Brachytherapy for Choroidal Melanoma

Houston, Samuel K.; Boldt, H. Culver; Markoe, Arnold M.; Murray, Timothy G.

doi:10.1016/b978-1-4557-0737-9.00145-4

Cited by 2 publications

(3 citation statements)

References 150 publications

(126 reference statements)

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“…Several patients had retinal detachment at the time of diagnosis as a result of tumour exudation. While exudation diminishes as the tumour shrinkages due to Ru-106 brachytherapy [20], the retina fastens accordingly.…”

Section: Discussionmentioning

confidence: 99%

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Predicting Visual Acuity Deterioration and Radiation-Induced Toxicities after Brachytherapy for Choroidal Melanomas

Espensen

Appelt

Fog

et al. 2019

Cancers

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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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Section: Discussionmentioning

confidence: 99%

“…Prescription procedures for Ru-106 treatments remain controversial [20]. Some centres use an apical prescribed dose of 85 Gy [1,24], some use 100 Gy to the apex [2,13], while others use at least 130 Gy to the apex along with restricted tumour base doses of at least 700 Gy [27].…”

Section: Discussionmentioning

confidence: 99%

Predicting Visual Acuity Deterioration and Radiation-Induced Toxicities after Brachytherapy for Choroidal Melanomas

Espensen

Appelt

Fog

et al. 2019

Cancers

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“…Brachytherapy is the direct irradiation of a tumor via the application of a radioactive source (radioisotope) to the tumor surface or interior. 101 There are two types of radioactive sources used in brachytherapy, gamma- or X-ray emitting isotopes and beta-particle-emitting isotopes. Of the isotopes most commonly used in ophthalmic radioactive, Cobalt-60, Palladium-103 and Iodine-125 are gamma sources and Ruthenium-106 (Ru-106) is a beta-particle source.…”

Section: Introductionmentioning

confidence: 99%

Uveal Melanoma; Current Trends in The Diagnosis and Management

Tarlan

Kıratlı

2016

tjo

104

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Uveal melanoma, which is the most common primary intraocular malignancy in adults, arises from melanocytes within the iris, ciliary body and choroid. The diagnosis is based principally on clinical examination of the tumor with biomicroscopy and indirect ophthalmoscopy and confirmed by diagnostic techniques such as ultrasonography, fundus fluorescein angiography and optical coherence tomography. The clinical diagnosis of posterior uveal melanomas can be made when the classical appearance of a pigmented dome-shaped mass is detected on dilated fundus exam. Uveal melanomas classically show low to medium reflectivity on A-scan ultrasonography and on B-scan ultrasonography the tumor appears as a hyperechoic, acoustically hollow intraocular mass. Management of a suspicious pigmented lesion is determined by its risk factors of transforming into a choroidal melanoma, such as documentation of growth, thickness greater than 2 mm, presence of subretinal fluid, symptoms and orange pigment, margin within 3 mm of the optic disc, and absence of halo and drusen. Advances in the diagnosis and local and systemic treatment of uveal melanoma have caused a shift from enucleation to eye-conserving treatment modalities including transpupillary thermotherapy and radiotherapy over the past few decades. Prognosis can be most accurately predicted by genetic profiling of fine needle aspiration biopsy of the tumor before the treatment, and high-risk patients can now be identified for clinical trials that may lead to target-based therapies for metastatic disease and adjuvant therapy which aims to prevent metastatic disease.

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Brachytherapy for Choroidal Melanoma

Cited by 2 publications

References 150 publications

Predicting Visual Acuity Deterioration and Radiation-Induced Toxicities after Brachytherapy for Choroidal Melanomas

Predicting Visual Acuity Deterioration and Radiation-Induced Toxicities after Brachytherapy for Choroidal Melanomas

Uveal Melanoma; Current Trends in The Diagnosis and Management

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