Conservative treatment of uveal melanoma: Local recurrence after proton beam therapy

Munzenrider, John E.; Verhey, Lynn; Gragoudas, Evangelos S.; Seddon, Johanna M.; Urie, Marcia; Gentry, Rick; Birnbaum, Steven; Ruotolo, D.; Crowell, Candace; McManus, P.L.; Finn, Susan M.; Sisterson, J. M.; Johnson, Kristin; Egan, Kathleen M.; Lento, Denise; Bassin, Pamela

doi:10.1016/0360-3016(89)90099-0

Cited by 75 publications

(24 citation statements)

References 38 publications

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“…5,6 The 5 and 15 yr local control rates of 97% and 95%, respectively, [6][7][8][9] and overall survival rate of 80% were reported, which is comparable to the survival rates reported for enucleation. 10 The probability of eye retention at 5 yr was estimated to be 90% for the entire group.…”

Section: Introductionmentioning

confidence: 54%

Fundus image fusion in EYEPLAN software: An evaluation of a novel technique for ocular melanoma radiation treatment planning

et al. 2010

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Purpose:The purpose of this study is to evaluate a novel approach for treatment planning using digital fundus image fusion in EYEPLAN for proton beam radiation therapy ͑PBRT͒ planning for ocular melanoma. The authors used a prototype version of EYEPLAN software, which allows for digital registration of high-resolution fundus photographs. The authors examined the improvement in tumor localization by replanning with the addition of fundus photo superimposition in patients with macular area tumors. Methods:The new version of EYEPLAN ͑v3.05͒ software allows for the registration of fundus photographs as a background image. This is then used in conjunction with clinical examination, tantalum marker clips, surgeon's mapping, and ultrasound to draw the tumor contour accurately. In order to determine if the fundus image superimposition helps in tumor delineation and treatment planning, the authors identified 79 patients with choroidal melanoma in the macular location that were treated with PBRT. All patients were treated to a dose of 56 GyE in four fractions. The authors reviewed and replanned all 79 macular melanoma cases with superimposition of pretreatment and post-treatment fundus imaging in the new EYEPLAN software. For patients with no local failure, the authors analyzed whether fundus photograph fusion accurately depicted and confirmed tumor volumes as outlined in the original treatment plan. For patients with local failure, the authors determined whether the addition of the fundus photograph might have benefited in terms of more accurate tumor volume delineation. Results: The mean follow-up of patients was 33.6Ϯ 23 months. Tumor growth was seen in six eyes of the 79 macular lesions. All six patients were marginal failures or tumor miss in the region of dose fall-off, including one patient with both in-field recurrence as well as marginal. Among the six recurrences, three were managed by enucleation and one underwent retreatment with proton therapy. Three patients developed distant metastasis and all three patients have since died. The replanning of six patients with their original fundus photograph superimposed showed that in four cases, the treatment field adequately covered the tumor volume. In the other two patients, the overlaid fundus photographs indicated the area of marginal miss. The replanning with the fundus photograph showed improved tumor coverage in these two macular lesions. For the remaining patients without local failure, replanning with fundus photograph superimposition confirmed the tumor volume as drawn in the original treatment plan. Conclusions: Local control was excellent in patients receiving 56 GyE of PBRT for uveal melanomas in the macular region, which traditionally can be more difficult to control. Posterior lesions are better defined with the additional use of fundus image since they can be difficult to mark surgically. In one-third of treatment failing patients, the superposition of the fundus photograph would have clearly allowed improved localization of tumor. The current practice s...

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Section: Introductionmentioning

confidence: 54%

Fundus image fusion in EYEPLAN software: An evaluation of a novel technique for ocular melanoma radiation treatment planning

et al. 2010

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“…Protons are useful in treating larger tumours or tumours close to the fovea or optic disc that are not suitable for plaque brachytherapy. Local control and eye preservation rates exceed 90% at 5 years [42][43][44][45][46] . In 59 patients treated with pbt at triumf in Vancouver, the 5-year actuarial local control rate was 91% (97% in patients treated with 60 GyE), with an overall eye conservation rate of 80% 46 .…”

Section: Intraocular Melanomamentioning

confidence: 99%

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

et al. 2014

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able and willing to travel abroad to a proton facility. Commonly accepted indications for referral include chordoma and chondrosarcoma, intraocular melanoma, and solid tumours in children and adolescents who have the greatest risk for long-term sequelae. Current data do not provide sufficient evidence to recommend routine referral of patients with most head-and-neck, breast, lung, gastrointestinal tract, and pelvic cancers, including prostate cancer. It is recommended that all referrals be considered by a multidisciplinary team to select appropriate cases.

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“…The patient outcome data revealed >99.7% local control at five years after treatment for small-and medium-sized tumors, retention of the eye in most cases and preservation of useful vision (Egger et al 2003, Gragoudas et al 1978, 1980, 1982, Munzenrider 2001, Munzenrider et al 1988, 1989, Seddon et al 1987, 1986, Suit et al 1977. After three decades of experience, the techniques used for treating uveal melanoma with proton therapy are fairly well understood (Gragoudas andMarie Lane 2005, Munzenrider 2001), and recent research efforts have focused on improving the dosimetric accuracy of these treatments (cf Newhauser 2005, Newhauser et al 2002a).…”

Section: Introductionmentioning

confidence: 99%

Monte Carlo calculations and measurements of absorbed dose per monitor unit for the treatment of uveal melanoma with proton therapy

Koch¹,

Newhauser²,

Titt³

et al. 2008

Phys. Med. Biol.

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The treatment of uveal melanoma with proton radiotherapy has provided excellent clinical outcomes. However, contemporary treatment planning systems use simplistic dose algorithms that limit the accuracy of relative dose distributions. Further, absolute predictions of absorbed dose per monitor unit are not yet available in these systems. The purpose of this study was to determine if Monte Carlo methods could predict dose per monitor unit (D/MU) value at the center of a proton spread-out Bragg peak (SOBP) to within 1% on measured values for a variety of treatment fields relevant to ocular proton therapy. The MCNPX Monte Carlo transport code, in combination with realistic models for the ocular beam delivery apparatus and a water phantom, was used to calculate dose distributions and D/MU values, which were verified by the measurements. Measured proton beam data included central-axis depth dose profiles, relative cross-field profiles and absolute D/MU measurements under several combinations of beam penetration ranges and rangemodulation widths. The Monte Carlo method predicted D/MU values that agreed with measurement to within 1% and dose profiles that agreed with measurement to within 3% of peak dose or within 0.5 mm distance-to-agreement. Lastly, a demonstration of the clinical utility of this technique included calculations of dose distributions and D/MU values in a realistic model of the human eye. It is possible to predict D/MU values accurately for clinical relevant range-modulated proton beams for ocular therapy using the Monte Carlo method. It is thus feasible to use the Monte Carlo method as a routine absolute dose algorithm for ocular proton therapy.

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Conservative treatment of uveal melanoma: Local recurrence after proton beam therapy

Cited by 75 publications

References 38 publications

Fundus image fusion in EYEPLAN software: An evaluation of a novel technique for ocular melanoma radiation treatment planning

Fundus image fusion in EYEPLAN software: An evaluation of a novel technique for ocular melanoma radiation treatment planning

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

Monte Carlo calculations and measurements of absorbed dose per monitor unit for the treatment of uveal melanoma with proton therapy

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