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Mobit P, Yang CC, Nittala MR, He R, Ahmed HZ, Shultz G, Lin A, Vijayakumar S. Eye Plaque Brachytherapy for Choroidal Malignant Melanoma: A Case Report on the Use of Innovative Technology to Expand Access, Improve Practice, and Enhance Outcomes. Cureus 2024; 16:e54572. [PMID: 38524010 PMCID: PMC10957294 DOI: 10.7759/cureus.54572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Our institute established an eye plaque interstitial brachytherapy (EPIBT) program in 2007 using the Collaborative Ocular Melanoma Study (COMS) eye plaque. In this case report, we demonstrated an eye plaque treatment planned and executed using Eye Physics Plaque (Los Alamitos, CA) for a 72-year-old male patient with an extra-large tumor with a maximum width of 18.6 mm and height of 13.7 mm. The use of a customized eye plaque, manufactured through three-dimensional (3D) printing, has empowered us to plan and administer treatment for this patient with uveal melanoma. Without this option, enucleation, an option declined by the patient, or proton beam therapy (PBT), which the patient was unwilling to pursue in another state, would have been the alternative course of action. We were able to use more than one activity of the I-125 seeds, which enabled us to shape and reduce the dose to normal surrounding structures at risk within the orbit and in the vicinity of the orbital cavity. Using the dose evaluation tools available with the modern treatment planning system, we reduced the prescription dose from 85 to 70 Gy, with D90 of 140 Gy, thereby providing effective treatment and limiting risk organ doses. In summary, we were able to dose-deescalate without compromising the chances of controlling retinal/scleral tumors. The patient is doing well from a recent follow-up visit 12 months after the eye plaque brachytherapy treatment. The tumor was 4.80 mm high, 1/3 of the original height, and vision is back to 20/60, demonstrating a successful treatment.
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Affiliation(s)
- Paul Mobit
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Claus Chunli Yang
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Mary R Nittala
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Rui He
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Hiba Z Ahmed
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Gary Shultz
- Radiation Oncology, G.V. (Sonny) Montgomery VA Medical Center, Jackson, USA
| | - Albert Lin
- Ophthalmology, University of Mississippi Medical Center, Jackson, USA
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Lee CH, Lee H, Lee SM, Choi EY, Lee J, Kim M. Clinical and Multimodal Imaging Features of Choroidal Nevi in the Korean Population. J Clin Med 2022; 11:jcm11226666. [PMID: 36431143 PMCID: PMC9698851 DOI: 10.3390/jcm11226666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
Choroidal nevus is a precursor of choroidal melanoma. Multimodal imaging has become vital in predicting the malignant transformation of choroidal nevi. This single-center, retrospective study analyzed clinical characteristics and multimodal imaging findings of 168 choroidal nevi (164 patients) of the Korean population. The mean age at presentation was 50 ± 15 (range, 13−85) (women, n = 88 [53.7%]). Choroidal nevi (melanotic, n = 164 [97.6%]; postequatorial, n = 160 [95.2%]) were densely located between the optic disc and foveola (65.5%). The mean maximum linear basal diameter on fundus photography and thickness on optical coherence tomography were 2.97 ± 1.51 mm and 521 ± 297 μm, respectively. On ultrasonography, the mean thickness was 0.87 ± 0.60 mm. Choroidal nevi in women were associated with a higher maximum linear basal diameter (3.23 ± 1.65 vs. 2.68 ± 1.21 mm; p = 0.033) and age at diagnosis (52 ± 14 vs. 47 ± 16 years; p = 0.046) than those in men. Choroidal nevi with associated subretinal fluid (23.2%) presented with larger basal diameter (p = 0.049) and thickness on B-scan and optical coherence tomography (p < 0.001), but a younger age at diagnosis (p < 0.001) than those of dry nevi. This multimodal imaging study of choroidal nevi revealed some distinct characteristics, including topographic distribution, sex-related differences, and a younger age at diagnosis of nevi with fluid.
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Affiliation(s)
| | | | | | | | | | - Min Kim
- Correspondence: ; Tel.: +82-2-2019-3440
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Tsuchiya H, Tachibana Y, Kishimoto R, Omatsu T, Hotta E, Tanimoto K, Wakatsuki M, Obata T, Tsuji H. Dual-Energy Computed Tomography-Based Iodine Concentration Estimation for Evaluating Choroidal Malignant Melanoma Response to Treatment: Optimization and Primary Validation. Diagnostics (Basel) 2022; 12:diagnostics12112692. [PMID: 36359535 PMCID: PMC9689166 DOI: 10.3390/diagnostics12112692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Contrast-enhanced imaging for choroidal malignant melanoma (CMM) is mostly limited to detecting metastatic tumors, possibly due to difficulties in fixing the eye position. We aimed to (1) validate the appropriateness of estimating iodine concentration based on dual-energy computed tomography (DECT) for CMM and optimize the calculation parameters for estimation, and (2) perform a primary clinical validation by assessing the ability of this technique to show changes in CMM after charged-particle radiation therapy. The accuracy of the optimized estimate (eIC_optimized) was compared to an estimate obtained by commercial software (eIC_commercial) by determining the difference from the ground truth. Then, eIC_optimized, tumor volume, and CT values (80 kVp, 140 kVp, and synthesized 120 kVp) were measured at pre-treatment and 3 months and 1.5−2 years after treatment. The difference from the ground truth was significantly smaller in eIC_optimized than in eIC_commercial (p < 0.01). Tumor volume, CT values, and eIC_optimized all decreased significantly at 1.5−2 years after treatment, but only eIC_commercial showed a significant reduction at 3 months after treatment (p < 0.01). eIC_optimized can quantify contrast enhancement in primary CMM lesions and has high sensitivity for detecting the response to charged-particle radiation therapy, making it potentially useful for treatment monitoring.
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Affiliation(s)
- Hiroki Tsuchiya
- Radiological Technology Section, Department of Medical Technology, QST Hospital, Chiba 263-8555, Japan
| | - Yasuhiko Tachibana
- Quantum-Medicine AI Research Group, National Institutes for Quantum Science and Technology (QST), Chiba 263-8555, Japan
- Department of Molecular Imaging and Theranostics, QST, 4-9-1 Anagawa, Chiba 263-8555, Japan
- Correspondence: ; Tel.: +81-43-206-3230
| | - Riwa Kishimoto
- Quantum-Medicine AI Research Group, National Institutes for Quantum Science and Technology (QST), Chiba 263-8555, Japan
- Department of Molecular Imaging and Theranostics, QST, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Tokuhiko Omatsu
- Quantum-Medicine AI Research Group, National Institutes for Quantum Science and Technology (QST), Chiba 263-8555, Japan
- Department of Molecular Imaging and Theranostics, QST, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Eika Hotta
- Radiological Technology Section, Department of Medical Technology, QST Hospital, Chiba 263-8555, Japan
| | - Katsuyuki Tanimoto
- Radiological Technology Section, Department of Medical Technology, QST Hospital, Chiba 263-8555, Japan
| | - Masaru Wakatsuki
- Department of Diagnostic Radiology and Radiation Oncology, QST Hospital, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Takayuki Obata
- Quantum-Medicine AI Research Group, National Institutes for Quantum Science and Technology (QST), Chiba 263-8555, Japan
- Department of Molecular Imaging and Theranostics, QST, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Hiroshi Tsuji
- International Particle Therapy Research Center, QST Hospital, 4-9-1 Anagawa, Chiba 263-8555, Japan
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Abstract
Primary intraocular neoplasms are tumors that originate within the eye. The most common malignant primary intraocular tumor in adults is uveal melanoma and the second is primary intraocular lymphoma or vitreoretinal (intraocular) lymphoma. The most common malignant intraocular tumor in children is retinoblastoma. Genetics plays a vital role in the diagnosis and detection of ocular tumors. In uveal melanoma, monosomy 3 is the most common genetic alteration and somatic mutations of BAP1, a tumor suppressor gene, have been reported in nearly 50% of primary uveal melanomas. The retinoblastoma gene RB1 is the prototype tumor suppressor gene-mutations in RB1 alleles lead to inactivated RB protein and the development of retinoblastoma. Immunoglobulin heavy chain (IgH) or T-cell receptor (TCR) gene rearrangement is observed in B-cell or T-cell primary vitreoretinal lymphoma, respectively. Other factors related to the genetics of these three common malignancies in the eye are discussed and reviewed.
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Affiliation(s)
- Nisha Nagarkatti-Gude
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yujuan Wang
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | - Martine J. Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Chi-Chao Chan
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
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