Dosimetric and radiobiologic comparison of 103 Pd COMS plaque brachytherapy and Gamma Knife radiosurgery for choroidal melanoma

Gorovets, Daniel; Gagne, Nolan L.; Melhus, Christopher S.

doi:10.1016/j.brachy.2016.12.003

Cited by 9 publications

(13 citation statements)

References 57 publications

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“…This fact was also observed by others [ 37 ]. Some authors reported that lower doses [ 35 , 38 , 39 ] should be sufficient to achieve acceptable local control rates in patients, and a radiobiological dose could play an important role when analyzing local control.…”

Section: Discussionmentioning

confidence: 99%

Radiobiological doses, tumor, and treatment features influence on local control, enucleation rates, and survival after epiescleral brachytherapy. A 20-year retrospective analysis from a single-institution: part I

Miguel¹,

Frutos-Baraja²,

López-Lara³

et al. 2018

jcb

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PurposeTo assess influence of the radiobiological doses, tumor, and treatment features on local control, enucleation rates, overall and disease-specific survival rates after brachytherapy for posterior uveal melanoma.Material and methodsLocal control, enucleation, overall and disease-specific survival rates were evaluated on the base of 243 patients from 1996 through 2016, using plaques loaded with iodine sources. Clinical and radiotherapy data were extracted from a dedicated prospective database. Biologically effective dose (BED) was included in survival analysis using Kaplan-Meier and Cox regressions. The 3-, 5-, 10-, and 15-year relative survival rates were estimated, and univariate/multivariate regression models were constructed for predictive factors of each item. Hazard ratio (HR) and confidence interval at 95% (CI) were determined.ResultsThe median follow-up was 73.9 months (range, 3-202 months). Cumulative probabilities of survival by Kaplan-Meier analysis at 3, 5, 10 and 15 years were respectively: 96%, 94%, 93%, and 87%, for local control; 93%, 88%, 81%, and 73% for globe preservation; 98%, 93%, 84%, and 73% for overall survival, and 98%, 96%, 92%, and 87% for disease-specific survival. By multivariate analysis, we concluded variables as significant: for local control failure – the longest basal diameter and the juxtapapillary location; for globe preservation failure – the longest basal dimension, the mushroom shape, the location in ciliary body, and the dose to the foveola; for disease-specific survival – the longest basal dimension. Some radiobiological doses were significant in univariate models but not in multivariate ones for the items studied.ConclusionsThe results show as predictive factors of local control, enucleation, and disease-specific survival rates those related with the features of the tumor, specifically the longest basal dimension. There is no clear relation between radiobiological doses or treatment parameters in patients after brachytherapy.

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Section: Discussionmentioning

confidence: 99%

Radiobiological doses, tumor, and treatment features influence on local control, enucleation rates, and survival after epiescleral brachytherapy. A 20-year retrospective analysis from a single-institution: part I

Miguel¹,

Frutos-Baraja²,

López-Lara³

et al. 2018

jcb

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“…This may be why the correlations between BED and VA loss has not been very consistent to date. It could be that lower doses as reported recently in the literature [ 55 , 56 , 60 ], should be sufficient to achieve acceptable local control rates in patients, and radiobiological dose could have an important role when analyzing VA loss.…”

Section: Discussionmentioning

confidence: 99%

Visual outcome after posterior uveal melanoma episcleral brachytherapy including radiobiological doses

Miguel¹,

Frutos-Baraja²,

López-Lara³

et al. 2018

jcb

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PurposeTo 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 methodsVisual 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.ResultsThe 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.ConclusionsVisual 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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“…Treatments are performed with a 6 MV photon beam and tertiary circular collimators (10 to 45 mm in diameter) as required to achieve steep dose gradients [ 58 , 59 ]. It should be noted that dose gradients for GK-SRS, proton beam therapy, and brachytherapy are generally steeper than those achievable in linac-based SRT with penumbras of about 2 mm versus 6 mm [ 58 , 60 , 61 ]. A dose of 50 Gy to 70 Gy prescribed to the 80% isodose is applied to the tumor in five fractions [ 55 , 56 , 57 , 58 ].…”

Section: External Beam Radiation Therapymentioning

confidence: 99%

Current and Emerging Radiotherapy Options for Uveal Melanoma

Semeniuk,

Yu,

Rivard

2024

Cancers

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What treatment options are there for patients having uveal melanoma? A randomized, prospective, multi-institutional clinical trial (COMS) showed no difference in survival between brachytherapy and enucleation for medium-sized lesions. With the obvious benefit of retaining the eye, brachytherapy has flourished and many different approaches have been developed such as low-dose-rate sources using alternate low-energy photon-emitting radionuclides, different plaque designs and seed-loading techniques, high-dose-rate brachytherapy sources and applicators, and low- and high-dose-rate beta-emitting sources and applicators. There also have been developments of other radiation modalities like external-beam radiotherapy using linear accelerators with high-energy photons, particle accelerators for protons, and gamma stereotactic radiosurgery. This article examines the dosimetric properties, targeting capabilities, and outcomes of these approaches. The several modalities examined herein have differing attributes and it may be that no single approach would be considered optimal for all patients and all lesion characteristics.

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Dosimetric and radiobiologic comparison of 103 Pd COMS plaque brachytherapy and Gamma Knife radiosurgery for choroidal melanoma

Cited by 9 publications

References 57 publications

Radiobiological doses, tumor, and treatment features influence on local control, enucleation rates, and survival after epiescleral brachytherapy. A 20-year retrospective analysis from a single-institution: part I

Radiobiological doses, tumor, and treatment features influence on local control, enucleation rates, and survival after epiescleral brachytherapy. A 20-year retrospective analysis from a single-institution: part I

Visual outcome after posterior uveal melanoma episcleral brachytherapy including radiobiological doses

Current and Emerging Radiotherapy Options for Uveal Melanoma

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