Gamma knife radiosurgery for uveal melanoma ineligible for brachytherapy by the Collaborative Ocular Melanoma Study criteria

Abstract

Purpose: To report outcomes of Gamma Knife radiosurgery (GKRS) in treating uveal melanoma lesions ineligible for standard brachytherapy. Methods: A retrospective interventional case series of uveal melanoma patients treated with GKRS between 1996 and 2004 was performed. The main outcome measures were local tumor control, metastasis, and death. Results: Four patients with uveal melanoma treated with GKS were identifi ed. Three tumors involved the ciliary body and one was macular with its border within 2 mm of the optic disc. Adequate globe stabilization was achieved by retrobulbar anesthesia in all cases. Pretreatment mean visual acuity was 20/30. Tumor volume as determined by magnetic resonance imaging ranged from 0.05 to 0.30 cc. Ultrasonographic greatest tumor diameter and height ranged from 11 to 18 mm (mean 14.5 mm) and 2.9 to 4.5 mm (mean 3.6 mm), respectively. The peripheral dose varied from 16.5 to 30 Gray. Local tumor control was achieved in all cases over a follow up period of 6 to 96 months. Mean fi nal visual acuity was 20/50. One eye was enucleated for neovascular glaucoma and one patient died from liver and lung metastasis. Conclusions: GKRS for uveal melanoma appears to be safe and effective. The metastasis and mortality rates appear to be comparable to those following brachytherapy and enucleation. Moreover, local tumor control and enucleation rates are similar to those following brachytherapy. The fi ndings in this small series suggest a role for GKRS in the treatment of selected cases of uveal melanomas.

Is it sufficient to repeat LINEAR accelerator stereotactic radiosurgery in choroidal melanoma?

“…secondary neovascular glaucoma (12,15). In our study, we had the same experience, because in our case report the patient underwent enucleation due to secondary glaucoma ( Figs 3, 4 and 5).…”

“…The patient race was Caucasian (n = 7918, 98 %), Hispanic (n = 105, 1 %), Asian (n = 44, < 1 %), or African American (n = 33, < 1 %). On the basis of the race (Caucasian, Hispanic, Asian, and African American), signifi cant differences were noted in the mean age at presentation (58, 48, 44, and 52 years; p < 0.001), distance of posterior tumor margin to foveola (5,5,6, and 4 mm; Pp < 0.001), distance of posterior tumor margin to optic disc (5,5,6, and 4 mm; p < 0.001), tumor base (11,12,12, and 13 mm; p < 0.001), tumor thickness (5.4, 7.1, 6.5, and 7.5 mm; p < 0.001), intraocular hemorrhage (10, 14, 11, and 24 %; p = 0.02), and rupture of Bruch's membrane (20,27,39, and 36 %; p = 0.001). On the basis of multivariate analysis, the rate of metastasis increased with an increasing age (p < 0.001), ciliary body location (p < 0.001), increasing tumor base (p < 0.001), increasing tumor thickness (p < 0.001), pigmented tumor (p = 0.001), subretinal fl uid (p = 0.001), intraocular hemorrhage (p = 0.045), and extraocular extension ( p= 0.036).…”

“…Based on tumor staging (I, II, III, and IV), features that showed a signifi cant increase with tumor staging included the age at presentation (57, 58, 60, 60 years) (p < 0.001), tumor base (8,12,17,17 mm) (p < 0.001), tumor thickness (2.9, 6.0, 10.1, 10.2 mm) (p < 0.001), distance to optic disc (3, 5, 5, 5 mm) (p < 0.001), distance to foveola (3, 5, 5, 5 mm) (p < 0.001), mushroom confi guration (6 %, 24 %, 34 %, 33 %) (p < 0.001), plateau confi guration (3 %, 4 %, 7 %, 11 %) (p < 0.001), tumor pigmentation (48 %, 53 %, 69 %, 78 %) (p < 0.001), and extraocular extension (0 %, 1 %, 11 %, 22 %) (p < 0.001). After therapy, Kaplan-Meier estimates of metastasis at 1, 5, 10, and 20 years were < 1 %, 5 %, 12 %, and 20 % for stage I, 2 %; 17 %, 29 %, and 44 % for stage II; 6 %, 44 %, 61 %, and 73 % for stage III, and 100 % by 1 year for stage IV.…”

Options of Irradiating Intraocular Melanoma at Linear Accelerator: A Mini Review

“…High rates of local control are achieved with five year control exceeding 95% in patients treated with proton-beam irradiation [16]. Other studies compare LSRS with brachytherapy which have similar metastasis rate, local tumor control rate, complications rate and mortality rate [17]. LSRS is feasible and well tolerated too.…”

Optical eye tracking system for real‐time noninvasive tumor localization in external beam radiotherapy

“…2,3 As far as EBRT is concerned, the use of Gamma Knife for stereotactic ocular irradiation has been reported, although allowing a limited number of possible treatment fractions due to the required invasive patient immobilization. 4 More recently, Linac-based stereotactic and proton beam radiotherapy represent the most favorable clinical options for different types of intraocular tumors. 5,6 The highly selective depth-dose distribution achievable with these EBRT techniques allows for improved dose conformity to the target volume, while sparing the surrounding healthy tissue and critical structures.…”