno F, Breve M, Cennamo G, Clemente S, Cella L. Personalized treatment planning in eye brachytherapy for ocular melanoma: Dosimetric analysis on ophthalmic structure at risk. Phys Med 2020; 76:285-293. [DOI: 10.1016/j.ejmp.2020.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/21/2022] Open
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Abolfathzadeh N, Naseripour M, Jaberi R, Azma Z, Alemzadeh SA, Arbab M, Sedaghat A. Ru-106 plaque radiotherapy for vasoproliferative tumors of retina: a 15-year single-center experience. Int Ophthalmol 2020; 40:2095-2102. [PMID: 32361860 DOI: 10.1007/s10792-020-01386-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study evaluates the outcomes of ruthenium-106 (Ru-106) plaque brachytherapy for vasoproliferative tumors (VPTs) of the ocular fundus in a single referral ocular oncology center. METHODS The clinical charts of all patients diagnosed with VPT who underwent plaque radiotherapy from 2002 to 2017 were reviewed. Clinical features, types of treatment, outcomes and complications were evaluated. RESULTS Of 46 patients with VPT diagnosis in our ocular oncology clinic, 25 (54.34%) cases were treated with Ru-106 plaque brachytherapy. Eleven patients (44%) were male, and the mean age at the time of diagnosis was 40.92 ± 13.11 years. The mean follow-up time was 47.56 ± 36.87 months. Inferotemporal quadrant was the most common site of the tumor (64.00%). The mean delivered apex and scleral dose was 101.56 ± 6.51 and 412.26 ± 113.66 Gray (Gy), respectively. Initial tumor length, width and thickness were 10.26 ± 3.42, 8.05 ± 2.83 and 4.27 ± 1.10 mm, respectively. The mean tumor thickness decreased to 2.60 ± 0.63 mm, postoperatively. Complete resolution of subretinal fluid around the tumor was achieved in 81.80% of cases. Visual acuity was more than 20/400 in 64% of patients before treatment and 60% of patients at last follow-up. CONCLUSION Our study showed that Ru-106 plaque radiotherapy is an effective and safe method of treatment in VPTs.
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Affiliation(s)
- Navid Abolfathzadeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran.,Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masood Naseripour
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran
| | - Ramin Jaberi
- Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Azma
- Radiation Medicine Department, Shahid Beheshti University, Tehran, Iran
| | - Sayyed Amirpooya Alemzadeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran
| | - Mona Arbab
- Radiation Oncology Department, Indiana University, Indiana, USA
| | - Ahad Sedaghat
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran.
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Yang X, Dalvin LA, Mazloumi M, Chang M, Shields JA, Mashayekhi A, Shields CL. Impact of uveal melanoma thickness on post-plaque radiotherapy outcomes in the prophylactic anti-vascular endothelial growth factor era in 1131 patients. Clin Exp Ophthalmol 2020; 48:610-623. [PMID: 32277560 DOI: 10.1111/ceo.13758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 03/17/2020] [Accepted: 04/04/2020] [Indexed: 02/01/2023]
Abstract
IMPORTANCE The impact of tumour thickness on radiation complications following plaque radiotherapy for uveal melanoma in the anti-vascular endothelial growth factor (VEGF) era remains unknown. BACKGROUND To evaluate treatment outcomes following plaque radiotherapy and prophylactic intravitreal bevacizumab for uveal melanoma based on initial tumour thickness. DESIGN This was a retrospective, interventional case series. PARTICIPANTS Patients with uveal melanoma were included in this study. METHODS A review of medical records was conducted of patients with uveal melanoma treated with plaque radiotherapy and prophylactic intravitreal bevacizumab from 7 July 2000 to 2 November 2018. MAIN OUTCOMES MEASURES Radiation-related outcomes of cystoid macular oedema (CME), radiation maculopathy, papillopathy, retinopathy, iris neovascularization (NVI) and neovascular glaucoma (NVG) were compared based on tumour thickness (small [<3.0 mm] vs medium [3.1-8.0 mm] vs large [>8.0 mm]). RESULTS Of 1131 eyes, 341 (30%) had small, 633 (56%) medium and 157 (14%) large melanoma. Comparison (small vs medium vs large) at 4 years following radiotherapy revealed large melanoma with greater Kaplan-Meier estimated risk of CME (37% vs 37% vs 63%, P < .001), earlier onset of CME (33 vs 26 vs 19 months, P < .001) and greater development of NVI (<1% vs 2% vs 13%, P < .001) and NVG (1% vs 2% vs 12%, P < .001). Radiation-induced maculopathy, papillopathy and retinopathy were not associated with tumour thickness. CONCLUSIONS AND RELEVANCE Compared with small and medium uveal melanoma, large uveal melanoma demonstrated greater 48-month risk for CME, shorter time to CME onset and greater development of NVI and NVG following plaque radiotherapy and prophylactic intravitreal bevacizumab.
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Affiliation(s)
- Xiaolu Yang
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Ophthalmology, Shanghai General Hospital, Shanghai, China
| | - Lauren A Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mehdi Mazloumi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Chang
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Arman Mashayekhi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Espensen CA, Appelt AL, Fog LS, Gothelf AB, Thariat J, Kiilgaard JF. Predicting Visual Acuity Deterioration and Radiation-Induced Toxicities after Brachytherapy for Choroidal Melanomas. Cancers (Basel) 2019; 11:E1124. [PMID: 31390850 PMCID: PMC6721463 DOI: 10.3390/cancers11081124] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 02/03/2023] Open
Abstract
Ruthenium-106 (Ru-106) brachytherapy is an established modality for eye-preserving treatment of choroidal melanoma. To achieve optimal treatment outcomes, there should be a balance between tumour control and the risk of healthy tissue toxicity. In this retrospective study, we examined normal tissue complication probability (NTCP) for visual acuity deterioration and late complications to aid the understanding of dose-dependence after Ru-106 treatments. We considered consecutive patients diagnosed with choroidal melanoma and primarily treated at a single institution from 2005-2014. Treatment plans were retrospectively recreated using dedicated software and image guidance to contour the tumour and determine the actual plaque position. Dose distributions were extracted from each plan for all relevant anatomical structures. We considered visual acuity deterioration and late complications (maculopathy, optic neuropathy, ocular hypertension, vascular obliteration, cataract and retinal detachment). Lasso statistics were used to select the most important variables for each analysis. Outcomes were related to dose and clinical characteristics using multivariate Cox regressions analysis. In total, 227 patients were considered and 226 of those were eligible for analysis. Median potential follow-up time was 5.0 years (95% CI: 4.5-6.0). Visual acuity deterioration was related to optic disc-tumour distance and dose metrics from the retina and the macula, with retina V10Gy showing the strongest correlation. Macula V10Gy was the only dose metric impacting risk of maculopathy, while optic disc-tumour distance also proved important. Optic disc V50Gy had the largest impact on optic neuropathy along with optic disc-tumour distance. Optic disc V20Gy was the only variable associated with vascular obliteration. Lens D2% had the largest impact on the risk of cataract along with older age and the largest base dimension. We found no variables associated with the risk of ocular hypertension and retinal detachment. Visual acuity deterioration and most late complications demonstrated dependence on dose delivered to healthy structures in the eye after Ru-106 brachytherapy for choroidal melanomas.
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Affiliation(s)
- Charlotte A Espensen
- Department of Oncology, Section of Radiotherapy, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ane L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds LS9 7TF, UK
| | - Lotte S Fog
- Department of Physical Sciences, The Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Anita B Gothelf
- Department of Oncology, Section of Radiotherapy, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Juliette Thariat
- Department of Radiation Oncology, Centre Francois Baclesse, 14000 Caen, France
- Laboratoire de Physique Corpusculaire IN2P3/ENSICAEN, 14000 Caen, France
- Laboratoire de Physique Corpusculaire IN2P3/ENSICAEN-UMR6534, Unicaen-Normandy University, 14000 Caen, France
| | - Jens F Kiilgaard
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
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Uveal melanoma: physiopathology and new in situ-specific therapies. Cancer Chemother Pharmacol 2019; 84:15-32. [DOI: 10.1007/s00280-019-03860-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/02/2019] [Indexed: 12/12/2022]
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Personalized re-treatment strategy for uveal melanoma local recurrences after interventional radiotherapy (brachytherapy): single institution experience and systematic literature review. J Contemp Brachytherapy 2019; 11:54-60. [PMID: 30911311 PMCID: PMC6431104 DOI: 10.5114/jcb.2019.82888] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/01/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose To report the results of a patient’s tailored therapeutic approach using a second course of interventional radiotherapy (brachytherapy) in patients with locally recurrent uveal melanoma. Material and methods Patients who had already undergone ocular brachytherapy treated at our IOC (Interventional Oncology Center) were considered. Five patients who has received a second course of treatment with a plaque after local recurrences were included in our study. Re-irradiation was performed with Ruthenium-106 (prescribed dose to the apex 100 Gy) or with Iodine-125 plaques (prescribed dose to the apex 85 Gy). Moreover, a systematic literature search was conducted through three electronic databases, including Medline/PubMed, Scopus, and Embase. Results All patients were initially treated with Ruthenium-106 plaque; the re-irradiation was performed with Ruthenium-106 plaque in three cases and with Iodine in two cases. Mean time between the first and the second plaque was 56.8 months (range, 25-93 months). Local tumor control rate was 100%, no patient underwent secondary enucleation owing to re-treatment failure. Distant metastasis occurred in 1 patient after 6 months from re-treatment. After a median follow-up of 44.2 months (range, 26-65 months) from re-treatment, all patients experienced worsening of the visual acuity (median visual acuity was 0.42 at time of recurrence and decline to 0.24 at the most recent follow-up); cataract occurred in two cases, no patient developed scleral necrosis. We considered 2 papers for a systematic review. Conclusions In selected cases, especially in presence of marginal local recurrence, a personalized re-treatment strategy with a plaque may offer high probability of tumor control and organ preservation but worsening of visual acuity.
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Slater K, Hoo PS, Buckley AM, Piulats JM, Villanueva A, Portela A, Kennedy BN. Evaluation of oncogenic cysteinyl leukotriene receptor 2 as a therapeutic target for uveal melanoma. Cancer Metastasis Rev 2018; 37:335-345. [DOI: 10.1007/s10555-018-9751-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Visual outcome after posterior uveal melanoma episcleral brachytherapy including radiobiological doses. J Contemp Brachytherapy 2018; 10:123-131. [PMID: 29789761 PMCID: PMC5961527 DOI: 10.5114/jcb.2018.75597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/10/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose To assess the long-term influence of radiobiological doses in the evolution of visual acuity (VA) in patients with uveal melanoma treated by episcleral brachytherapy. Material and methods Visual acuity was evaluated prospectively from a case series of 243 patients in 2016 treated with 125I. Data analysis was applied to trend VA outcome and find the accurate best-fit line. Biologically effective dose (BED) was included in survival analysis with the use of Kaplan-Meier and Cox regressions. Hazard ratio (HR) and confidence interval at 95% (CI) were determined. Variables statistically significant were analyzed and compared by log-rank tests. Results The median follow-up was 74.2 months (range, 3-223). Exponential regression shows a 25% reduction and 50% in visual acuity score (VAS) scale for 5 and 27.8 months, respectively. Cumulative probabilities of survival analysis were 57%, 42%, 27%, and 23% at 3, 5, 10, and 15 years, respectively. Multivariable analysis found tumor height (HR = 1.18, 95% CI: 1.07-1.29), applicator size (HR = 1.22, 95% CI: 1.08-1.36), juxtapapillary localization (HR = 1.70, 95% CI: 1.01-2.84), and dose to foveola (HR = 1.01, 95% CI: 1.00-1.01) significantly associated with VA loss. Log-rank tests were significant for all those variables. BED has a strong influence in univariate model, but not statistically significant in the multivariate one. Conclusions Visual acuity changes can be modeled by an exponential function for the first 5 years after treatment. No relation between VA loss and BED has been found; nevertheless, apical height, plaque size, juxtapapillary localization, and dose to fovea were found as statistical significant variables.
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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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Ruthenium brachytherapy for uveal melanoma - single institution experience. J Contemp Brachytherapy 2017; 9:548-552. [PMID: 29441099 PMCID: PMC5808002 DOI: 10.5114/jcb.2017.72606] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/21/2017] [Indexed: 02/03/2023] Open
Abstract
Purpose The aim of this study was to report on results of uveal melanoma treatment with ruthenium-106 (106Ru) brachytherapy with long-term follow-up, in terms of local tumor control, eye retention rate, radiation retinopathy, and patients’ survival. Material and methods Medical records of patients treated with ruthenium plaque due to uveal melanoma at the Department of Ophthalmology, Poznan University of Medical Sciences, Poland, between 1994 and 2014 were retrospectively reviewed. Results We identified 126 patients: 53 men, 73 women, mean age 60.04 years (range, 21-89). The largest basal diameter ranged from 4.04 mm to 18.9 mm (median, 10.67 mm), tumor height was 1.9 mm to 7.42 mm (median, 4.8 mm). Median scleral radiation dose was 570 Gy (range, 235-1,500 Gy), median apical dose 100 Gy (range, 60-129 Gy). Median follow-up was 66.5 months (range, 2-261 months). We noted a total of 19 (15%) recurrences. The actuarial rate of recurrence was 9.5% at 3 years, and 13.5% at 5 years postoperatively. Nine (7%) eye globes were lost, median time to enucleation was 5 years. The eye retention rate at 5 years was 92.7% and 81% at 10 years. Forty-three (34%) patients died before the end of the study, 24 (19%) of them due to metastatic disease. Metastatic death was related to: tumor size and TNM stage at presentation (p = 0.002 vs. p = 0.0006, respectively) but not to age, gender, and plaque dosimetry. Conclusions 106Ru brachytherapy is an effective, globe sparing treatment that provides good tumor control and a high rate of survival. However, some ocular complications tend to appear late post-treatment, and therefore long-term follow-up is advised.
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Nomogram for predicting radiation maculopathy in patients treated with Ruthenium-106 plaque brachytherapy for uveal melanoma. J Contemp Brachytherapy 2017; 9:540-547. [PMID: 29441098 PMCID: PMC5807992 DOI: 10.5114/jcb.2017.71795] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/06/2017] [Indexed: 01/08/2023] Open
Abstract
Purpose To develop a predictive model and nomogram for maculopathy occurrence at 3 years after 106Ru/106Rh plaque brachytherapy in uveal melanoma. Material and methods Clinical records of patients affected by choroidal melanoma and treated with 106Ru/106Rh plaque from December 2006 to December 2014 were retrospectively reviewed. Inclusion criteria were: dome-shaped melanoma, distance to the fovea > 1.5 mm, tumor thickness > 2 mm, and follow-up > 4 months. The delivered dose to the tumor apex was 100 Gy. Primary endpoint of this investigation was the occurrence of radiation maculopathy at 3 years. Analyzed factors were as follows: gender, age, diabetes, tumor size (volume, area, largest basal diameter and apical height), type of plaque, distance to the fovea, presence of exudative detachment, drusen, orange pigment, radiation dose to the fovea and sclera. Univariate and multivariate Cox proportional hazards analyses were used to define the impact of baseline patient factors on the occurrence of maculopathy. Kaplan-Meier curves were used to estimate freedom from the occurrence of the maculopathy. The model performance was evaluated through internal validation using area under the ROC curve (AUC), and calibration with Gronnesby and Borgan tests. Results One hundred ninety-seven patients were considered for the final analysis. Radiation-related maculopathy at 3 years was observed in 41 patients. The proposed nomogram can predict maculopathy at 3 years with an AUC of 0.75. Distance to fovea appeared to be the main prognostic factor of the predictive model (hazard ratio of 0.83 [0.76-0.90], p < 0.01). Diabetes (hazard radio of 2.92 [1.38-6.20], p < 0.01), and tumor volume (hazard radio of 21.6 [1.66-281.14], p = 0.02) were significantly predictive for maculopathy occurrence. The calibration showed no statistical difference between actual and predicted maculopathy (p = 1). Conclusions Our predictive model, together with its nomogram, could be a useful tool to predict the occurrence of radiation maculopathy at 3 years after the treatment.
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Pagliara MM, Tagliaferri L, Azario L, Lenkowicz J, Lanza A, Autorino R, Caputo CG, Gambacorta MA, Valentini V, Blasi MA. Ruthenium brachytherapy for uveal melanomas: Factors affecting the development of radiation complications. Brachytherapy 2017; 17:432-438. [PMID: 29275868 DOI: 10.1016/j.brachy.2017.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/02/2017] [Accepted: 11/03/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate how treatment complications are related to dosimetric parameters after ruthenium-106 brachytherapy for uveal melanoma, in a large, clinically homogeneous population. METHODS AND MATERIALS A retrospective review was performed to evaluate patients affected by small and medium size uveal melanoma, treated with ruthenium-106 brachytherapy from December 2006 to December 2014. We excluded tumors with posterior margin within 1 mm from the edge of the optic disc and foveola. Main outcome measures were occurrence and time to radiation-related maculopathy, cataract, and optic neuropathy. Secondary end points included local recurrence and distant metastases. Kaplan-Meier analysis with log-rank test and univariate Cox proportional hazards model at 3 years were performed to identify the covariates affecting the outcome of radiation complications. RESULTS Two hundred thirty-nine patients, with sufficient data to evaluate the end points, were enrolled. Three years after plaque treatment, radiation maculopathy was found in 61 (25.5%) patients, cataract developed in 10 patients (4.2%) receiving a dose of 27 Gy or higher to the lens, and optic neuropathy was observed in 13 patients (5.4%) with an optic nerve dose exceeding 50 Gy and tumor proximity to optic disc of less than 4 mm. Tumor recurrences and tumor-related metastasis were found respectively in 20 (8.36%) and 14 (5.85%) patients. CONCLUSIONS Radiation maculopathy occurs within a median time of 31 months in 25% of cases after plaque treatment for uveal melanoma. The most significant risk factors are total dose and distance of tumor margin from the fovea. If the distance is greater than 11.22 mm, no signs of retinal damage are detected.
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Affiliation(s)
- Monica M Pagliara
- Ocular Oncology Unit, Department of Ophthalmology, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Luca Tagliaferri
- Gemelli Advanced Radiation Therapy Center, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Azario
- Physics Institute, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacopo Lenkowicz
- Gemelli-ART, Fondazione Policlinico Universitario "A.Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angela Lanza
- Ocular Oncology Unit, Department of Ophthalmology, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa Autorino
- Gemelli Advanced Radiation Therapy Center, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmela G Caputo
- Ocular Oncology Unit, Department of Ophthalmology, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria A Gambacorta
- Gemelli Advanced Radiation Therapy Center, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Gemelli Advanced Radiation Therapy Center, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria A Blasi
- Ocular Oncology Unit, Department of Ophthalmology, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
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Rao YJ, Sein J, Badiyan S, Schwarz JK, DeWees T, Grigsby P, Rao PK. Patterns of care and survival outcomes after treatment for uveal melanoma in the post-coms era (2004-2013): a surveillance, epidemiology, and end results analysis. J Contemp Brachytherapy 2017; 9:453-465. [PMID: 29204166 PMCID: PMC5705833 DOI: 10.5114/jcb.2017.70986] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/28/2017] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The Collaborative Ocular Melanoma Study (COMS) established modern treatment recommendations for uveal melanoma. We aim to evaluate patterns of care and survival outcomes in the time after COMS. MATERIAL AND METHODS The retrospective study population includes 2,611 patients in the SEER database treated for uveal melanoma between 2004-2013. Patients stage were T1-4N0M0. Data analyzed included age, clinical stage, tumor size, race, and treatment. Treatments included enucleation (EN) and globe preserving therapy (GPT), which consisted of limited surgical resection or ablation (LSRA), external beam radiation (EBRT), or brachytherapy (BT). Patients treated with radiation may receive radiation therapy alone (RTA) or radiation therapy and supplemental laser therapy (RT+SLT). We evaluated disease specific survival (DSS) and overall survival (OS) using log-rank statistics, and Cox univariate and multivariate analysis. RESULTS The median follow-up was 44 months. Treatment strategy was EN in 538 (20.6%) patients, LSRA in 80 (3.1%), EBRT in 609 (23.3%), and BT in 1,384 (53.0%). 1,876 patients received RTA and 117 received RT+SLT. Enucleation was associated with inferior DSS and OS compared to GPT in multivariate analysis (MVA) (p < 0.01). Limited surgical resection or ablation and radiation had similar DSS and OS. Brachytherapy and EBRT had similar DSS and OS. Radiation therapy and supplemental laser therapy was associated with improved DSS compared to RTA in UVA (p = 0.03), but not MVA. The 5-year DSS for enucleation, RTA, and RT+SLT were 66.7%, 87.0%, and 94.7% (p < 0.01), respectively. CONCLUSIONS Globe preserving treatments such as limited surgery or radiation are commonly utilized alternatives to enucleation, and resulted in favorable survival outcomes. Additional research is required to compare the outcomes of the various globe preserving treatment strategies.
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Affiliation(s)
- Yuan James Rao
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julia Sein
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Shahed Badiyan
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Todd DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Perry Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Prabakar Kumar Rao
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
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Tarmann L, Wackernagel W, Ivastinovic D, Schneider M, Winkler P, Langmann G. Tumor parameters predict the risk of side effects after ruthenium-106 plaque brachytherapy of uveal melanomas. PLoS One 2017; 12:e0183833. [PMID: 28859118 PMCID: PMC5578662 DOI: 10.1371/journal.pone.0183833] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/12/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To report on radiation-related side effects and complications after ruthenium-106 plaque brachytherapy of uveal melanomas. METHODS Medical records of 143 eyes with uveal melanoma, treated by ruthenium-106 brachytherapy between 1997 and 2012 at a single center, were analyzed. We evaluated the occurrence of radiation-related side effects on the anterior and posterior segment of the eye. The influence of patient, tumor and treatment parameters on outcome was analyzed by multivariate time to event analysis considering competing risks. RESULTS The median overall follow-up was 37.9 months. After treatment, the estimated risk at 12, 24 and 48 months for developing anterior segment complications was 25.3%, 37.5% and 50.3% for cataract formation and 5.4%, 6.4% and 8.1% for secondary glaucoma, respectively. The estimated risk for the occurrence of posterior segment complications 12, 24 and 48 months after treatment was 3.1%, 6.7% and 18.3% for radiation retinopathy, 18.3%, 27.1% and 42.6% for radiation maculopathy and 16.5%, 21.0% and 32.8% for radiation neuropathy, respectively. The risk of an increase in retinal detachment after treatment was 14.7%, 14.7% and 17.4% at 12, 24 and 48 months, respectively. The risk of vitreous hemorrhage occurring after treatment was 6.2%, 8.1% and 12.7%, and the risk of tumor vasculopathy was 15.4%, 17.4% and 19.0%. Scleral necrosis was observed in one patient. CONCLUSION Radiation-related side effects and complications are common among patients treated with ruthenium brachytherapy for uveal melanoma. However, the risk for those largely depends on individual tumor parameters. Before treatment, patients should be informed of their specific risks to develop various side effects. Patient information before treatment should cover not only general information about the treatment and possible complications and side effects but should also give details on the specific risks of the patient in her individual situation. This also includes elucidating the patient's individual resources and expectations and her willingness for long-term regular follow-up examinations and secondary adjunct treatments.
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Affiliation(s)
- Lisa Tarmann
- Department of Ophthalmology, Medical University Graz, Graz, Austria
| | - Werner Wackernagel
- Department of Ophthalmology, Medical University Graz, Graz, Austria
- * E-mail:
| | | | - Mona Schneider
- Department of Ophthalmology, Medical University Graz, Graz, Austria
| | - Peter Winkler
- Department of Therapeutic Radiology and Oncology, Medical University Graz, Graz, Austria
| | - Gerald Langmann
- Department of Ophthalmology, Medical University Graz, Graz, Austria
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INTERACTS (INTErventional Radiotherapy ACtive Teaching School) guidelines for quality assurance in choroidal melanoma interventional radiotherapy (brachytherapy) procedures. J Contemp Brachytherapy 2017; 9:287-295. [PMID: 28725254 PMCID: PMC5509988 DOI: 10.5114/jcb.2017.68761] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/23/2017] [Indexed: 12/13/2022] Open
Abstract
Eye plaque brachytherapy represents a safe and effective therapeutic approach for choroidal melanoma, combining clinical outcomes with an eye and visual preservation. As it represents a complex procedure, a specific quality assurance program is strongly suggested to improve patients and operators safety, and to reduce possible complications linked to surgical procedure and radiation exposure. The aim of this paper is to describe the INTERACTS (Interventional Radiotherapy Active Teaching School) guidelines for quality assurance in choroidal melanoma interventional radiotherapy (brachytherapy) used in our institution.
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Montel AM, Dos Santos RG, da Costa PR, Silveira-Lacerda EDP, Batista AA, Dos Santos WG. Neutron activation increases activity of ruthenium-based complexes and induces cell death in glioma cells independent of p53 tumor suppressor gene. Biometals 2017; 30:295-305. [PMID: 28258507 PMCID: PMC5352776 DOI: 10.1007/s10534-017-0006-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/21/2017] [Indexed: 12/15/2022]
Abstract
Novel metal complexes have received great attention in the last decades due to their potential anticancer activity. Notably, ruthenium-based complexes have emerged as good alternative to the currently used platinum-based drugs for cancer therapy, providing less toxicity and side effects to patients. Glioblastoma is an aggressive and invasive type of brain tumor and despite of advances is the field of neurooncology there is no effective treatment until now. Therefore, we sought to investigate the potential antiproliferative activity of phosphine-ruthenium-based complexes on human glioblastoma cell lines. Due to its octahedral structure as opposed to the square-planar geometry of platinum(II) compounds, ruthenium(II) complexes exhibit different structure-function relationship probably acting through a different mechanism from that of cisplatin beyond their ability to bind DNA. To better improve the pharmacological activity of metal complexes we hypothesized that neutron activation of ruthenium in the complexes would allow to decrease the effective concentration of the compound needed to kill tumor cells. Herein we report on the effect of unmodified and neutron activated phosphine ruthenium II complexes on glioblastoma cell lines carrying wild-type and mutated p53 tumor suppressor gene. Induction of apoptosis/authophagy as well as generation of reactive oxygen species were determined. The phosphine ruthenium II complexes tested were highly active against glioblastoma cell lines inducing cell death both through apoptosis and autophagy in a p53 independent fashion. Neutron activation of ruthenium compounds rendered them more active than their original counterparts suggesting a new strategy to improve the antitumor activity of these compounds.
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Affiliation(s)
- Aline Monezi Montel
- Laboratório de Genética Humana e Biologia Molecular, Unidade Acadêmica de Ciências da Saúde, Regional Jataí, Universidade Federal de Goiás, cidade Universitária-Campus Jatobá, BR 364, Km 195, n. 3800, Jataí, CEP 75801020, Brazil
| | | | | | | | | | - Wagner Gouvêa Dos Santos
- Laboratório de Genética Humana e Biologia Molecular, Unidade Acadêmica de Ciências da Saúde, Regional Jataí, Universidade Federal de Goiás, cidade Universitária-Campus Jatobá, BR 364, Km 195, n. 3800, Jataí, CEP 75801020, Brazil.
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Milam RW, Batson SA, Breazzano MP, Ayala-Peacock DN, Daniels AB. Modern and Novel Radiotherapy Approaches for the Treatment of Uveal Melanoma. Int Ophthalmol Clin 2017; 57:11-27. [PMID: 27898610 DOI: 10.1097/iio.0000000000000153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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